Forgone health care due to cost among older adults in European countries and in Israel.
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ABSTRACT:
SUBMITTER: Litwin H
PROVIDER: S-EPMC3535497 | biostudies-other | 2009 Sep
REPOSITORIES: biostudies-other
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Project description:The COVID-19 pandemic exacerbated issues regarding access to healthcare for older people, by far the most vulnerable population group. In particular, older adults avoided seeking medical treatment for fear of infection or had their medical treatments postponed or denied by health facilities or health professionals. In response, remote medical services were recognized as an essential adjustment mechanism to maintain the continuity of healthcare provision. Using the SHARE Corona Survey data, we estimate logistic and multilevel regression models for the remote care of 44,152 persons aged 50 and over in 27 European countries and Israel. Our findings suggest that those aged 80+ were the least likely to use remote healthcare. However, women, better educated individuals, older adults who lived in urban areas, those with no financial strain, and active Internet users used remote medical consultations more often. Those who reported poor or fair health status, two or more chronic diseases, or hospitalization in the last 12 months were significantly more likely to use remote healthcare. Furthermore, remote medical consultations were more frequent for those who had their healthcare postponed or went without it due to fear of coronavirus infection. Finally, older adults used remote care more frequently in countries with less healthcare coverage and lower health expenditures. Health systems should prioritize vulnerable groups in maintaining continuity in access to healthcare, despite the availability of remote care. Policymakers should improve telemedicine regulation and offer incentives for providers of remote healthcare services by adapting reimbursement policies. Remote medical care could play an important role in maintaining healthcare access for older adults and increasing health systems' preparedness in future health emergencies.
| S-EPMC9337840 | biostudies-literature
Project description:Self-rated health (SRH) is a multidimensional measure, predictive of morbidity and mortality. Comparative studies of determinants, however, are rare due to a lack of comparable cross-national data. This paper contributes towards filling in this gap, using data for persons aged 50 or higher in 11 European countries from the SHARE study (2004). The analysis aims at identifying key elements composing SRH using multinomial logistic regression models. In addition, the homogeneity of associations across populations is assessed. The findings indicate that education, depression, chronic conditions, mobility difficulties, somatic symptoms and levels of physical activity constitute important components of SRH; ADLs and obesity, on the other hand, are not significant and IADLs are important only in a few countries. All these associations point to the expected direction and are homogeneous across countries. However, demographic factors, age and gender, though significant in many countries have divergent associations. Effects of smoking also differentiate between southern and northern Europe.
| S-EPMC5547370 | biostudies-other
Project description:IntroductionIt is well-known that the prevalence of chronic diseases is high among older people, especially those who are poor. Moreover, chronic diseases can result in catastrophic health expenditure. The relationship between chronic diseases and their financial burden on households is thus double-sided, as financial difficulties can give rise to, and result from, chronic diseases. Our aim was to examine the levels of catastrophic health expenditure imposed by private out-of-pocket payments among older people diagnosed with diabetes mellitus, cardiovascular diseases and cancer in 15 European countries.MethodsThe SHARE dataset for individuals aged 50+ and their households, collected in 2010-2012 was used. The total number of participants included in this study was N = 51,661. The sample consisted of 43.8% male and 56.2% female participants. The average age was 67 years. We applied an instrumental variable approach for binary instrumented variables known as a treatment-effect model.ResultsWe found that being diagnosed with diabetes mellitus and cardiovascular diseases was associated with catastrophic health expenditure among older people even in comparatively wealthy countries with developed risk-pooling mechanisms. When compared to the Netherlands (the country with the lowest share of out-of-pocket payments as a percentage of total health expenditure in our study), older people diagnosed with diabetes mellitus in Portugal, Poland, Denmark, Italy, Switzerland, Belgium, the Czech Republic and Hungary were more likely to experience catastrophic health expenditure. Similar results were observed for diagnosed cardiovascular diseases. In contrast, cancer was not associated with catastrophic health expenditure.DiscussionOur study shows that older people with diagnosed chronic diseases face catastrophic health expenditure even in some of the wealthiest countries in Europe. The effect differs across chronic diseases and countries. This may be due to different socio-economic contexts, but also due to the specific characteristics of the different health systems. In view of the ageing of European populations, it will be crucial to strengthen the mechanisms for financial protection for older people with chronic diseases.
| S-EPMC4933384 | biostudies-literature
Project description:Objectives: The current study set out to examine the links between contact frequency with one's social network and cognitive health in later life. It assessed both direct and indirect pathways and the possible role of ethnicity in the effect of the social network on cognitive function. Method: We used data from adults aged 50 and above, which was collected in Israel as part of the Survey of Ageing, Retirement and Health (SHARE). A moderated mediation analysis was conducted to test the direct and indirect associations between contact frequency and cognitive function, as well as the moderation of these associations by population group. Three population groups were examined - veteran-Jews, Arabs and immigrants from the former Soviet Union. Results: Contact frequency with the close social milieu was found to be directly positively related to cognitive function. The association was also mediated by depressive symptoms, such that frequent contacts were linked to cognitive health via reduced depressive symptoms. This indirect link differed, however, among the three population groups. Conclusion: Contact frequency is important for cognitive health in the second half of life, and it operates both directly and by decreasing depressive symptoms. However, these links are not found among all ethnic groups and may, therefore, depend on the culture and social norms of each group and the meaning attributed to social ties.
