Delayed medical care for older adults: The role of household composition and disability status.

Research Objective: To investigate: (1.) How the risk of delayed medical care varies by household composition and (2.) Whether the relationship between household composition and delayed care differs by disability status. Study Design: Data are from the Integrated Health Interview Series (IHIS). Disability was defined by the presence of an activity limitation. Household composition is was constructed as living: with a spouse, alone, or with others. Respondents were asked whether they delayed care in the past year for several reasons, including: cost, difficulty making a timely appointment, limited office hours, difficulty getting through by phone, lack of transportation, or too long of a wait in the office. We used logistic regression to assess the odds of each type of delayed care, with sub-group analyses by disability status, controlling for demographic characteristics. Population Studied: Non-institutionalized adults aged 65 and older who answered questions on reasons for delayed medical care (n=17,663). Principal Findings: Fifteen percent of those living alone and with others delayed care for any reason vs. 10% of those living with a spouse. Older adults with disabilities had higher rates of delayed care than those without disabilities (18% vs. 10%). In multivariate models, having a disability was associated with higher odds of each type of delayed care. In sub-group analyses, living alone and living with others were associated with higher odds of delayed care due to cost or lack of transportation, compared with older adults living with a spouse, regardless of disability status. However, older adults without disabilities living alone had lower odds of delayed care due to difficulty getting a timely appointment, limited office hours, or long waits in the doctor's office if they lived alone, compared with those living with a spouse. Conclusions: Risk of delayed care is associated with both household composition and disability status. In particular, the risk of delayed care due to cost or lack of transportation is higher for older adults living alone or with others, compared with those living with a spouse. These relationships differ by disability status, however, and older adults living alone without a disability actually face lower odds of several types of delayed care compared with their counterparts living with a spouse. Implications for Policy, Delivery or Practice: Patterns of living arrangements for older adults have changed in recent decades, with a decline in institutionalization and an increase in multigenerational households. Such arrangements are impacted by disability, with older adults acting as caregivers (e.g., for spouses or grandchildren) and receiving care themselves (e.g., from spouses and adult children). Despite evidence of these changing patterns and complex roles, there is limited research on how household composition affects health services use. Delayed medical care can lead to poor health outcomes and increased risk of hospitalization or nursing home use, especially for older adults with complex medical conditions. Identifying who is at greatest risk of delayed care by household composition and disability status can help to target interventions, including home and community-based care and medical transportation.