RESEARCH ON AGING Zimmer et al. / COGNITIVE STATUS AND DECLINE Impact of Cognitive Status and Decline on Service and Support Utilization Among Older Adults in Taiwan

Using a sample of older adults in Taiwan, this study examines the impact of cognition on the use of informal support and formal health services. Results confirm the hypoth-esis that cognitive impairment is associated with increased use of informal care, while effects on formal service utilization are less consequential. A scale constructed from a subset of the Mini-Mental State Exam is significantly associated with receipt of instrumental activities of daily living assistance, while correlations with use of formal services such as hospitalization and physician visits are insignificant. A decline in cognitive status over time is correlated with the initiation of informal support but is not associated with formal service utilization. Implications of these results for a rap-idly aging society such as Taiwan are discussed. With current low levels of fertility, future generations of older adults will have fewer social network resources. Absent of dramatic changes in cultural norms with respect to familial support in old age, the future will see an expanding care burden that must be borne by fewer family members. The past decade has witnessed a burgeoning of interest among geron-tologists in population aging and the challenges it poses. A substantial part of the world’s population is already aging, and the few regions 267 AUTHORS ’ NOTE: The authors wish to thank two anonymous reviewers for their helpful comments on revising the article and Dr. Albert Hermalin for his suggestions on an earlier ver-sion. An earlier version of this article was presented at the meeting of the Gerontological Societ