| S-EPMC6215531 | biostudies-literature
Project description:The purpose of the present study was to identify health and well-being typologies among a sample of older European adults. Further, we examined various demographic, social, and health behaviour characteristics that were used to discriminate between such groups. The participants were 1,381 community-dwelling adults aged 65 years and above (M age = 73.65; SD = 7.77) from six European Union (EU) countries who completed self-reported questionnaires. Hierarchical cluster analysis was initially conducted followed by a k means analysis to confirm cluster membership. Four clusters were identified and validated: 'good health and moderate functioning' (38.40%), 'moderate health and functioning' (30.84%), 'obese and depressed' (20.24%) and 'low health and functioning' (10.51%). The groups could be discriminated based on age, gender, nationality, years of education, social isolation and health behaviours (alcohol consumption and walking behaviour). The results of the study demonstrate heterogeneity with regard to the relationships between the variables examined. The information can be used in targeting older Europeans for health promotion interventions.
| S-EPMC5547292 | biostudies-other
Project description:BackgroundLower psychological wellbeing is associated with poor outcomes in a variety of diseases and healthy populations. However, no study has investigated whether psychological wellbeing is associated with the outcomes of COVID-19. This study aimed to determine whether individuals with lower psychological wellbeing are more at risk for poor outcomes of COVID-19.MethodsData were from the Survey of Health, Aging, and Retirement in Europe (SHARE) in 2017 and SHARE's two COVID-19 surveys in June-September 2020 and June-August 2021. Psychological wellbeing was measured using the CASP-12 scale in 2017. The associations of the CASP-12 score with COVID-19 hospitalization and mortality were assessed using logistic models adjusted for age, sex, body mass index, smoking, physical activity, household income, education level, and chronic conditions. Sensitivity analyses were performed by imputing missing data or excluding cases whose diagnosis of COVID-19 was solely based on symptoms. A confirmatory analysis was conducted using data from the English Longitudinal Study of Aging (ELSA). Data analysis took place in October 2022.ResultsIn total, 3,886 individuals of 50 years of age or older with COVID-19 were included from 25 European countries and Israel, with 580 hospitalized (14.9%) and 100 deaths (2.6%). Compared with individuals in tertile 3 (highest) of the CASP-12 score, the adjusted odds ratios (ORs) of COVID-19 hospitalization were 1.81 (95% CI, 1.41-2.31) for those in tertile 1 (lowest) and 1.37 (95% CI, 1.07-1.75) for those in tertile 2. As for COVID-19 mortality, the adjusted ORs were 2.05 (95% CI, 1.12-3.77) for tertile 1 and 1.78 (95% CI, 0.98-3.23) for tertile 2, compared with tertile 3. The results were relatively robust to missing data or the exclusion of cases solely based on symptoms. This inverse association of the CASP-12 score with COVID-19 hospitalization risk was also observed in ELSA.ConclusionThis study shows that lower psychological wellbeing is independently associated with increased risks of COVID-19 hospitalization and mortality in European adults aged 50 years or older. Further study is needed to validate these associations in recent and future waves of the COVID-19 pandemic and other populations.
| S-EPMC10194836 | biostudies-literature
Project description:BackgroundThe adoption of digital health care within health systems is determined by various factors, including pricing and reimbursement. The reimbursement landscape for digital health in Europe remains underresearched. Although various emergency reimbursement decisions were made during the COVID-19 pandemic to enable health care delivery through videoconferencing and asynchronous care (eg, digital apps), research so far has primarily focused on the policy innovations that facilitated this outside of Europe.ObjectiveThis study examines the digital health reimbursement strategies in 8 European countries (Belgium, France, Germany, Italy, the Netherlands, Poland, Sweden, and the United Kingdom) and Israel.MethodsWe mapped available digital health reimbursement strategies using a scoping review and policy mapping framework. We reviewed the literature on the MEDLINE, Embase, Global Health, and Web of Science databases. Supplementary records were identified through Google Scholar and country experts.ResultsOur search strategy yielded a total of 1559 records, of which 40 (2.57%) were ultimately included in this study. As of August 2023, digital health solutions are reimbursable to some extent in all studied countries except Poland, although the mechanism of reimbursement differs significantly across countries. At the time of writing, the pricing of digital health solutions was mostly determined through discussions between national or regional committees and the manufacturers of digital health solutions in the absence of value-based assessment mechanisms. Financing digital health solutions outside traditional reimbursement schemes was possible in all studied countries except Poland and typically occurs via health innovation or digital health-specific funding schemes. European countries have value-based pricing frameworks that range from nonexistent to embryonic.ConclusionsStudied countries show divergent approaches to the reimbursement of digital health solutions. These differences may complicate the ability of patients to seek cross-country health care in another country, even if a digital health app is available in both countries. Furthermore, the fragmented environment will present challenges for developers of such solutions, as they look to expand their impact across countries and health systems. An increased emphasis on developing a clear conceptualization of digital health, as well as value-based pricing and reimbursement mechanisms, is needed for the sustainable integration of digital health. This study can therein serve as a basis for further, more detailed research as the field of digital health reimbursement evolves.
