The Use of Health Services by Older Adults. Wolinsky, F. D., & Johnson, R. J. (1991).

Wolinsky, F. D., & Johnson, R. J. (1991). The Use of Health Services by Older Adults. Journal of Gerontology, 46(6), 12.

Department of Medicine, Indiana University School of Medicine.

Abstract: Using baseline data on the 5,151 respondents surveyed as part of the panel design of the Longitudinal Study on Aging (LSOA), this article estimates, cross-sectionally, the relationships hypothesized in the behavioral model of health services utilization. In addition to the traditional indicators of the predisposing, enabling, and need characteristics, the richness of the LSOA permits the inclusion of measures of multigenerational living arrangements, kin and nonkin social supports, health worries and the sense of health control, health insurance coverage, residential stability, and several multiple-item scales of functional limitations. Despite these innovations, the ability of the behavioral model to accurately predict the use of health services by older adults remains relatively unchanged. Important conceptual clarifications involving the hypothesized relationships, however, are identified and discussed.
http://www.ncbi.nlm.nih.gov/pubmed/1940101

My notes:

6 instruments were used to measure need characteristics in this study. One of these is a standard dichotomous question asking the patients to rate their overall health. The remaining 21 items include:

• The Activities of Daily Living (ADL) scale by Katz et al. (1963)
• The Instrumental Activities of Daily Living (IADL) scale by Duke University Center for the Study of Aging and Human Development (1978)
• Nagi's (1976) disability scale

5 unidimensional scales emerged from the principal component analyses

1. Basic activities of daily living scale (Basic ADL; alpha=.827): containing 5 items from ADL, including bathing, dressing, getting out of bed, walking, and toileting
2. Household activities of daily living scale (Household ADL; alpha=.828): containing 4 items from IADL including meal preparation, shopping, light housework and heavy housework
3. Advanced activities of daily living scale (Advanced ADL; alpha=.641): containing 3 items from ADL and IADL, including managing money, telephoning and eating

The other 2 scales contain items from Nagi's (1976) disability scale with one scale concerns lower and the other concerning upper body limitations.

1. Lower body limitation scale (alpha=.863) includes difficulties in walking a quarter of a mile, walking up 10 steps without rest, standing or being on one's feet for 2 hours, stooping, crouching, kneeling and lifting or carry 25 pounds.
2. Upper body limitation scale (alpha=.588) includes difficulties in sitting for 2 hours, reaching up over one's head, reaching out as if to shake hands, and using fingers to grasp objects.

In this article, the authors also found that, among the 3 ADL scales, having difficulties with the advanced ADLs was the single significant predictor of events such as taking the bed-disability days, hospital contact and mortality. Advanced ADLs, at the same time, are also instrumental in the detection of cognitive impairments.

On the other hand, lower body limitations, as opposed to those of the upper body, seem to be a better determinant for the utilization of health services.