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Patterns of Health and Social Services Utilization*

Published online by Cambridge University Press:  29 November 2010

François Béland
François Béland
Affiliation:
Cité de la santé de Laval and Université de Montréal
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Abstract

Utilization of an array of health and social services from formal and informal sources is studied here 1) to identify profiles of services utilization and 2) to predict the location of elderly in these profiles by a set of independent variables such as the sociodemographic characteristics of the elderly, their physical and mental health status and the density of their social support network. Two samples of non-institutionalized elderly living in two middle-sized towns were drawn from the universal old-age Canadian pension scheme. Their utilization of hospital, medical and pharmaceutical services was assessed, and their use of services for help with adivities of daily living was measured by a set of six indicators. A cluster analysis was run to identify profites of services utilization, and a discriminant analysis used the profiles as the criterion to be predicted by a set of variables. Five profiles of utilization were obtained; four of them identified elderly with very few experiences of services utilization and a fifth, a low number of elderly with utilization of all of the services listed in this study. Most of the elderly were users of a small subset of medical and social services. The location of elderly in the profiles was predicted by physical health status, coresidence and income. These results show that health and social services from both formal and informal sources are utilized by elderly. It is suggested that new types of formal agencies which consider the simultaneous delivery of social and health services will succeed inasmuch as they have the ability to interact with a system of informal care.

Résumé

L'utilisation des services de santé et des services sociaux a fait l'objet de nombreuses études au cours des dernières années. Mais peu de ces études ont tenté d'étudier l'utilisation conjointe d'une gamme de ces services. Cette étude vise à établir des profils d'utilisation de services de santé et de services sociaux offerts par des réseaux formels et informels d'aide. Par la suite, la capacité de caractéristiques socio-démographiques, de l'état de santé physique et mental et de la densité du réseau social de personnes âgées de deux échantillons urbains d'expliquer leur localisation dans les différents profils d'utilisation est examinée. Les deux échantillons de personnes âgées ont été tirés depuis le fichier de bénéficiaires du régime de pension universelle du gouvernement canadien. Leur utilisation de services hospitaliers et médicaux, leur consommation de médicaments et leur recours aux services d'aide aux activités de la vie quotidienne ont été mesurés. Les profils de services ont été identifiés à l'aide de l'analyse de regroupement, tandis que la capacité de classification des variables prédictrices de l'utilisation dans les profils a été évaluée par l'analyse discriminante. Cinq profils d'utilisation ont été identifiés par l'analyse discriminante. L'un d'eux regroupe les personnes avec une utilisation importante de tous les services tandis que les quatre autres profils regroupent des personnes qui utilisent peu de services de divers types. La localisation de personnes âgées dans les différents profils est prédite par la santé physique, la corésidence et le revenu. Les résultats de l'analyse tendent à démontrer que les services formels et informels de santé et de services sociaux sont utilisés par les personnes âgées selon des modalités treès différentes. Le succeès des organismes qui offrent une gamme de services sociaux et de santé dépend de leur capacité à tenir compte de cette double structure d'utilisation des services par les personnes âgées; soit une utilisation de services sociaux et de santé, provenant de sources formelles et informelles.

Keywords

Health servicessocial servicesprofiles of servicesformal sourcesinformal sources.
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 8 , Issue 1 , Spring/printemps 1989 , pp. 19 - 33
Copyright
Copyright © Canadian Association on Gerontology 1989

