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Older adults with memory problems (especially those diagnosed with dementia) consume a great number of health services. However, little is known about the special needs of memory-impaired, noninstitutionalized older adults who seek treatment from primary care physicians (PCPs) for memory problems. The study outlined in this chapter investigated the interrelationships among level of education, residence, physical and mental status, and the use of PCPs for memory problems. A probability-based (random-digit dialing) survey of households with individuals more than 60 years of age occurred in six Southern states: Alabama, Arkansas, Georgia, Louisiana, Mississippi, and Tennessee (N = 1,368). We developed two multivariate logistic regression models. The first estimated the additive effects of sociodemographic and health status characteristics on the likelihood of service utilization. The second model inserted two multiplicative terms: the “instrumental activities of daily living (IADL)” by “memory impairment” and the “low education” by “memory impairment” interaction terms. Three main findings emerged from the analyses: (1) rural/urban differences in use of PCPs approached statistical significance, (2) for lower educated older adults, the odds of using a PCP declined steadily as their number of memory impairments increased, and (3) as older adults experienced increases in IADL limitations and memory impairments, their likelihood of service use declined. The chapter ends with a discussion on program planning, policy, and practice initiatives in light of the findings.

The purpose of the present study is to investigate whether family caregivers with a stronger sense of coherence (SOC) who are caring for community dwelling older adults with cognitive impairment are less likely to use mental health services. An adaptation of the Anderson behavioral model of access to health care was employed as a conceptual framework. Data were collected for 304 impaired older adult/family caregiver dyads. Caregiver mental health service use and sense of coherence were measures as well as predisposing factors (age, gender, race, education, type of familial relationship, family size, and co-residence with impaired family member), enabling factors (self-reported awareness of services, travel times to mental health services, social support, and insurance), and need factors (chronic health conditions and distress). The impaired elder’s age, level of physical impairment, and level of memory impairment were also examined. Logistic regression results indicated that caregivers who have a stronger SOC were less likely to use mental health services (OR=0.91, p=0.006). Other significant independent predictors of mental health service use were social support (OR=0.34, p=0.032) and caregivers aiding family members with higher levels of physical impairment (OR=1.14, p=0.033). The results of this study support clinicians and planners developing mental health services that use SOC to mitigate the detrimental effects of caregiving. Future research is needed to target effective measures to positively manipulate this variable.