COGNITIVE IMPAIRMENT AND THE USE OF HEALTH-SERVICES IN AN ELDERLY RURAL-POPULATION - THE MOVIES PROJECT

Objective: To describe the patterns of use of health and human service s by elderly rural individuals and to determine whether cognitively im paired persons had a distinctive pattern of service utilization. Desig n: An epidemiological survey and cognitive screening of an age-stratif ied random community sample. Setting: The mid-Monongahela Valley, a ru ral community in Southwestern Pennsylvania. Participants: 1366 non-ins titutionalized 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 Examinat ion; Immediate and Delayed Recall of a Story; Immediate and Delayed Re call of a Word List; CERAD modification of the Boston Naming Test; Ver bal Fluency for initial letters P and S and for names of Fruits and An imals; Temporal Orientation; Praxis; Clock Drawing; and Trailmaking Te sts A and B.) We also obtained basic demographic information and enqui red about the use of health and human services in the previous year. R esults: Approximately 10% of the sample was classified (by operational criteria) as cognitively impaired. In univariate analyses, cognitive impairment -as found to be significantly associated with the use of ce rtain health services: hospitaiization 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 servi ces (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 l evel, the use of home health care (OR = 3.4; 95% CI = 1.8, 6.4) and so cial services (OR = 2.-3; 95% CI = 1.1, 4.9) remained significantly as sociated with cognitive impairment. Conclusions: The association of co gnitive impairment with the use of these health and human services und erscores the general frailty of the impaired group. These findings als o point to potential target groups in the community for further evalua tion and services for dementia. The findings support the need for educ ation 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.