title: Effect of caregiving relationship and formal long-term care service use on caregiver well-being.
abstract: OBJECTIVE
  Despite efforts to revise the traditional long-term care (LTC) model, informal caregivers continue to provide a substantial amount of support to older adults as front-line care providers. The present study aimed to understand the effect of informal caregiving on caregivers' well-being in Singapore with respect to different types of patient-caregiver relationships. Second, this study examined the association between formal LTC service use and caregivers' well-being.
  
  
  METHODS
  Two waves of data for 781 dyads of patients with LTC needs and their caregivers from a longitudinal study were analyzed. Multilevel regression models were used to examine the association between caregivers' well-being (self-rated general health, stress level and quality of life) and LTC service use among different patient-caregiver relationships.
  
  
  RESULTS
  Spousal caregivers reported significantly lower quality of life compared with adult children caregivers. Non-immediate family caregivers showed better overall well-being compared with spouse and adult children caregivers. Caregivers of patients referred to nursing homes reported higher levels of stress and poorer self-rated general health compared with caregivers of patients referred to community-based services. Spouse and non-immediate family caregivers of patients who utilized nursing home or home-based services presented poorer self-rated general health than caregivers of the patients who did not use any formal services.
  
  
  CONCLUSIONS
  Developing a better understanding of the associations between well-being and formal LTC service use for different types of patient-caregiver relationships is critical for policy makers and healthcare providers who aim to create holistic systems of care. Geriatr Gerontol Int 2017; 17: 1714-1721.
authors.affiliation: Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Eom
authors.affiliation: Center for Aging Research and Education, Duke-NUS Medical School, Singapore.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Penkunas
authors.affiliation: Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.|Center for Aging Research and Education, Duke-NUS Medical School, Singapore.|Department of Sociology, National University of Singapore, Singapore.
authors.forename: Angelique W M
authors.initials: AWM
authors.lastname: Chan
mesh_terms: D000368:Aged; D017028:Caregivers / Q000523:psychology*; D005190:Family / Q000523:psychology*; D005260:Female; D006304:Health Status; D006699:Home Care Services; D006801:Humans; D008134:Long-Term Care; D008137:Longitudinal Studies; D008297:Male; D011788:Quality of Life; D012846:Singapore; D013315:Stress, Psychological / Q000453:epidemiology
keywords: caregiver quality of life; caregiver stress; caregiver well-being; caregiving relationships; long-term care