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References

REFERENCES

1.Broyles, R., Manger, P., Binder, D.A., Angus, D.E., Charette, A.The Use of Physicians Services Under a National Health Insurance Scheme: An Examination of me Canada Health Survey. Med Care, 1983;21:1037–1054.Google Scholar
2.Chappel, N.L.Social Support and the Receipt of Home Care Services. The Gerontologist, 1985;25:47–54.Google Scholar
3.Daadand, S.O.Use of Public Services for the Aged and the Role of the Family. The Gerontologist, 1983;23:650–656.Google Scholar
4.Evashwick, C, Rowe, G., Diehr, P., Branch, L.Factors Explaining the Use of Health Care Services by the Elderly. Health Serv Res, 1984;19:357–382.Google Scholar
5.Golfarb, M.G., Hornbrook, M.C., Higging, C.S.Determinants of Hospital Use: A Cross-Diagnostic Analysis. Med Care, 1983;21:48–66.Google Scholar
6.Ingman, S.R., Lawson, I.R.Utilization of Specialized Ambulatory Care by the Elderly: A Study of a Clinic. Med Care, 1982;20:331–338.Google Scholar
7.Knapp, D.A., Knapp, D.A., Wiser, T.H., Michocki, R.J., Nuessie, S.J., Knapp, W.K.Drug Prescribing for Ambulatory Patients 85 years of age and older. J Am Geriatrics Soc, 1984;32:138–143.Google Scholar
8.Markides, K., Levin, J.S., Ray, L.A.Determinants of Physician Utilization among Mexican-Americans: A Three Generations Study. Med Care, 1985;23:236–246.Google Scholar
9.Catrell, F. Transportation of the Rural Aged. In Atchley, R. (ed). Rural Environment and Aging, Washington D.C. (Gerontological Society), 1975: 187.Google Scholar
10.Lopez-Aqueres, W., Kemp, B., Staples, F., Brummel-Smith, K.Use of Health Care Services by Older Hispanics. J Am Geriatrics Soc, 1984;32:435–440.Google Scholar
11.Pattersen, C., Crescenki, C, Steel, K.Hospital Use by the Extremely Elderly (Nonagenarians): A Two-Year Study. J Am Geriatrics Soc, 1984;32:350–352.Google Scholar
12.Russel, L.B.An Aging Population and the Use of Medical Care. Med Care, 1981;19:633–643.Google Scholar
13.Scott, J.P., Roberto, K.A.Use of Informal and Formal Support Network by Rural Elderly Poor. The Gerontologist, 1985;25:624–630.Google Scholar
14.Shapiro, E., Roosand, L.L.Using Health Care: Rural/Urban Differences Among the Manitoba Elderly. The Gerontobgist, 1984;24:270–274.Google Scholar
15.Steel, K., Marksen, E., Crescenzi, C., Hoffman, S., Bissonnette, A.An Analysis of Types and Costs of Health Care Services Provided to an Elderly Innercity Population. Med Care, 1982;20:1090–1100.Google Scholar
16.Stollor, E.P.Patterns of Physician Utilization by the Elderly: Med Care, 1982;20:1080–1089.Google Scholar
17.Wan, T.T.H.Use of Health Services by the Elderly in Low-Income Communities. Millbank Mem Fund Q, 1982;60:82–107.Google Scholar
18.Wolinsky, F.D., Coe, R.M.Physician and Hospital Utilization among Non-Institutionalized Elderly Adults: An Analysis of the Health Interview Survey. J Gerontol, 1984: 39:334–341.Google Scholar
19.Wolinsky, F.D., Coe, R.M., Miller, D.R., Prendergast, J.M., Creek, M.J., Chavez, M.N.Health Services Utilization among die Non-Institutionalized Elderly. J Health Soc Beh, 1983;24:325–337.Google Scholar
20.German, P.S., Shapiro, S., Skinner, E.A.Mental Healdi of die Elderly: Use of Health and Mental Health Services. J Am Geriatrics Soc, 1985;33:246–252.Google Scholar
21.Wan, T.T.H., Odell, B.G.Factors Affecting the Use of Social and Health Services among die Elderly. Ageing and Society, 1981;1:95–115.Google Scholar
22.Berg, R.L., Browning, F.E., Hill, J.G., Wenkert, W.Assessing die Health Care Needs of the Aged. Health Serv Res, 1979;5:36–59.Google Scholar
23.Comptroller General of die United States. The Well-Being of Older People in Cleveland, Ohio. Washington D.C, (General Accounting Office), 1977.Google Scholar
24. Comptroller General of the United States. Profiles of Older People. Washington D.C, (General Accounting Office), 1980.Google Scholar
25.Branch, L.G., Jette, A.M.The Framingham Disability Study I: Social Disability among the Aging. Am J Pubi Health, 1981;71:1211–1216.Google Scholar
26.Jette, A.M., Branch, L.G.The Framingham Disability Study II: Physical Disability among the Aged. Am J Pubi Health, 1981;71:1211–1216.Google Scholar
27.Isaacs, B., Neville, Y.The Needs of Old People: The “Interval” as a Mediod of Measurement. Brit J Prev Soc Med, 1976;30:79–85.Google Scholar
28.Journal of the American Geriatrics Society NIA Conference on Assessment. J Am Geriatrics Soc, 1983;31:636–664 & 721–765.Google Scholar
29.Pinker, R.A.Facing Up to die Eighties: Health and Welfare Needs of British Elderly. The Gerontologist, 1980;20:273–283.Google Scholar
