Healthcare Utilization and Advance Care Planning among Older Adults Across Cognitive Levels

Rahemi, Zahra; Malatyali, Ayse; Bacsu, Juanita; Sefcik, Justine S.; Petrovsky, Darina; Baker, Zachary G.; Ma, Kris Pui Kwan; Smith, Matthew Lee; Adams, Swann Arp

doi:10.1177/07334648231191667

Cited by 3 publications

(4 citation statements)

References 32 publications

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“…Our results align with prior research, suggesting that disparities in healthcare persist, particularly concerning socioeconomic factors like age, race/ethnicity, and education (Brown et al, 2016;Mcmaughan et al, 2020;Rahemi, Malatyali, et al, 2023).…”

Section: Discussionsupporting

confidence: 91%

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Social Determinants of Health and Healthcare Utilization Disparities among Older Adults with and Without Cognitive Impairment

Rahemi,

Shalhout,

Bacsu

et al. 2024

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The purpose of this study was to determine the healthcare utilization patterns in a national sample of older adults across several social determinants of health factors (ethnicity, gender, race, education) with normal and dementia/impaired cognition. We used datasets from the Health and Retirement Study (HRS, 2018) to evaluate healthcare utilization, including metrics such as hospital and nursing home stays, hospice care, and number of visits to the doctor. Logistic models were used to predict healthcare utilization separately in those with normal cognition and dementia. Our final sample comprised 15,607 adults (mean age: 65.2 normal cognition, mean age 71.5 dementia). Hispanics with normal cognition were less likely to stay in a hospital than non-Hispanic respondents (OR: 0.52-0.71, p<0.01). Being female was associated with a higher risk for shorter nursing home days (OR: 1.41, p<0.01) and doctor visits (OR: 1.63-2, p<0.01) in cognitively normal older adults. Being female was associated with a lower risk for hospital stay in those with dementia (OR: 0.50-0.78, p<0.01). Respondents identifying as Black or other races with dementia were less likely to experience nursing home days (OR: 0.42, p<0.04). Black respondents with normal cognition were less likely to experience doctor visits (OR: 0.32-0.37, p<0.01). Those with more than a high school education in both groups were more likely to experience doctors’ visits. The study points to the continued disparities in healthcare utilization linked to participants’ social determinants of health factors and cognition.

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Section: Discussionsupporting

confidence: 91%

“…(BLINDED FOR REVIEW). Furthermore, those individuals with ACP were more likely to experience longer stays in hospitals, nursing homes, and home healthcare (Rahemi, Malatyali, et al, 2023).…”

Section: Social Determinants Of Health and Healthcare Utilization Dis...mentioning

confidence: 99%

Social Determinants of Health and Healthcare Utilization Disparities among Older Adults with and Without Cognitive Impairment

Rahemi,

Shalhout,

Bacsu

et al. 2024

Preprint

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“…Our findings were consistent with other researchers indicating that healthcare disparities persist in relation to variations in socioeconomic factors, particularly with respect to age, race/ethnicity, education, and rural location. 1,23–25 Charron-Chenier and Mueller found that despite having greater clinical needs, households who were Black consistently demonstrated lower levels of healthcare use, even when controlling for socioeconomic, demographic, and healthcare insurance coverage differences between groups, 8 which underscores the existence of health disparities in both health outcomes and access to healthcare.…”

Section: Discussionmentioning

confidence: 99%

Healthcare Disparities Among Older Adults: Exploring Social Determinants of Health and Cognition Levels

Rahemi,

Bacsu,

Shalhout

et al. 2024

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BackgroundThe purpose was to investigate the impact of sociodemographic factors on healthcare utilization among adults with different cognition levels (normal and impairment/dementia).MethodsWe used cross-sectional data from the Health and Retirement Study (N=17,698) to assess healthcare utilization: hospital stay, nursing home stay, hospice care, and doctor visits.ResultsA cohort comparison between normal and dementia/impaired cognition groups revealed significant differences. The dementia/impaired group had lower education levels, higher single/widowed status, and more racial and ethnic minorities. They experienced longer hospital and nursing home stays, varied doctor visit frequencies, and had higher mean age, greater loneliness scores, and lower family social support scores. Differences in hospitalization, nursing home, hospice care, and doctor visits were influenced by factors such as race, age, marital status, education, and rurality.ConclusionThere were disparities in healthcare utilization based on participants’ characteristics and cognition levels, especially in terms of race/ethnicity, education, and rural location.

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“…For instance, this prevalence is elevated among individuals of Hispanic ethnicity, residing in rural areas, identifying as female, having lower levels of education, being of older age, and having co-morbidities. Overall, older adults from underrepresented and racial/ethnic minority groups have higher rates of chronic disease and cognitive impairment and lower rates of advance care planning (ACP) and comfort care at the end of life (EOL) [3, 6, 7]. It is imperative to explore the underlying causes of disparities in ACP and EOL care, aiming to eradicate inequities in healthcare based on factors such as race, ethnicity, and other personal identities.…”

Section: Introductionmentioning

confidence: 99%

Past Disparities in Advance Care Planning Across Sociodemographic Characteristics and Cognition Levels in the United States

Rahemi,

Bacsu,

Shalhout

et al. 2024

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We aimed to examine past advance care planning (ACP) in U.S. older adults across different sociodemographic characteristics and cognition levels. We established the baseline trends from 10 years ago to assess if trends in 2024 have improved upon future data availability. We considered two legal documents in the Health and Retirement Study 2014 survey as measures for ACP: a living will and durable power of attorney for healthcare (DPOAH). Logistic regression models were fitted with outcome variables (living will, DPOAH, and both) stratified by cognition levels (dementia/impaired cognition versus normal cognition). Predictor variables included age, gender, ethnicity, race, education, marital status, rurality, everyday discrimination, social support, and loneliness. Age, ethnicity, race, education, and rurality were significant predictors of ACP (having a living will, DPOAH, and both the living will and DPOAH) across cognition levels. Participants who were younger, Hispanic, Black, had lower levels of education, or resided in rural areas were less likely to complete ACP. Examining ACP and its linkages to specific social determinants is essential to understanding disparities and educational strategies needed to facilitate ACP uptake among different population groups. Accordingly, this study aimed to examine past ACP disparities in relation to specific social determinants of health and different cognition levels. Future studies are required to evaluate whether existing disparities have improved over the last 10 years when 2024 data is released. Addressing ACP disparities among diverse populations, including racial and ethnic minorities with reduced cognition levels, is crucial for enhancing health equity and access to care.

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Healthcare Utilization and Advance Care Planning among Older Adults Across Cognitive Levels

Cited by 3 publications

References 32 publications

Social Determinants of Health and Healthcare Utilization Disparities among Older Adults with and Without Cognitive Impairment

Social Determinants of Health and Healthcare Utilization Disparities among Older Adults with and Without Cognitive Impairment

Healthcare Disparities Among Older Adults: Exploring Social Determinants of Health and Cognition Levels

Past Disparities in Advance Care Planning Across Sociodemographic Characteristics and Cognition Levels in the United States

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