Community-Dwelling Older Adults: Services, Cost, and Changes
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With every generation living longer than the last, and the baby boomer generation (one of the largest generations in US history) starting to reach age 65, the demographics of the United States (U.S.) is aging. Older adults are one of the fastest growing segments of the United States population. In 2011, thirteen percent of all people in the U.S. were over the age of 65, and this population is projected to represent almost one quarter of the total US population by 2060. With advanced age and an increased prevalence of chronic illness and disabilities, the older adults’ population will require routine health care services to improve and maintain optimal health. Enhancing and maintaining the health of older adults is key to reducing cost and disease burden in the United States. Thus, with the goal of improving the health, function, and quality of life of older adults, the Health People 2020 proposed numerous objectives targeting the use of preventive services and long-term services and supports. This dissertation consists of three related components; each of which will broaden the understanding of the use of health care services among community-dwelling older adults. The first study examines the association between psychological distress and the utilization of United States Preventive Services Task Force (USPSTF) recommendations on preventive care services among community-dwelling older adults. The study uses the 2011 Medical Expenditure Panel Survey (MEPS) for analysis, and the results show that community-dwelling older adults with psychological distress were less likely to use one, but not all, of the recommended preventive health services. The second study examines the healthcare cost associated with sensory difficulties. Sensory difficulties are common among older adults, and the prevalence is shown to increase with age. Using five MEPS panel data, the results show that community-dwelling older adults with sensory difficulties have higher utilization of office-based visits, emergency room visits, and prescription medications, and higher spending on office-based visits. Using the two most recent 2000 and 2007 National Home and Hospice Care Survey (NHHCS) data, the third study investigates the change in home health care utilization among community-dwelling older adults since the Supreme Court’s 1999 Olmstead v. L.C. ruling, which indicated that states should ensure that persons with disabilities are treated in the most integrated setting appropriate to their needs. The findings suggest significant changes in patient characteristics, functional status, and service utilized. This research improves the understanding of the healthcare cost and health services utilization of community-dwelling older adults. The research findings suggest that there are still unmet health care needs that can be provided to older adults living in the community.
Lin, Szu-Hsuan (2015). Community-Dwelling Older Adults: Services, Cost, and Changes. Doctoral dissertation, Texas A & M University. Available electronically from