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Abstract
BackgroundInsufficient social security combined with family structure changes has resulted in a poverty of the elderly. The objective of this study was to examine an association of living arrangements of the elderly with chronic disease prevalence and prescription drug use.Methods2008 Korea Health Panel Survey (KHPS) data were used in this study. Information on living arrangements, socio-demographics, health behaviors, chronic disease prevalence and healthcare expenditures including out-of-pocket (OOP) prescription drug expenditures for elderly aged 65 or older were collected from self-reported diaries and receipts. OOP prescription drug expenditure as a total cost that subject paid to a pharmacy for prescription drugs was examined. Logistic regression was used to identify differences in major chronic disease prevalence by living arrangements. The association of living arrangements with prescription drug use was analyzed using generalized linear model with a log link and a gamma variance distribution.ResultsProportions of elderly living alone, elderly living with a spouse only, and elderly living with adults aged 20–64 were 14.5%, 48.3%, and 37.2%, respectively. Elderly living alone showed 2.43 odds ratio (OR) (95% confidence interval (CI) = 1.66-3.56) for having major chronic diseases prevalence compared to elderly living with adults. Despite a higher major chronic disease prevalence, elderly living alone showed lower OOP prescription drug expenditures (Cost Ratio = 0.80, 95% CI = 0.67-0.97) after adjusting for the number of major chronic diseases. Total OOP prescription drug expenditures were significantly lower in patients with a low income level versus high income level.ConclusionsEven though elderly living alone had a higher risk of chronic disease, they spent less on OOP prescription drug expenditures. Optimal drug use is important for elderly with chronic diseases to achieve good health outcomes and quality of life. Public health policies should be supplemented to optimize medical treatment for vulnerable elderly living alone.
Highlights
Insufficient social security combined with family structure changes has resulted in a poverty of the elderly
We explored whether elderly living alone were vulnerable to potential medication underuse compared to elderly living with a spouse or other adults
Korea Health Panel Survey (KHPS), a panel study conducted by Korea Institute for Health and Social Affairs (KIHASA) that has examined health care utilization and expenditures of national populations in South Korea since 2008, used a housing unit sampling frame based on the Korean Census and selected household samples using a 2-stage cluster sampling method stratified by residence area
Summary
Insufficient social security combined with family structure changes has resulted in a poverty of the elderly. Growing drug use in the elderly has led to drug expenditure increases, and recent statistics in 2005 reported a 21.3% increase in total drug expenditures by the elderly compared to that in 2001 [9,10,11] This figure itself has engaged social concerns, but living arrangements for the elderly as a factor possibly influencing healthcare utilization has received less attention. Especially those living alone, have a higher risk of social isolation [12], but many Asian countries do not have a sufficient social security system such as old-age pension. An insufficient social security with living arrangement changes has resulted in a poverty of the elderly
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