Health-care and home-care utilization among frail elderly persons in Belgium.

BACKGROUND: The patterns of health- and home-care utilization among Belgian frail elderly persons living at home with varying socio-economic status are currently unknown. METHODS: In this cross-sectional study based on a representative sample of 4777 elderly participants (≥65 years) in the Belgian Health Interview Survey the prevalence of frailty, as determined by items referring to the Fried phenotype, was estimated according to age, gender, comorbidity, place of residence, survey year, living situation and socio-economic status. Differing health-care utilization [contacts with a general practitioner (GP), specialist and emergency department; and hospital admission) and home-care utilization (home nursing, home help and meals-on-wheels] patterns among the frail, prefrail and robust subpopulations were examined. RESULTS: Overall, 9.3% respondents (426) were classified as frail, 30.7% (1636) as prefrail and 60.0% (2715) as robust. Frailty was associated with age, gender, comorbidity, region, survey year and socio-economic status. The frail and prefrail groups were more likely than the robust to contact a GP, a specialist or an emergency department and were more likely to be admitted to hospital, independent of age, gender, comorbidity, survey year, living situation, region and socio-economic status. They were also more likely to appeal to home nursing, home help and meals-on-wheels than the robust participants. CONCLUSION: Even after adjustment for potential confounders, including age, gender and comorbidity, frailty among Belgian elderly persons is associated with their socio-economic status and is strongly associated with their health- and home-care utilization.

Long-term care use and socio-economic status in Belgium: a survival analysis using health care insurance data.

BACKGROUND: The small but growing literature on socio-economic inequality in morbidity among older persons suggests that social inequalities in health persist into old age. A largely separate body of literature looks at the predictors of long-term care use, in particular of institutional care. Various measures of socio-economic status are often included as control variables in these studies. Review articles generally conclude that the evidence for such variables being a predictor for institutionalization is "inconclusive". In this paper we look at the association among older persons in Belgium between one particular measure of socio-economic status - preferential status in public health care insurance - and first use of home long-term care and residential care. Preferential status entitles persons to higher reimbursement rates for health care from the public health care insurance system and is conditional on low income. We also study whether preferential status is related to the onset of five important chronic conditions and the time of death. METHODS: We use survival analysis; the source of the data is a large administrative panel of a sample representative for all older persons in Belgium (1,268,740 quarterly observations for 69,562 individuals). RESULTS: We find a strong association between preferential status and the likelihood of home care use, but for residential care it is small for men and non-existent for women. We also find that preferential status is significantly related to the chance of getting two out five chronic conditions - COPD and diabetes, but not dementia, hip fracture and Parkinson's disease - and to the probability of dying (not for women). For home care use and death, the association with preferential status declines with increasing age from age 65 onwards, such that it is near zero for those aged around 90 and older. CONCLUSION: We find clear associations between an indicator of low income and home care use, some chronic conditions and death. The associations are stronger among men than among women. We also find that the association declines with age for home care use and death, which might be explained by selective survival.

Equity in GP and specialist contacts by older persons in Belgium.

OBJECTIVES: To explore the existence of socioeconomic differences in probability and intensity of general practitioner (GP) and specialist contacts among the Belgian elderly population, compared with the younger population. METHODS: A nationally representative cross-sectional study based on 4,825 older (≥65) and 14,738 younger participants (<65) in the Belgian Health Interview Surveys 2001 and 2004. Socioeconomic differences in contacts with a GP and specialist were examined using two-part hurdle models; use versus nonuse by logistic regression, and intensity of use by zero-truncated negative binomial regression. RESULTS: The intermediate income group was more likely to contact a GP and tenants reported more GP contacts. Lower educated older persons were less likely to contact a specialist and household income seemed to play a role in the intensity of specialist contacts. CONCLUSIONS: The probability and intensity of general practitioner and specialist contacts among the Belgian older population are mainly determined by sociodemographic and health status variables, but a certain degree of inequity remains. The socioeconomic gradient differs in probability and intensity of contacts, indicating the advantage of using a two-part model in investigating socioeconomic differences in healthcare utilisation.

Preventive care use among the Belgian elderly population: does socio-economic status matter?

OBJECTIVE: To analyze the association between influenza and pneumococcus vaccination and blood cholesterol and blood sugar measurement by Belgian elderly respondents (≥ 65 years) and socio-demographic characteristics, risk factors, health status and socio-economic status (SES). METHODS: A cross-sectional study based on 4,544 non-institutionalized elderly participants of the Belgian Health Interview Surveys 2004 and 2008. Multivariate logistic regression models were constructed to examine the independent effect of socio-demographic characteristics, risk factors, health status and SES on the four preventive services. RESULTS: After adjustment for age, sex, region, survey year, living situation, risk factors (body mass index, smoking status, physical activity) and health status (self-assessed health and longstanding illness) lower educated elderly were significantly less likely to report a blood cholesterol and blood sugar measurement. For instance, elderly participants with no degree or only primary education were less likely to have had a cholesterol and blood sugar measurement compared with those with higher education. Pneumococcus vaccination was not related to educational level, but lower income groups were more likely to have had a pneumococcus immunization. Influenza vaccination was not significantly related to SES. CONCLUSION: The results highlight the need to promote cholesterol and blood sugar measurement for lower SE groups, and pneumococcus immunization for the entire elderly population. Influenza immunization seems to be equally spread among different SE groups.

Transitions in formal and informal care utilisation amongst older Europeans: the impact of national contexts.

The objective of this study was to explore how long-term care systems, and in particular the incorporation of needs-based entitlements to care services or benefits, influence formal and informal care utilisation dynamics. We used the Survey of Health, Ageing and Retirement in Europe (SHARE) wave 1 and 2 data, restricting the sample to persons 65+ from 9 European countries (N = 6,293). The effects of changes in health and household composition on formal and informal care transitions were estimated using logistic regression, allowing these effects to vary across countries. The results indicated that, in all countries, formal and informal care were more often complements than substitutes. The likelihood of becoming a formal or informal care user varied significantly between countries. In the Scandinavian countries and in several continental European countries with needs-based entitlements, the transition to formal care was strongly related to informal support being or becoming unavailable. We found little evidence of country differences in the effect of health variables on the transition to formal care. The analysis suggested that, whilst rates of formal care utilisation continue to differ considerably between European countries, formal care allocation practices are not very dissimilar across Northern and continental European welfare states, as we found evidence for all countries of targeting of older persons living alone and of the most care-dependent older people.

Healthcare utilisation among the Belgian elderly in relation to their socio-economic status.

OBJECTIVES: To analyse the association between healthcare utilisation of elderly persons (65 and over) in Belgium in terms of contacts with GP or specialist and the socio-economic indicators household income, highest educational level within the household, and housing tenure. METHODS: A cross-sectional study based on 4494 non-institutionalised elderly participants in the Belgian Health Interview Surveys of 2001 and 2004. Socio-economic gradients in contacts (yes or no) with a GP or specialist were explored, based on the socio-behavioural model of Andersen, a conceptual framework that includes the most important determinants of healthcare utilisation. Three multivariate models were constructed using multiple logistic regression. RESULTS: After adjustment for age, sex, health status (self-assessed health, functional restrictions, and comorbidity), region, and living situation, initial differences in contacts with a GP and specialist between the different socio-economic groups disappeared among the elderly. On the other hand, contacts with a specialist remain dependent on SES in the younger population. CONCLUSIONS: Adjustment for the determinants of healthcare utilisation among the Belgian elderly nullified the socio-economic gradients in contacts with a GP and specialist that initially existed. The results point to a potential link with the Belgian social and health policy.