Barriers and Facilitators of the Outpatient Health Service Use by the Elderly

Abstract

Objectives: Increasing care needs for the elderly are an important concern for different countries, especially those with an aging population. It is important for health policy making to have knowledge of the factors affecting the use of health services in the elderly to identify the potential problems and develop appropriate interventions for improving utilization and increasing access to health services. This study aims to investigate the barriers and facilitators of the outpatient health service use in the elderly Methods & Materials: In this systematic review, studies in English published from 1996 to 2019 were searched in Web of Science, PubMed and Scopus databases using PRISMA guidelines and related keywords. After eliminating duplicate and irrelevant articles, the quality of remaining articles was evaluated by two evaluators independently, based on STROBE checklist. Narrative synthesis method was used to combine the data Results: Forty-four eligible studies were included for the review. The determinants of the health service use were divided into three categories of predisposing factors (e.g. age, gender, marital status, ethnicity), enabling factors (e.g. income, insurance coverage, education level, employment status, social network, social support), and need factors (e.g. having chronic disease, self-assessed health status, severity of disease, number of diseases, comorbid diseases, physical disability, unhealthy lifestyle). Findings showed that age >80 years, ethnic minority, being unemployed and retired, low educational level, small and limited social network, and physical disability were the barriers to using outpatient health services, while being female, married, having insurance, social support, having a companion during a disease, having children, high income level, and shorter distance to the health care centers were the facilitators of using outpatient health services in the elderly Conclusion: A group of factors are associated with the outpatient health service use by the elderly. These factors include predisposing, enabling, and need-related factors according to Andersen’s behavioral model of health service use. Interventions to increase the use of health services by the elderly should be based on these factors, and should be taken into account by the policymakers to reduce the burden of health services caused by diseases.

Why do older people not use the public health services of the integrated aging program? A multidimensional approach in a qualitative study

“…Limited literacy of the older people and inattention to health issues may lead to non-seriousness in checking and treating diseases in the early stages. They usually refer to the hospitals over the terrible stage, resulting in higher costs for the older people and the community [ 32 ].…”

“…Long-distance and transportation are other barriers to the older people's referral. The Integrated Aging Program was supposed to cover the people closest to the place of residence, but unfortunately, due to the limited capacity of the centres, renting the site, and the frequent relocation of the centres some patients have to travel a long way which is unpleasant and difficult for frail older people [ 30 , 32 , 33 , 40 , 43 ]. Moreover, the lack of social support (especially by children) and has led to the non-referral of some older peoples.…”

“…In the present study, general practitioners and primary healthcare providers stated that physical difficulties of the older adults were the main reasons which affecting other factors such as the unfavourable environment of the centres, access conditions, and transportation system. From point of care providers, further Iranian studies indicated that physical status was one of the influential factors [ 17 , 32 ]. Older adults also felt that the services were counted useless.…”

Effectiveness of auricular acupressure on constipation and related quality of life among the older people in the residential care home: a randomized clinical trial

“…In Iran, the growth of the old people population is very high in the short term, often due to the rapid decline in the birth rate. According to forecasts, Iran is the third country in the Middle East region in terms of the rapid growth of the old people population [ 2 ]. The number of Iranian older people is expected to double between 2016 and 2040 [ 3 ].…”

“…The number of Iranian older people is expected to double between 2016 and 2040 [ 3 ]. An increase in the old people population inevitably increases the prevalence of chronic diseases and disabilities [ 2 ].…”