@article {10919, title = {Education-Related Inequalities in Dental Services Use among Older Adults in 23 Countries}, journal = {Journal of Dental Research}, year = {2020}, abstract = {This study aimed to measure the magnitude of education-related inequalities in the use of dental services among older adults (aged 50?y or older) from a sizable multicountry sample of 23 upper-middle- and high-income countries. This study used cross-sectional data from nationally representative surveys of people aged 50 y and over. Countries included in the Health and Retirement Study surveys were the following: Brazil, China, South Korea, Mexico, United States, Austria, Belgium, Croatia, Czech Republic, Denmark, Estonia, France, Germany, Greece, Italy, Israel, Luxembourg, Poland, Portugal, Slovenia, Spain, Sweden, and Switzerland. The dependent variable was the use of dental services, based on the self-report of having had a dental visit within the previous year, except for the United States and South Korea, which used 2-y recall periods. Educational level was used as the measure of socioeconomic position and was standardized across countries. Multivariate logistic regression modeling was used to evaluate the factors associated with the use of dental services, and the magnitude of education inequalities in the use of dental services was assessed using the slope index of inequality (SII) to measure absolute inequalities and the relative index of inequality for relative inequalities. The pooled prevalence of the use of dental services was 31.7\% and ranged from 18.7\% in China to 81.2\% in Sweden. In the overall sample, the absolute difference in the prevalence of use between the lowest and highest educational groups was 20?percentage points. SII was significant for all countries except Portugal. Relative educational inequalities were significant for all countries and ranged from 3.2 in Poland to 1.2 in Sweden. There were significant education-related inequalities in the use of dental care by older adults in all countries. Monitoring these inequalities is critical to the planning and delivery of dental services.}, keywords = {Dental Care, Epidemiology, health care disparities, Health Services for the Aged, Oral Health, Socioeconomic factors}, isbn = {0022-0345}, doi = {10.1177/0022034520935854}, author = {Andrade, F. Bof de and Antunes, J.L.F. and Andrade, F.C.D. and Lima-Costa, M.F.F. and Macinko, J.} } @article {8825, title = {Medicare Part D Implementation and Associated Health Impact Among Older Adults in the United States.}, journal = {Int J Health Serv}, volume = {48}, year = {2018}, month = {2018 01}, pages = {42-56}, abstract = {

This study examined the effect of Medicare (Part D) implementation on health outcomes among U.S. older adults. Study participants were initially extracted from the 2004-2008 Health and Retirement Study (HRS). Data from respondents who further participated in the HRS 2005-2007 Prescription Drug Study were analyzed (N = 746). This was a retrospective pre-post design with a treatment and a control group. The difference-in-differences approach with panel ordered logistic regressions was used to examine the Part D effect on three patient health outcomes before and after the implementation, controlling for patient sociodemographic characteristics. People with continuous Part D enrollment from 2006-2008 were less likely to have a worse self-rated health than those who were not enrolled in Part D (odds ratio [OR] = 0.48; p < .05). A higher Charlson Comorbidity Index score was associated with a higher likelihood of having worse self-rated overall health, worse mental health, and worse activities of daily living impairment (ORs = 1.12, 1.17, and 1.36, respectively; all ps < .001). The Part D implementation appears to have a positive effect on older adults{\textquoteright} overall health outcomes. A decrease in out-of-pocket cost for health care may encourage older adults to utilize more needed medications, which in turn helped maintain better health.

}, keywords = {Aged, Health Services for the Aged, Humans, Medicare Part D, United States}, issn = {1541-4469}, doi = {10.1177/0020731416676226}, url = {http://joh.sagepub.com/lookup/doi/10.1177/0020731416676226}, author = {Chen, Cheng-Chia and Hsien-Chang Lin and Seo, Dong-Chul} } @article {7752, title = {Out-of-pocket spending in the last five years of life.}, journal = {J Gen Intern Med}, volume = {28}, year = {2013}, month = {2013 Feb}, pages = {304-9}, publisher = {28}, abstract = {

BACKGROUND: A key objective of the Medicare program is to reduce risk of financial catastrophe due to out-of-pocket healthcare expenditures. Yet little is known about cumulative financial risks arising from out-of-pocket healthcare expenditures faced by older adults, particularly near the end of life.

