Indicators of potential health-related social needs and the association with perceived health and well-being outcomes among community-dwelling medicare beneficiaries
Indicators of potential health-related social needs and the association with perceived health and well-being outcomes among community-dwelling medicare beneficiaries
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DOI：
10.1007/s11136-019-02410-7
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发表时间：
2020-06-01
影响因子：
3.5
通讯作者：
Norman, Gregory J.
中科院分区：
文献类型：
--
作者：
Anderson, Jessa K. Engelberg;Jain, Purva;Norman, Gregory J.
目的与健康相关的社会需求(HRSNs)会使老年人更加脆弱，并影响他们的健康、福祉和就地老龄化能力。目前的研究评估了几个领域(例如，交通、社会隔离)的潜在HRSNs(PHRSNs)的流行率，并在医疗保险受益人的样本中探索了与健康和福祉结果的关联。方法对《2012年国家健康和老龄化趋势研究》中具有代表性的社区居民医疗保险受益者样本(N=5758)进行横断面分析。PHRSNs的二元指标分为五个领域：医疗和公用事业财务需求、住房、营养、社会隔离和交通。结果是抑郁/焦虑、自评健康、意义/满意度、感知控制/适应性。变量被加权，多变量回归模型评估了pHRSN变量和结果之间的关联，控制了社会人口统计学和健康状况。结果在估计的3200万社区居住受益人中，约有1330万人的pHRSN呈阳性，1140万人的pHRSN呈阳性。按领域划分，住房的患病率为7%，交通的患病率为8%，UMFN和营养的患病率为12%，社会隔离的患病率为33%。除了住房，每个领域都与四个结果中的至少两个显著相关(p<；0.05)，其中pHRSN阳性与更大的抑郁/焦虑和更差的自我评估总体健康相关。结论超过40%的医疗保险受益人有1个pHRSN指标，这意味着他们更脆弱，这可能会限制他们的就地老龄化能力。鉴于日益老龄化的人口，需要更好的措施和方法来识别、监测和解决人权状况。例如，通过协调护理利用现有的以社区为基础的服务可能是解决老年人人权状况的有效战略。
Purpose Health-related social needs (HRSNs) can make older adults' more vulnerable and impact their health, well-being, and ability to age-in-place. The current study assessed the prevalence of potential HRSNs (pHRSNs) across several domains (e.g., transportation, social isolation) and explored the associations with health and well-being outcomes in a sample of Medicare beneficiaries. Methods Cross-sectional analyses were conducted with a representative sample of community-dwelling Medicare beneficiaries (N = 5758) from the 2012 National Health and Aging Trends Study. Binary indicators of pHRSNs were created for five domains: medical and utility financial needs (MUFN), housing, nutrition, social isolation, and transportation. Outcomes were depression/anxiety, self-rated health, meaning/satisfaction, perceived control/adaptability. Variables were weighted, and multivariate regression models assessed associations between pHRSN variables and outcomes, controlling for sociodemographics and health conditions. Results Of the estimated 32 million community-dwelling beneficiaries, approximately 13.3 million were positive for >= 1 pHRSN and 11.4 million for >= 2 pHRSNs. The prevalence by domain was 7% for housing, 8% for transportation, 12% for UMFN and nutrition, and 33% for social isolation. Each domain, except for housing, was significantly (p < .05) associated with at least two of the four outcomes, where being positive for a pHRSN was associated with greater depression/anxiety and poorer self-rated general health. Conclusions Over 40% of Medicare beneficiaries had >= 1 pHRSN indicators, which means they are more vulnerable and that may limit their ability to age-in-place. Given the growing aging population, better measures and methods are needed to identify, monitor, and address HRSNs. For example, leveraging existing community-based services through coordinated care may be an effective strategy to address older adults' HRSNs.