Use of health services by Brazilian older adults with and without functional limitation

Abstract

OBJECTIVE To analyze the use of health services and the quality of medical care received by Brazilian older adults with and without functional limitation.METHODS The main analyses were based on a national sample representing 23,815 participants of the National Survey on Health (PNS) aged 60 years or older. Functional limitation was defined by the difficulty to perform at least one out of ten basic or instrumental activities of daily living. Potential confounding variables included predisposing and enabling factors of the use of health services.RESULTS The prevalence of functional limitation was 30.1% (95%CI 29.2–31.4). The number of doctor visits and hospitalizations in the past 12 months showed statistically significant associations with functional limitation, both for users of the public system (OR = 2.48 [95%CI 2.13–2.88] for three or more doctor visits and OR = 2.58 [95%CI 2.15–3.09] for one or more hospitalizations) and of the private system (OR = 2.56 [95%CI 1.50–4.36] and OR = 2.22 [95%CI 1.64–3.00], respectively). The propensity to use basic health units was higher among users of the private system with functional limitations (OR = 2.01 [95%CI 1.12–3.59]). Only two out of seven indicators of the quality of medical care received were associated with functional limitation, in the perception of users of public and private systems. The public system users with functional limitations did worse evaluation of the freedom for choosing the doctor and waiting time for an appointment, when compared with users of the same system without these limitations (OR = 0.81 [95%CI 0.67–0.99] and OR = 0.76 [95%CI 0.62–0.93], respectively).CONCLUSIONS Older adults with functional limitations use more health services in comparison with those without such limitations. The magnitude of the association between functional limitation and number of doctor visits and hospitalizations was similar in the public and private health systems.

Factors associated with the frequency of medical consultations by older adults: a national study

“…As emphasized, the increase in the older adult population has increased the demand on health services (2) , including the investigated modality (frequency of medical appointments). The results reinforce the influence of previously mentioned aspects in the literature, and emphasize the interference of self-perception regarding the general health condition through the use of consultations with a medical professional.…”

“…The change in the age structure in society due to reduced birth rates and increased life expectancy is not always accompanied by changes which ensure decent conditions during aging (1)(2)(3)(4)(5)(6) . The added amount of years lived has contributed to a higher incidence of diseases (7) , especially chronic non--communicable diseases, which contribute to a worsening in functional disability and compromise the quality of life of older adults (6,8) .…”

“…The indicated changes have a direct impact on the increased demand for healthcare (2,5) , regardless of the modality to be taken advantage of and its purpose, with consultations with a medical professional being one of the most recurrent alternatives (4,9) . It is well known that medical appointments are a promising instrument for early diagnosis, preventive action, treatment and necessary guidance.…”

“…It is well known that medical appointments are a promising instrument for early diagnosis, preventive action, treatment and necessary guidance. However, excessive use (five or more consultations) of this type of care may reflect the low resolution of health services, with negative repercussions in terms of economic and service levels, personal and collective contexts (2) .…”

Avaliação e intervenção do equilíbrio em idosos

“…53 Such facts corroborate the probability of aging with functional limitations, which can saturate the public and private health care system if effective health promotion actions are not implemented. 54 It was observed in the selected studies that the use of instruments in the evaluation of the elderly has brought satisfactory results, especially when accompanied by physical exercise programs, with improved muscle strength and reduced risk of falls in the target population. 55 It is emphasized that the elderly should maintain autonomy in ADLs, it is essential to keep the focus on the investigations of functional losses, paying attention to an overall assessment 56 in order to prevent addiction, since it can cause an emotional discontent stemming from a feeling of impotence and uselessness.…”