Differences in Reasons for Delayed Medical Care between Old (65-79) and Oldest-Old (80+) Open Access

Abstract

In the United States, the number of older adults is growing at a rate faster than other portions of the population. This demographic shift will have significant consequences on the healthcare system and national economy. In order to decrease cost and improve outcomes, timely medical care is crucial. While most literature investigating delayed healthcare among older adults has groups all individuals ages 65 and older together, this may be too broad of an age range to describe the health, healthcare, and health-related behaviors for older individuals. Therefore, we sought to address the following research question: Among older adults, does age group predict reason for delay seeking medical care?

METHODS: The sample for this study was drawn from 13,172 participants ages 65 and older with valid data to the question "Have you delayed getting needed medical care for any of the following reasons in the past 12 months?" in the 2014 cycle of the Behavioral Risk Factor Surveillance System (BRFSS). Using weighted analyses, univariate and multivariate polytomous logistic regression analyses were conducted to assess differences between old (65-79) and oldest-old (80+).

RESULTS: Analyses show that after accounting for sex, race, education level, language, living alone, veteran status, disability, residence in metro area, income, and primary source of healthcare, reasons for delayed medical care differ significantly by age group. However, income was an effect modifier of the relationship between age group and reasons for delay. Differences between age groups existed in four of the five reasons for delay; however, these differences were seen most frequently within the lowest income level (<$15,000). In this lowest income level, the oldest-old were less likely to attribute their delay in medical care to inability to get appointment soon enough, having to wait too long to see the doctor, the office being closed when they got there, and lack of transportation.

CONCLUSIONS: While many services aimed to increase healthcare access have grouped all individuals ages 65+ in one service category, this may be too broad to effectively target services. Analyses presented indicate that among older adults, reasons for delay seeking medical care vary between old and oldest-old.

Table of Contents

INTRODUCTION.........................................................................1

LITERATURE REVIEW..................................................................2

Rationale..........................................................................2

Rates of delayed care among older adults..............................3

Delayed care due to insurance and cost - older adults.............3

Non-cost related reasons for delayed care.............................5

Other potential covariates...................................................6

METHODS.................................................................................8

Study sample....................................................................8

Survey population..............................................................8

Predictor variable...............................................................9

Outcome variable...............................................................9

Covariates.........................................................................9

Sample weighting.............................................................12

Statistical analysis............................................................12

RESULTS..................................................................................14

Descriptive.......................................................................14

Polytomous Logistic Regression...........................................17

Factors to Reasons for Delay in Medical Care.........................18

DISCUSSION.............................................................................20

Public Health Implications and Recommendations...................22

APPENDIX A - TABLES AND FIGURES............................................28

Table 1. Weighted Characteristics of individuals 60-79 and 80+

Table 2. Weighted Analysis of Reasons for delayed Medical care among individuals ages 60-79 and 80+

Table 3. Weighted Analysis of Reasons for delayed Medical Care by Income Group

Table 4. Unadjusted Reasons for Delayed Medical care

Table 5. Fully Adjusted Model

Table 6. Most Parsimonious Model

Table 7. Final Model

About this Master's Thesis

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School	Rollins School of Public Health
Department	Executive Masters of Public Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Aging Gerontology Health Sciences, Epidemiology
Keyword	Aging Healthcare Access Gerontology Delayed Care BRFSS
Committee Chair / Thesis Advisor	Suglia, Shakira , Emory University
Committee Members	Cothron, Anna Lea, Tennessee Commission on Aging and Disability
Partnering Agencies	CDC

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