DESIGN: Using the nationally representative Health and Retirement Study (HRS) cohort, we conducted retrospective analyses of Medicare beneficiaries{\textquoteright} total out-of-pocket healthcare expenditures over the last 5 years of life.

PARTICIPANTS: We identified HRS decedents between 2002 and 2008; defined a 5 year study period using each subject{\textquoteright}s date of death; and excluded those without Medicare coverage at the beginning of this period (n = 3,209).

MAIN MEASURES: We examined total out-of-pocket healthcare expenditures in the last 5 years of life and expenditures as a percentage of baseline household assets. We then stratified results by marital status and cause of death. All measurements were adjusted for inflation to 2008 US dollars.

RESULTS: Average out-of-pocket expenditures in the 5 years prior to death were $38,688 (95 \% Confidence Interval $36,868, $40,508) for individuals, and $51,030 (95 \% CI $47,649, $54,412) for couples in which one spouse dies. Spending was highly skewed, with the median and 90th percentile equal to $22,885 and $89,106, respectively, for individuals, and $39,759 and $94,823, respectively, for couples. Overall, 25 \% of subjects{\textquoteright} expenditures exceeded baseline total household assets, and 43 \% of subjects{\textquoteright} spending surpassed their non-housing assets. Among those survived by a spouse, 10 \% exceeded total baseline assets and 24 \% exceeded non-housing assets. By cause of death, average spending ranged from $31,069 for gastrointestinal disease to $66,155 for Alzheimer{\textquoteright}s disease.

CONCLUSION: Despite Medicare coverage, elderly households face considerable financial risk from out-of-pocket healthcare expenses at the end of life. Disease-related differences in this risk complicate efforts to anticipate or plan for health-related expenditures in the last 5 years of life.

}, keywords = {Aged, Cause of Death, Female, Health Expenditures, Health Services for the Aged, Humans, Male, Marital Status, Medicare, Retrospective Studies, Socioeconomic factors, Terminal Care, United States}, issn = {1525-1497}, doi = {10.1007/s11606-012-2199-x}, author = {Amy Kelley and Kathleen McGarry and Sean Fahle and Samuel M Marshall and Qingling Du and Jonathan S Skinner} } @article {7626, title = {Health and medical services use: a matched case comparison between CCRC residents and national health and retirement study samples.}, journal = {J Gerontol Soc Work}, volume = {54}, year = {2011}, note = {Gaines, Jean M Poey, Judith L Marx, Katherine A Parrish, John M Resnick, Barbara England Journal of gerontological social work J Gerontol Soc Work. 2011 Nov;54(8):788-802. doi: 10.1080/01634372.2011.595476.}, month = {2011 Nov}, pages = {788-802}, publisher = {54}, abstract = {

Little is known about the health status of adults living in continuing care retirement communities (CCRC). Using matched-case control, 458 adults from the Health and Retirement Study (HRS) or a CCRC-based sample were compared on total comorbidity, self-rated health, home health services use, and hospitalizations. At year 2, the CCRC sample reported more comorbidities (96\%) but significantly better self-rated health (96\% good/excellent) than the HRS sample (93\% comorbidity, 73\% good/excellent; p < .01). There were no significant differences in frequency of home health use or hospitalization. Living in a CCRC appears to be associated with higher self-ratings of health in this sample.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Aging, Case-Control Studies, Chronic disease, depression, Female, Geriatric Assessment, Health Services, Health Services for the Aged, Health Status, Home Care Services, Hospitalization, Humans, Interview, Psychological, Male, Middle Aged, Multivariate Analysis, Psychometrics, Retirement}, issn = {1540-4048}, doi = {10.1080/01634372.2011.595476}, author = {Gaines, Jean M and Judith L Poey and Marx, Katherine A and J. M. Parrish and Resnick, Barbara} } @article {7443, title = {Continuity of care with a primary care physician and mortality in older adults.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {65}, year = {2010}, month = {2010 Apr}, pages = {421-8}, publisher = {65A}, abstract = {

BACKGROUND: We examined whether older adults who had continuity of care with a primary care physician (PCP) had lower mortality.