| S-EPMC10576236 | biostudies-literature
Project description:This review identifies the content of virtual visits in community nursing services to older adults and explores the manner in which service users and the nurses use virtual visits.An integrative literature review.Data collection comprised a literature search in three databases: Cinahl, Medline, and PubMed. In addition, a manual search of reference lists and expert consultation were performed. A total of 12 articles met the inclusion criteria. The articles were reviewed in terms of study characteristics, service content and utilization, and patient and health care provider experience.Our review shows that in most studies the service is delivered on a daily basis and in combination with in-person visits. The findings suggest that older home-dwelling patients can benefit from virtual visits in terms of enhanced social inclusion and medication compliance. Service users and their nurses found virtual visits satisfactory and suitable for care delivery in home care to the elderly. Evidence for cost-saving benefits of virtual visits was not found.The findings can inform the planning of virtual visits in home health care as a complementary service to in-person visits, in order to meet the increasingly complex needs of older adults living at home.
| S-EPMC4258330 | biostudies-other
Project description:BackgroundThe impact of quarantine in older adults have been reported in several studies with contradictory results, reporting from negative effects to no significant outcomes or even beneficial consequences. Heterogeneity in aging plays a role in each region, the aim of this study is to analyze the impact of quarantine on health conditions (physical and mental) and lifestyle in older adults in five Centro American countries during COVID-19 pandemic.MethodIn this cross-sectional study, n = 712 older adults 60 years and older from Mexico, Guatemala, El Salvador, Honduras and Costa Rica were assessed by telephone. Sociodemographic data, physical and mental health, lifestyle and quarantine conditions were asked previous informed consent.ResultsIn general, mean of days in quarantine at the moment of the study was 142 days (approximately four months and three weeks). In the analysis of the impact of the days in quarantine effects were found on the frequency of falls, functional ability in Activities of Daily Living (ADL), general cognitive function, memory, orientation, language, frequency of drinking alcohol, having a balanced diet, and being active cognitively. Some differences were found between countries.ConclusionsEffects of quarantine on older adults in Centro America, requires attention of governments and healthcare to prevent long term morbidity and disability, and to promote healthy aging.
| S-EPMC9094529 | biostudies-literature
Project description:Importance:Hearing loss (HL) is common among older adults and is associated with poorer health and impeded communication. Hearing aids (HAs), while helpful in addressing some of the outcomes of HL, are not covered by Medicare. Objective:To determine whether HA use is associated with health care costs and utilization in older adults. Design, Setting, and Participants:This retrospective cohort study used nationally representative 2013-2014 Medical Expenditure Panel Survey data to evaluate the use of HAs among 1336 adults aged 65 years or older with HL. An inverse propensity score weighting was applied to adjust for potential selection bias between older adults with and without HAs, all of whom reported having HL. The mean treatment outcomes of HA use on health care utilization and costs were estimated. Exposures:Encounter with the US health care system. Main Outcomes and Measures:(1) Total health care, Medicare, and out-of-pocket spending; (2) any emergency department (ED), inpatient, and office visit; and (3) number of ED visits, nights in hospital, and office visits. Results:Of the 1336 individuals included in the study, 574 (43.0%) were women; mean (SD) age was 77 (7) years. Adults without HAs (n = 734) were less educated, had lower income, and were more likely to be from minority subpopulations. The mean treatment outcomes of using HAs per participant were (1) higher total annual health care spending by $1125 (95% CI, $1114 to $1137) and higher out-of-pocket spending by $325 (95% CI, $322 to $326) but lower Medicare spending by $71 (95% CI, -$81 to -$62); (2) lower probability of any ED visit by 2 percentage points (PPs) (24% vs 26%; 95% CI, -2% to -2%) and lower probability of any hospitalization by 2 PPs (20% vs 22%; 95% CI, -3% to -1%) but higher probability of any office visit by 4 PPs (96% vs 92%; 95% CI, 4% to 4%); and (3) 1.40 more office visits (95% CI, 1.39 to 1.41) but 0.46 (5%) fewer number of hospital nights (95% CI, -0.47 to -0.44), with no association with the number of ED visits, if any (95% CI, 0.01 to 0). Conclusions and Relevance:This study demonstrates the beneficial outcomes of use of HAs in reducing the probability of any ED visits and any hospitalizations and in reducing the number of nights in the hospital. Although use of HAs reduced total Medicare costs, it significantly increased total and out-of-pocket health care spending. This information may have implications for Medicare regarding covering HAs for patients with HL.
| S-EPMC6145737 | biostudies-literature