The Adverse Consequences of Unmet Need Among Older Persons Living in the Community: Dual-Eligible Versus Medicare-Only Beneficiaries
The Adverse Consequences of Unmet Need Among Older Persons Living in the Community: Dual-Eligible Versus Medicare-Only Beneficiaries
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DOI：
10.1093/geronb/gbu124
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发表时间：
2014-11-01
影响因子：
6.2
通讯作者：
Mor, Vincent
中科院分区：
文献类型：
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作者：
Allen, Susan M.;Piette, Elizabeth R.;Mor, Vincent
客观的。我们的目标是估计和比较老年人口中社会经济和医疗弱势群体（同时符合医疗保险和医疗补助资格的人与仅符合医疗保险资格的人）中与未满足援助需求相关的选定不良后果的发生率。方法。使用国家健康和老龄化趋势研究 (NHATS) 的数据（一项针对老年医疗保险人群的代表性调查），我们计算了与残疾相关的自我护理、家务和行动活动援助需求的发生率，以及双重资格和仅医疗保险状态下未满足需求的不良后果的发生率。结果。在 NHATS 访谈前一个月，超过 200 万社区居住的老年人由于自我护理援助需求未得到满足（例如，弄脏了衣服）而遭受了不利后果，超过 200 万人由于家务援助需求未得到满足（例如没有杂货）而遭受了不利后果，超过 300 万人因与行动相关的活动援助需求未得到满足而经历了至少一种不利后果（例如，不得不卧床）。具有双重资格的人在所研究的 11 种不良后果中，有 6 种的发生率较高，并且比其他人更有可能在所有 3 个领域中产生至少一种不良后果。讨论。一些护理模式正在兴起，其目标是为双重资格人群整合医疗护理、行为健康和长期服务。未满足需求的不利后果指标可用于监测此类护理系统的质量和充分性。
Objective. Our objective is to estimate and compare the prevalence of selected adverse consequences associated with unmet need for assistance among a socioeconomically and medically vulnerable subgroup of the older adult population, those who are dually eligible for Medicare and Medicaid, with those eligible for Medicare only.Method. Using data from the National Health and Aging Trends Study (NHATS), a representative survey of the older Medicare population, we calculated the prevalence of disability-related need for assistance with self-care, household tasks, and mobility activities and the prevalence of adverse consequences of unmet need by dually eligible and Medicare only status.Results. Over 2 million community-dwelling older persons experienced an adverse consequence due to unmet need for assistance with self-care (e.g., soiled their clothes), over 2 million experienced adverse consequences due to unmet need for assistance with household tasks (e.g., went without groceries), and over 3 million persons experienced at least one adverse consequence of unmet need for assistance with mobility-related activities (e.g., had to stay in bed) in the month prior to the NHATS interview. Dually eligible persons experienced higher rates of 6 of the 11 adverse consequences studied and were more likely to have at least one adverse consequence in all 3 domains than others.Discussion. Several care models are emerging with the goal of integrating medical care, behavioral health, and long-term services for the dual eligible population. Indicators of adverse consequences of unmet need could be used to monitor the quality and adequacy of such care systems.