METHODS: Secondary analyses were conducted using baseline interview data (1993-1994) from the nationally representative Survey on Assets and Health Dynamics among the Oldest Old (AHEAD). The analytic sample included 5,457 self-respondents 70 years old or more who were not enrolled in managed care plans. AHEAD data were linked to Medicare claims for 1991-2005, providing up to 12 years of follow-up. Two time-dependent measures of continuity addressed whether there was more than an 8-month interval between any two visits to the same PCP during the prior 2-year period. The "present exposure" measure calculated this criterion on a daily basis and could switch "on" or "off" daily, whereas the "cumulative exposure" measure reflected the percentage of follow-up days, also on a daily basis allowing it to switch on or off daily, for which the criterion was met.

RESULTS: Two thousand nine hundred and fifty-four (54\%) participants died during the follow-up period. Using the cumulative exposure measure, 27\% never had continuity of care, whereas 31\%, 20\%, 14\%, and 8\%, respectively, had continuity for 1\%-33\%, 34\%-67\%, 68\%-99\%, and 100\% of their follow-up days. Adjusted for demographics, socioeconomic status, social support, health lifestyle, and morbidity, both measures of continuity were associated (p < .001) with lower mortality (adjusted hazard ratios of 0.84 for the present exposure measure and 0.31, 0.39, 0.46, and 0.62, respectively, for the 1\%-33\%, 34\%-67\%, 68\%-99\%, and 100\% categories of the cumulative exposure measure).

CONCLUSION: Continuity of care with a PCP, as assessed by two distinct measures, was associated with substantial reductions in long-term mortality.

}, keywords = {Aged, Continuity of Patient Care, Female, Health Services for the Aged, Humans, Male, Mortality, Physicians, Family}, issn = {1758-535X}, doi = {10.1093/gerona/glp188}, author = {Frederic D Wolinsky and Suzanne E Bentler and Li Liu and John F Geweke and Elizabeth A Cook and Maksym Obrizan and Elizabeth A Chrischilles and Kara B Wright and Michael P Jones and Gary E Rosenthal and Robert L. Ohsfeldt and Robert B Wallace} } @article {7177, title = {Does more health care improve health among older adults? A longitudinal analysis.}, journal = {J Aging Health}, volume = {19}, year = {2007}, month = {2007 Dec}, pages = {888-906}, publisher = {19}, abstract = {

OBJECTIVE: This research assesses the association of health services use with subsequent physical health among older Americans, adjusting for the confounding between health care use and prior health.

METHOD: Longitudinal data are from the Survey on Assets and Health Dynamics Among the Oldest Old (AHEAD). Linear and logistic regressions are used to model the linkages between medical care use and health outcomes, including self-rated health, functional limitations, and mortality.

RESULTS: There is limited evidence that increased health care use is correlated with improved subsequent health. Increased use of medical care is largely associated with poorer health outcomes. Moreover, there are no significant interaction effects of health care use and baseline health on Activities of Daily Living and Instrumental Activities of Daily Living, despite the existence of a significant but very small interaction effect on self-rated health.

CONCLUSIONS: The findings have implications for the quality of care delivered by the American health care system.

}, keywords = {Activities of Daily Living, Aged, Health Services, Health Services for the Aged, Health Status, Humans, Longitudinal Studies, United States}, issn = {0898-2643}, doi = {10.1177/0898264307308338}, author = {Ezra Golberstein and Jersey Liang and A. R. Quinones and Frederic D Wolinsky} } @article {6976, title = {Informal care and health care use of older adults.}, journal = {J Health Econ}, volume = {23}, year = {2004}, month = {2004 Nov}, pages = {1159-80}, publisher = {23}, abstract = {

Informal care by adult children is a common form of long-term care for older adults and can reduce medical expenditures if it substitutes for formal care. We address how informal care by all children affects formal care, which is critically important given demographic trends and the many policies proposed to promote informal care. We examine the 1998 Health and Retirement Survey (HRS) and 1995 Asset and Health Dynamics Among the Oldest-Old Panel Survey (AHEAD) using two-part utilization models. Instrumental variables (IV) estimation controls for the simultaneity of informal and formal care. Informal care reduces home health care use and delays nursing home entry.

