Physician visits, emergency room utilization, and overnight hospitalization in the old-old in Israel: The cross-sectional and longitudinal aging study (CALAS)

OBJECTIVES: The objective of this paper is to assess the risk factors for p hysician contact in the month before the interview (PM) and emergency room utilization (ERU) and overnight hospitalization (OH) in the year before the interview, through the use of the behavioral model as a conceptual framewo rk. DESIGN: A random stratified sample of subjects age 75 to 94 was selected fr om the National Population Register (a complete listing of the Israeli popu lation maintained by the Ministry of the Interior). The study sample consis ted of Jews living in Israel on January 1, 1989, stratified by age (four 5- year age groups: 75-79, 80-84, 85-89, and 90-94), sex, and place of birth ( Europe/America, Asia/ Africa, and Israel). SETTING: Community-dwelling old-old Jewish Israelis. PARTICIPANTS: 1,487 people living in the community at the time of the basel ine interview. MEASUREMENTS: The dependent variables were PM in the month before the inter view and ERU and OH in the previous year. The independent variables were: p redisposing variables (age, sex, place of birth, and education); enabling v ariables (income and the social network variables of marital status, living arrangements, and number of in-person contacts per week with any child); a nd need variables (number of self-reported chronic medical conditions, subj ective health, depressive symptoms, number of difficulties with activities of daily living and instrumental activities of daily living, measures of ph ysical robustness, and engaging in regular physical sportive activities). R ESULTS: The predisposing and enabling factors were only minimally associate d with utilization rates in the old old in Israel, with the exception of lo wer rates of ERU by those who were living alone. Age was not significantly associated with healthcare utilization in the old-old population studied. H ealthcare utilization was found to be associated primarily with health and functional status. CONCLUSION In a system of free and equal access to healthcare services, the demand for health services by a population with high levels of chronic dis ease and disability is driven primarily by health needs, rather than by ext raneous factors such as income and education. The study indicates that equi ty in the provision of health services is attainable. Policy makers should provide for actual need, remove artificial barriers, and prepare accurate e stimates of future needs.