Objective: The purpose of this research was to determine whether geographic access influences service utilization in a community-based sample of older adults with cognitive impairment. Methods: A telephone screener for cognitive impairment was administered to 9,100 elderly Arkansans with caregivers, resulting in a sample with 317 elder/caregiver dyads. Self-reported service utilization was collected for three sectors: home health, physical health, and mental health. Geographic access was measured from (a) self-reported awareness of services in each sector and (b) the travel time to the closest provider in each sector calculated using a Geographic Information System. Results: Travel time significantly predicted home health service utilization while perceived awareness significantly predicted mental health service utilization. Neither measure of geographic access predicted use of physical health services. Discussion: Because rural elders with less geographic access receive fewer home/mental health services, they may be at greater risk for hospitalization or nursing home placement.
Get full access to this article
View all access options for this article.
References
1.
Biegel, D. E.
, Bass, D. M., Schulz, R., & Morycz, R. (1993). Predictors of in-home and outofhome service use by family caregivers of Alzheimer's disease patients. Journal of Aging and Health, 5(4), 419-438.
2.
Buckwalter, K. C.
, Russell, D.,& Hall, G. (1994). Needs, resources, and responses of rural caregivers of persons with Alzheimer's disease. In E. Light, G. Niederehe, & B. D. Lebowitz (Eds.), Stress effects of family caregivers of Alzheimer's patients(pp. 301-315). New York: Springer.
3.
Chumbler, N.
, & Zhang, M. (1998). A telephone screening to classify demented older adults. Clinical Gerontologist, 19(3), 79-84.
4.
Cohen, D.
,& Cairl, R. (1996). Mental health care policy in an aging society. In B. L. Levin& J. Petrila (Eds.), Mental health services: A public health perspective(pp. 301-324). New York: Oxford University Press.
5.
Cohen, M. A.
, & Tumlinson, A. (1997). Understanding the state variation in Medicare home health care: The impact of Medicaid program characteristics, state policy, and provider attributes. Medical Care, 35(6), 618-633.
6.
Coward, R. T.
, Duncan, R. P.,& Freudenberger, K. M. (1994). Residential differences in the use of formal services prior to entering a nursing home. The Gerontologist, 34(1), 44-49.
7.
Folstein, M. F.
, Folstein, S. E.,& McHugh, P. R. (1975). “Mini-mental state”: Apractical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189-198.
8.
Fortney, J.
, Rost, K., & Warren, J. (2000). Comparing alternative methods of measuring geographic access to health services. Health Services and Outcomes Research Methodology, 1(2), 173-184.
9.
Ganguli, M.
, Seaberg, E., Belle, S., Fischer, L., & Kuller, L. H. (1993). Cognitive impairment and the use of health services in an elderly rural population: The MoVIES project. Journal of American Geriatric Society, 41(10), 1065-1070.
10.
Himes, C. L.
,& Rutrough, T. S. (1994). Differences in the use of health services by metropolitan and nonmetropolitan elderly. Journal of Rural Health, 10(2), 80-88.
11.
Krout, J. A.
(1988). Community size differences in service awareness among elderly adults. Journal of Gerontology, 43(1), S28-S30.
12.
Leaf, P. J.
, Livingston, M. M., Tischler, G. L., Weissman, M. M., Holzer, C. E., III,& Myers, J. K. (1985). Contact with health professionals for the treatment of psychiatric and emotional problems. Medical Care, 23(12), 1322-1337.
13.
McConnel, C. E.
,& Zetzman, M. R. (1993). Urban/rural differences in health service utilization by elderly persons in the United States. Journal of Rural Health, 9(4), 270-280.
14.
Mitchell, J.
(1995). Service awareness and use among older North Carolinians. Journal of Applied Gerontology, 14(2), 193-209.
15.
Mitchell, J.
, & Krout, J. A. (1998). Discretion and service use among older adults: The behavioral model revisited. The Gerontologist, 38(2), 159-168.
16.
Neese, J. B.
, Abraham, I. L., & Buckwalter, K. C. (1999). Utilization of mental health services among rural elderly. Archives of Psychiatric Nursing, 13(1), 30-40.
17.
Pearlin, L. I.
, Mullan, J. T., Semple, S. J., & Skaff, M. M. (1990). Caregiving and the stress process: An overview of concepts and their measures. The Gerontologist, 30, 583-594.
18.
Penning, M. J.
(1995). Cognitive impairment, caregiver burden, and the utilization of home health services. Journal of Aging and Health, 7(2), 233-253.
19.
Scheidt, R. J.
(1998). The mental health of the elderly in rural environments. In R. T. Coward& J. A. Krout (Eds.), Aging in rural settings: Life circumstances& distinctive features(pp. 85-103). New York: Springer.
20.
Schoenberg, N. E.
,& Coward, R. T. (1998). Residential differences in attitudes about barriers to using community-based services among older adults. Journal of Rural Health, 14(4), 295-304.
21.
Tennstedt, S. L.
, Sullivan, L. M., McKinlay, J. B.,& D'Agostino, R. B. (1990). Howimportant is functional status as a predictor of service use by older people?Journal of Aging and Health, 2(4), 439-461.
22.
Watts, C. A.
, Scheffler, R. M., & Jewell, N. P. (1986). Demand for outpatient mental health services in a heavily insured population: The case of the Blue Cross and Blue Shield Association's federal employees health benefits program. Health Services Research, 21(2), 267-289.
23.
Weinberger, M.
, Gold, D. T., Divine, G. W., Cowper, P. A., Hodgson, L. G., Schreiner, P. J., et al. (1993). Expenditures in caring for patients with dementia who live at home. American Journal of Public Health, 83(3), 338-341.
24.
Welch, H. G.
, Wennberg, D. E., & Welch, W. P. (1996). The use of medicare home health care services. New England Journal of Medicine, 335(5), 324-329.
25.
Wolinsky, F. D.
, Coe, R. M., Miller, D. K., Prendergast, J. M., Creel, M. J., & Chàvez, M. N. (1983). Healthservices utilization among the noninstitutionalized elderly. Journal of Health and Social Behavior, 24, 325-337.
26.
Wolinsky, F. D.
, & Johnson, R. J. (1991). The use of health services by older adults. Journal of Gerontology, 46(6), S345-S357
