Abstract
There is widespread concern about the potential impact on health and social care services of the ageing population and long-term health conditions, such as dementia. To effectively plan services it is important to understand current need and use and identify gaps in provision. Using data from the Cognitive Function and Ageing Study Wales (CFAS Wales), we used logistic regression to model the relationship between health (self-rated health, cognitive impairment, and activities of daily living), and the use of health and care services. CFAS Wales is a longitudinal cohort study of people aged 65 years and over, in two areas in Wales, UK, over-sampling those aged 75 years and over. Participants (n = 3593) answered a wide range of health and lifestyle questions and completed a variety of cognitive and physical health assessments. Data from 3153 people from wave 1 and 1968 people from wave 2 were analysed.As anticipated we found poorer health, on some indicators, predicted greater service use, including social care, hospital, general practitioner, and nursing services. However, cognitive impairment did not predict greater service use, except for social care. Controlling for age, sex, socio-economic status, social connection indices and area environment, conversely we found lower reported uptake of allied health services by people with cognitive impairment. Further analysis showed that people with a cognitive impairment were less likely to report having a sight-check or seeing a dentist in the previous year, a finding replicated in wave 2. These differences were not explained by transportation issues. In contrast, we did not find a significant difference in reported uptake of hearing checks or physiotherapist use, with mixed evidence of differences in chiropodist visits. Not accessing these preventative services may not only exacerbate existing conditions but have further downstream negative consequences for health and well-being in people who are cognitively impaired.
Highlights
Across the world populations are ageing, with increases in both the absolute number and proportion of older people making up populations (World Health Organisation, 2015)
This paper examines the association between use of a variety of health and social care services and a broader range of need variables, including self-rated health, cognitive health, and activities of daily living in a large sample of adults aged 65 years and over, allowing adjustment for demographic, social, and environmental factors
5% of participants were classified as users of social care, 38% used hospital, 37% used General Practitioner (GP) and 12% used nursing services; 90% of people used at least one allied health service (Table 2)
Summary
Across the world populations are ageing, with increases in both the absolute number and proportion of older people making up populations (World Health Organisation, 2015). The Andersen behavioural model of health service use (Andersen, 1995) identifies three characteristics that influence a person’s access to and use of health services: predisposing factors (including individual socio-cultural characteristics such as social structures, health beliefs, and demographics), enabling factors (reflecting the logistics of getting care including the means to access services, e.g. finance or transportation, and availability of services in the community, e.g. waiting lists), and need factors (relating to perceived need for help, for example how people experience their symptoms and the importance they give them; and evaluated need, reflecting professional decisions about an individual’s need). Whilst the Andersen model focuses on health services, this could be applied to social care and other forms of assistance
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