30.Kane, R.A., Kane, R.L.Assessing the Elderly: A Practical Guide to Measurement. Lexington, Lexington Books, 1981.Google Scholar
31.Hard, Z., Noelker, L., Blake, B.F.Comprehensive Services for the Aged: Theoretical and Empirical Perspectives. The Gerontologist, 1985;25:644–649.Google Scholar
32.Beck, W., Streib, F.Older Families: A Decade Review. J Marr & Fam, 1980;42:937–956.Google Scholar
33.Béland, F.The Family and Adults 65 Years of Age and Over: Go-Residency and Availability of Help. Can R Soc Anthr, 1984;21:302–317.Google Scholar
34.Béland, F.Des Données descriptives pour L. planification de services sociaux et de santé pour les personnes âgées. Québec, Ministère des Affaires sociales, 1983.Google Scholar
35.Moon, N.The Role of the Family in the Economic Well-Being of the Elderly. The Gerontologist, 1983;23:45–50.Google Scholar
36.Robinson, B., Thurnher, M.Taking Care of Aged Parents: A Family Cycle Transition. The Gerontologist, 1979;19:3–9.Google Scholar
37.Shanas, E.Social Myth as a Hypothesis: The Case of Family & Relations of Old People. The Gerontologist, 1979;19:3–9.Google Scholar
38.Stephens, R.C., Blau, Z.S., Oser, G.T., Miller, M.D., Aging, Social Support Systems and Social Policy. J of Geront Soc Work, 1978;1:33–47.Google Scholar
39.Treas, J.Family Support Systems for the Aged: Some Social and Demographic Considerations. The Gerontologist, 1977;17:476–491.Google Scholar
40.Cantor, M.H.Neighbors and Friends. Research on Aging, 1979;1:434–463.Google Scholar
41.Marshall, V.W.Factors affecting response and completion rates in some Canadian studies. Canadian Journal on Aging, 1987: 6:217–227.Google Scholar
42.Everett, B.S.Cluster Analysis. London, Heineman, 1980.Google Scholar
43.Lorr, M.Cluster Analysis for Social Scientists. San Francisco, Jossey-Bass, 1983.Google Scholar
44.Dixon, W.J. (Eds). BMDP Statistical Software 1983. Berkeley, University of California Press, 1983.Google Scholar
45.Morrison, D.F.Multivariate Statistical Analysis. New-York, McGraw-Hill, 1976.Google Scholar
46.Blishen, B.R.A Socio-Economie Index for Occupations in Canada. Can R Soc Anthr, 1967;4:41–53.Google Scholar
47.Blishen, B.R., McRoberts, H.A.A Revised Socioeconomic Index for Occupations in Canada. Can R Soc Anthr, 1976;13:71–80.Google Scholar
48.Bradburn, N.M.The Structure of Psychological Well-Bang. Chicago, Aldine, 1969.Google Scholar
49.Hodkinson, H.M.Evaluation of a Mental Test Score for Assessment in the Elderly. Age and Ageing, 1972;1:233–238.Google Scholar
50.Katz, S., Ford, A.B., Moskovitz, R.W., Jackson, B.A., Joffe, M.W.Studies of illness in the Aged: The Index of ADL, A Standardized Measure of Biological and Psychological Function. J Am Med Ass, 1963;186:914–919.Google Scholar
51.Belloc, N.B., Breslow, L., Hochstin, J.R.measurement of Physical Health in the General Population Survey. Am J Epidemiol, 1971;93:328–336.Google Scholar
52.Petrowsky, M.Marital Status, Sex and the Social Networks of the Elderly. J Marr & Fam, 1976;38:749–756.Google Scholar
53.Powers, E.A., Bultena, G.L.Sex Differences in Intimate Friendships of Old Age. J Marr & Fam, 1976;39:739–747.Google Scholar
54.Blau, Z.S.Structural Constraints on Friendship in Old Age. Am Soc R, 1961;26:409–439.Google Scholar
55.Mossey, J.M., Havens, B., Roos, N.P., Shapiro, E.The Manitoba Longitudinal Study on Aging: Description and Methods. The Gerontologist, 1981;21:551–558.Google Scholar
56.Lowenthal, M.F., Robinson, B. Social Networks and Isolation. In Binstock, R.H.Shana, E. (eds). Handbook of Aging and the Social Sciences. New York, Van Nostrand Reinhold, 1976.Google Scholar
57.McCall, N., Wai, H.S.An Analysis of the Use of Medicare Services by the Continuously Enrolled Aged. Med Care, 1983;21:567–585.Google Scholar
58.Roos, N.P., Shapiro, E., Roos, L.L.Aging and the Demand for Health Services: Which Aged and Whose Demands. The Gerontologist, 1984;24:31–36.Google Scholar
59.Daadand, S.O.Care Systems. Ageing and Society, 1983;3:1–21.Google Scholar
60.Branch, L.G., Jette, A.M.Elders' Use of Informal Long-Term Care Assistance. The Gerontologist, 1983;23:51–56.Google Scholar
61.Coe, R.M., Wolinsky, F.D., Miller, D.K., Prendergast, J.M.Complementary and Compensatory Functions in Social Network Relations among the Elderly. The Gerontohgist, 1984;24:396–400.Google Scholar
62.Diamond, L.M., Greenberg, L., Morris, R.L.Elder Care for the 1980s': Health and Social Service in one Prepaid Health Maintenance System. The Gerontologist, 1983;23:148–153.Google Scholar