}, keywords = {Aged, Female, Health Care Surveys, health policy, Health Services for the Aged, Home Care Services, Home Nursing, Homes for the Aged, Humans, Male, Nursing homes, United States}, issn = {0167-6296}, doi = {10.1016/j.jhealeco.2004.04.008}, author = {Courtney Harold Van Houtven and Edward C Norton} } @article {6945, title = {Religion and preventative health care utilization among the elderly.}, journal = {Soc Sci Med}, volume = {58}, year = {2004}, month = {2004 Jan}, pages = {109-18}, publisher = {58}, abstract = {

Evidence supporting a relationship between religion and physical health has increased substantially in the recent past. One possible explanation for this relationship that has not received much attention in the literature is that health care utilization may differ by religious involvement or religious denomination. A nationally representative sample of older adults was used to estimate the effects of religious salience and denomination on six different types of preventative health care (i.e. flu shots, cholesterol screening, breast self-exams, mammograms, pap smears, and prostate screening). Findings show that both men and women who report high levels of religiosity are more likely to use preventative services. Denominational differences show that affiliated individuals, especially those who are Jewish, are significantly more likely to use each type of preventative care than non-affiliated individuals. The results of this study open the door to further exploration of this potentially important, but relatively neglected, link between religion and health.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Catholicism, Diagnostic Tests, Routine, Female, Health Services for the Aged, Health Status, Humans, Interviews as Topic, Jews, Logistic Models, Longitudinal Studies, Male, Patient Acceptance of Health Care, Preventive Health Services, Primary Health Care, Protestantism, Religion and Psychology, Socioeconomic factors, United States}, issn = {0277-9536}, doi = {10.1016/s0277-9536(03)00152-7}, author = {Benjamins, Maureen Reindl and Brown, Carolyn} } @article {6860, title = {High out-of-pocket health care spending by the elderly.}, journal = {Health Aff (Millwood)}, volume = {22}, year = {2003}, month = {2003 May-Jun}, pages = {194-202}, publisher = {22}, abstract = {

We use data from the Health and Retirement Study to examine the elderly{\textquoteright}s out-of-pocket health care spending. We find that Medicare HMOs, employer supplements, and Medicaid effectively insulate against the risk of high expenditures. At the ninetieth percentile, Medicare beneficiaries with employer supplements or enrolled in Medicare HMOs spend 1,600 dollars less out of pocket than beneficiaries with traditional Medicare spend. For the poor elderly, Medicaid offers similar protection. Among the near-poor elderly, there is little employer coverage, so Medicare HMOs provide most of the protection against financial risk. There is evidence that Medicare HMO benefits have eroded since 1998, raising the question of whether the near-poor have lost financial protection since then.

}, keywords = {Aged, Drug Costs, Drug Prescriptions, Financing, Personal, Health Care Surveys, Health Expenditures, Health Maintenance Organizations, Health Services for the Aged, Humans, Insurance, Health, Medicare, Poverty, United States}, issn = {0278-2715}, doi = {10.1377/hlthaff.22.3.194}, author = {Dana P Goldman and Julie M Zissimopoulos} } @article {6876, title = {Screening mammography and Pap tests among older American women 1996-2000: results from the Health and Retirement Study (HRS) and Asset and Health Dynamics Among the Oldest Old (AHEAD).}, journal = {Ann Fam Med}, volume = {1}, year = {2003}, month = {2003 Nov-Dec}, pages = {209-17}, publisher = {1}, abstract = {

BACKGROUND: We wanted to determine the frequency of self-reported receipt of screening mammography and Papanicolaou (Pap) tests in older women and investigate important predictors of utilization, based on 2 national longitudinal surveys.

METHODS: This cohort study includes participants from 4 waves (1994-2000) of the Health and Retirement Study (HRS)--5,942 women aged 50 to 61 years, and 4 waves (1993-2000) of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey--4,543 women aged 70 years and older. The self-reported receipt of screening mammograms and Pap smears in the most recent 2 years were reported in 1996 and 2000 for HRS, with predictors of receipt measured in 1994 and 1998. In AHEAD, the self-reported receipt of screening mammograms and Pap smears in the most recent 2 years were reported in 1995 and 2000, with predictors of receipt measured in 1993 and 1998.

RESULTS: Receipt of mammography is stable at 70\% to 80\% among women aged 50 to 64 years, then declines to around 40\% among those aged 85 to 90 years. For Pap tests there is a decline from 75\% among women aged 50 to 54 years to 25\% in those aged 85 to 90 years. For both mammography and Pap tests, the rates increased in all groups from 1995/1996 to 2000. Higher education, being married, higher income, not smoking, and vigorous exercise were consistently associated with higher rates of receipt.

