ArticleThe Gerontologist2024
Dementia Care in Rural Appalachia: Multilevel Analysis of Individual- and County-Level Factors.
Article in The Gerontologist, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
6 citing papers in PubMed.
- Utilization of home- and community-based services among rural family caregivers of persons with dementia: the role of the area deprivation index.Frontiers in public health · 2025Trial
- Differences in patient access to and utilization of caregiving services: a scoping review.BMC health services research · 2026Article
- Appalachian Home- and Community- Based Services for People Affected by Dementia.Online journal of rural nursing and health care : the official journal of the Rural Nurse Organization · 2026Article
- Patient-centered burdens and economic outcomes among patients who are veterans, people with intellectual and developmental disabilities, and people living in rural areas and their caregivers: a scoping review.Frontiers in public health · 2026Article
- Support for Care Partners and Caregivers: 2023 Summit Session 5.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2025Article
- Social worlds of Appalachian women caregivers of older relatives living with dementia.Frontiers in global women's health · 2024Article
Corrections and comments
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Authors and funding
3 authors.
Funding
Abstract
BACKGROUND AND
objectivesHome- and community-based services (HCBS) are underutilized, despite offering significant health benefits to both care recipients and caregivers. Drawing upon Andersen's extended behavioral model of health services use, we examined individual- and county-level factors influencing HCBS utilization for dementia care in rural Appalachia. RESEARCH DESIGN AND
methodsWe analyzed data from telephone interviews with 123 dementia family caregivers in rural Appalachian counties (Mage = 64.7, SDage = 12.2). Multilevel analyses were conducted to examine the effects of individual-level and county-level factors on the use of home-based services (home healthcare and personal care services) as well as community-based services (adult day care and transportation services).
resultsResults indicated that caregivers' receipt of informal support from family or friends was associated with more use of home-based services (B = 0.42, p = .003). Conversely, longer travel times to service providers were linked to use of fewer community-based services (B = -0.21, p < .001). Residing in counties with more home health agencies was associated with higher utilization of home-based services (B = 0.41, p = .046). However, higher county tax expenditures for HCBS were not linked to home-based or community-based service use. DISCUSSION AND IMPLICATIONS: Findings suggest that informal support in caring for the person living with dementia enables HCBS use in rural Appalachia. In contrast, limited geographic accessibility and service availability can impede HCBS use in rural regions. Policymakers are urged to allocate direct public funding to service providers to expand service availability in underresourced rural regions.
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