OBJECTIVE: To describe the patterns of use of health and human
services by elderly rural individuals and to determine whether cognitively
impaired persons had a distinctive pattern of service utilization.
DESIGN: An epidemiological survey and cognitive screening of an
age-stratified random community sample.
SETTING: The
mid-Monongahela Valley, a rural community in Southwestern Pennsylvania.
PARTICIPANTS: 1366 non-institutionalized persons aged 65 years and
older, fluent in English, and with at least a sixth grade education.
MEASUREMENTS: We administered a battery of cognitive screening tests
(the Mini-Mental State Examination; Immediate and Delayed Recall of a
Story; Immediate and Delayed Recall of a Word List; CERAD modification of
the Boston Naming Test; Verbal Fluency for initial letters P and S and for
names of Fruits and Animals; Temporal Orientation; Praxis; Clock Drawing;
and Trailmaking Tests A and B.) We also obtained basic demographic
information and inquired about the use of health and human services in the
previous year.
RESULTS: Approximately 10% of the sample was
classified (by operational criteria) as cognitively impaired. In
univariate analyses, cognitive impairment was found to be significantly
associated with the use of certain health services: hospitalization in the
previous 6 months (odds ratio, OR = 2.1; 95% CI = 1.3, 3.3), previous
nursing home use (OR = 9.3; 95% CI = 3.8, 22.9), home health care (OR =
4.6; 95% CI = 2.7, 8.0), social services (OR = 6.5; 95% CI = 3.4, 12.4),
mental health services (OR = 2.8; 95% CI = 1.2, 6.2), and the regular use
of prescription medications (OR = 2.0; 95% CI = 1.3, 3.2). Visits to
physicians were not significantly different between the impaired and
unimpaired groups. In a multiple regression model, which included age and
educational level, the use of home health care (OR = 3.4; 95% CI = 1.8,
6.4) and social services (OR = 2.3; 95% CI = 1.1, 4.9) remained
significantly associated with cognitive impairment.
CONCLUSIONS:
The association of cognitive impairment with the use of these health and
human services underscores the general frailty of the impaired group.
These findings also point to potential target groups in the community for
further evaluation and services for dementia. The findings support the
need for education regarding cognitive impairment and dementia to be made
available to providers of these services, particularly informal social
services such as those provided by church groups.