by Cheryl Dawes
The fastest growing segment of the population is adults 85 years old and older--the oldest old. A large percentage of this growing group is likely to use long-term care such as nursing homes or home care services. As the need for these costly services increases, so does the importance of finding cost-effective ways to meet this demand.
University of Washington researchers are developing a clearer picture of this future demand by studying long-term care attitudes and preferences among older adults. This includes examining differences and similarities among different ethnic groups toward long-term care options. Studies of long-lived populations can help project future health care demand. Comparisons of different populations with differing approaches to long-term care might shed light on the most successful approaches, according to Dr. Wayne McCormick, associate professor of Medicine in the Division of Gerontology and Geriatric Medicine.
In a recent study, McCormick and his colleagues compared attitudes toward the use of long-term care between older Japanese Americans and older Caucasian Americans. The investigators found that when faced with disability due to dementia, a significantly larger proportion of Japanese Americans than Caucasian Americans intended to use nursing homes.
To make the comparison, McCormick's group analyzed information collected from structured interviews with more than 2500 healthy older adults. These individuals were enrolled in parallel studies that collected health information on individuals over 65 in King County, Wash. One project followed healthy older Japanese Americans and the other followed a similar group of Caucasian Americans.
Study participants were asked to think about two hypothetical situations-if they were disabled due to dementia and if they were disabled due to hip fracture. For each situation they were asked whether they would want to be cared for by a nursing home, by paid home health care or by loved ones.
If disabled by dementia, 53 percent of the Japanese Americans said they would use nursing home care, compared with 38 percent of the Caucasian Americans. Forty-two percent of older Caucasians intended to be cared for at home, while 39 percent of the older Japanese Americans intended to receive care at home. If receiving care at home, there was a greater percentage of Japanese Americans than Caucasian Americans that expected loved ones to provide care rather than paid care providers.
In the situation in which disability was the result of a hip fracture, preferences for care were more similar between the two groups. The largest proportion of each group (81 percent of Japanese and 72 percent of Caucasians) intended to use some form of home care. Thirteen percent of both groups said they would use nursing home care if disabled by a hip fracture.
The difference in long-term care intentions for the two disabling situations is likely related to the different social consideration of the diagnoses, says McCormick. "A hip fracture is nothing to be ashamed of, but dementia might be."
Study participants were also asked what their families, friends, ministers and communities would want them to do in each of the two hypothetical situations. The Japanese Americans believed that their own preferred sources of care agreed with what their social support system would want for them. This contrasted with the Caucasian Americans who expressed more uncertainty about what their social support system might prefer.
Historically ethnic minorities have used nursing homes less than Caucasians, notes McCormick. However, this research suggests that attitudes about nursing home use may be changing. It is an open question whether older adults actually use the types of long-term care they intend to use. "The next phase of the research is to find out what people actually do after they have expressed their wishes and how much the care costs," he says.
McCormick and his colleagues speculate that their results may reflect trends among older Japanese Americans such as unusual longevity, increased work demands on younger generations of potential caregivers, and increased assimilation into American culture. Such trends are likely to affect how other ethnic minorities use various long-term care options in the future. They point out that ethnic minority older adults are among the fastest growing groups in the country. It is important to identify their preferences in order to prepare to meet their needs. The next large group to look at is Hispanic Americans, says McCormick.
McCormick's colleagues on this study were Drs. Cynthia Ohata, Jay Uomoto, Heather Young, Amy Graves, Walter Kukull, Linda Teri, Peter Vitaliano, James Mortimer, Susan McCurry, James Bowen, and Eric Larsen.