Configuration of services used by depressed older adults

Abstract

As a more comprehensive service use measure, this study identifies service use configurations based on the use of 17 services. Factors associated with service use configurations are examined guided by the Andersen and Network Episode models. Self-report data at admission and at six-month follow-up were collected, along with information from medical charts among 140 older adults hospitalized for major depression. The data document service access and levels of use in three sectors of care (psychiatric, medical, and psychosocial services) and assess need, predisposing, enabling, and social network factors associated with use. Three distinct service use configurations were identified with cluster analysis: (1) home care users; (2) moderate users of outpatient mental health services; and (3) heavy users of all formal services. Rather than psychiatric needs, post-acute service use was related to: (1) concurrent physical conditions; (2) the availability of formal and informal services; and (3) financial stability. No difference in psychiatric outcomes was found by service use configuration. It is important to understand service use patterns as a measure of service use, given the co-occurring medical, psychiatric, and psychosocial conditions of older adults and corresponding needs in multiple sectors of care.

Mental health service use among Canadian older adults with anxiety disorders and clinically significant anxiety symptoms

“…According to Andersen's (2008) behavioral model of health services use, three categories of individual characteristics influence service use: predisposing characteristics, enabling resources, and the need for care. Recent research guided by this model has begun to examine the correlates of mental health service use among older adults in general (Li, Proctor, & Morrow-Howell, 2005;Pickard, 2006) and among older adults with depression (Choi, Morrow-Howell, & Proctor, 2006;Crabb & Hunsley, 2006). However, to the best of our knowledge, there has been no published literature on the correlates of service use among older adults with anxiety.…”

Measurement Issues of Service Use Among Elders

“…Eight studies (40%: Brennan et al, 2003;Choi et al, 2006;Clark et al, 2003;Fillenbaum et al, 2004;Green & Pope, 2001;Leon-Munoz et McCall et al, 2003;Peng et al, 2003) qualified service use in terms of frequency of some unit, such as visits, contacts, stays, days, hours, and admission. Specifically, utilization was measured by some unit in 47% (n D 7) of medical sector studies, 50% (n D 2) of mental health sector studies, and none of social service sector studies.…”

“…Informal service normally refers to services and supports from family members, friends, and neighbors. All the studies reviewed focused on the formal service for elders; only Choi et al (2006) measured 1 informal service in addition to 16 formal services. Previous research has documented that informal services for elders and their caregivers play an important role in elders' lives and influence elders' use of formal services (Li et al).…”

“…In individual sectors of care, provider type was used in six studies measuring service use in the medical sector and two studies measuring service use in the mental health sector. Services were distinguished and classified based on type of service provided in a majority of the studies (n D 13; 65%; Alkema, Reyes, & Wilber, 2006;Bookwala et al, 2004;Brennan, 2005;Choi et al, 2006;Green & Pope, 2001;Kuo & Torres-Gil, 2001;Leon-Munoz et al, 2005;Li, Edwards, & Morrow-Howell, 2004;Li, 2004;Peng, Navaie-Waliser, & Feldman, 2003;Peters et al, 2004;Rinehart, 2002;Schonfeld, Larsen, & Stiles, 2006). Within the sector of care, service type was used in six studies measuring service use in the medical sector, one study measuring service use in the mental health sector, and seven studies measuring service use in the social service sector.…”

“…Within the sector of care, service type was used in six studies measuring service use in the medical sector, one study measuring service use in the mental health sector, and seven studies measuring service use in the social service sector. Finally, services were distinguished and classified based on location of service provided in eight studies (40%; Bookwala et al, 2004;Choi et al, 2006;Clark, Stump, & Damush, 2003;Fillenbaum et al, 2004;Finlayson, 2002;Kuo & Torres-Gil, 2001;Leon-Munoz et al, 2005;Stel et al, 2004). Within the sector of care, service type was used in six studies measuring service use in the medical sector, one study measuring service use in the mental health sector, and two studies measuring service use in the social service sector.…”