CONCLUSIONS: Although the use of mammography and Pap tests for screening declines into old age, use has been increasing recently. The large and increasing number of tests performed might not be justified given the lack of evidence of effect in older age-groups.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Breast Neoplasms, Cost-Benefit Analysis, Female, Health Services for the Aged, Humans, Longitudinal Studies, Mammography, Middle Aged, Multivariate Analysis, Papanicolaou Test, Patient Acceptance of Health Care, Risk, United States, Uterine Cervical Neoplasms, Vaginal Smears}, issn = {1544-1709}, doi = {10.1370/afm.54}, author = {Truls Ostbye and Gary N. Greenberg and Donald H. Taylor Jr. and Lee, Ann Marie M.} } @article {8742, title = {Prevalence and outcomes of comorbid metabolic and cardiovascular conditions in middle- and older-age adults.}, journal = {J Clin Epidemiol}, volume = {54}, year = {2001}, month = {2001 Sep}, pages = {928-34}, abstract = {

UNLABELLED: To estimate age group differences in the prevalence and outcomes of three common and often comorbid metabolic conditions (i.e., obesity, hypertension, and diabetes) and heart disease.

DESIGN: Nationally representative prospective cohort study.

SETTING: PARTICIPANTS{\textquoteright} homes.

PARTICIPANTS: 9825 adults aged 51 to 61 years (middle-age) in 1992, and 7370 adults aged 70 years and over (older-age) in 1993.

MEASUREMENTS: Two-year dichotomous outcomes included: doctor visits, hospitalization, mobility difficulty, activity of daily living limitation, poor perceived health, and mortality. Odds ratios (OR) were adjusted for sociodemographic characteristics and history of cancer or lung disease.

RESULTS: Those with one condition represented 80\% and 70\% of the middle- and older-age groups, respectively, while just 1-2\% of each age group reported all three metabolic conditions. Thirteen percent and 32\%, respectively, reported heart disease with or without metabolic conditions. Diabetes comorbid with other metabolic conditions, and particularly with heart disease, substantially elevated the risk of adverse outcomes such as health-related quality of life deficits, health services use, and mortality in both middle- and older-age adults. In the middle-age group, the OR was 6.81 for mortality in patients with a combination of obesity and diabetes and 6.10 in those with a combination of heart disease and diabetes. There also were significant ORs for mortality in middle-aged patients with heart disease (OR = 2.40), diabetes (OR = 2.63) and for those with a combination of obesity, hypertension, and diabetes (OR = 3.26).

CONCLUSION: The impact of these often comorbid conditions underscores the importance of targeted and aggressive prevention, particularly among middle-age adults.

}, keywords = {Age Distribution, Aged, Aged, 80 and over, Cardiovascular Diseases, Cohort Studies, Diabetes Complications, Diabetes Mellitus, Female, Health Services for the Aged, Humans, Hypertension, Male, Middle Aged, Obesity, Odds Ratio, Outcome Assessment, Health Care, Prevalence, Prospective Studies, Quality of Life, United States}, issn = {0895-4356}, doi = {10.1016/s0895-4356(01)00350-x}, author = {Oldrige, Neil B. and Timothy E. Stump and Nothwehr, F. and Daniel O. Clark} } @article {6588, title = {Medical insurance and the use of health care services by the elderly.}, journal = {J Health Econ}, volume = {16}, year = {1997}, month = {1997 Apr}, pages = {129-54}, publisher = {16}, abstract = {

The objective of this paper is to find how health insurance influences the use of health care services by the elderly. On the basis of the first wave of the Asset and Health Dynamics Survey, we find that those who are the most heavily insured use the most health care services. Because our data show little relationship between observable health measures and either the propensity to hold or to purchase private insurance, we interpret this as an effect of the incentives embodied in the insurance, rather than as the result of adverse selection in the purchase of insurance.

}, keywords = {Activities of Daily Living, Aged, Health Care Surveys, Health Services for the Aged, Health Status Indicators, Hospitalization, Humans, Insurance, Health, Medicare, Office Visits, Patient Acceptance of Health Care, Private Sector, Probability, United States}, issn = {0167-6296}, doi = {10.1016/s0167-6296(96)00515-2}, url = {https://www.ncbi.nlm.nih.gov/pubmed/10169091}, author = {Michael D Hurd and Kathleen McGarry} }