title: Physician visits, emergency room utilization, and overnight hospitalization in the old-old in Israel: the cross-sectional and longitudinal aging study (CALAS).
abstract: OBJECTIVE
  The objective of this paper is to assess the risk factors for physician contact in the month before the interview (PM) and emergency room utilization (ERU) and overnight hospitalization (OH) in the year before the interview, through the use of the behavioral model as a conceptual framework.
  
  
  METHODS
  A random stratified sample of subjects age 75 to 94 was selected from the National Population Register (a complete listing of the Israeli population maintained by the Ministry of the Interior). The study sample consisted of Jews living in Israel on January 1, 1989, stratified by age (four 5-year age groups: 75-79, 80-84, 85-89, and 90-94), sex, and place of birth (Europe/America, Asia/Africa, and Israel).
  
  
  METHODS
  Community-dwelling old-old Jewish Israelis.
  
  
  METHODS
  1,487 people living in the community at the time of the baseline interview.
  
  
  METHODS
  The dependent variables were PM in the month before the interview and ERU and OH in the previous year. The independent variables were: predisposing variables (age, sex, place of birth, and education); enabling variables (income and the social network variables of marital status, living arrangements, and number of in-person contacts per week with any child); and need variables (number of self-reported chronic medical conditions, subjective health, depressive symptoms, number of difficulties with activities of daily living and instrumental activities of daily living, measures of physical robustness, and engaging in regular physical sportive activities).
  
  
  RESULTS
  The predisposing and enabling factors were only minimally associated with utilization rates in the old old in Israel, with the exception of lower rates of ERU by those who were living alone. Age was not significantly associated with healthcare utilization in the old-old population studied. Healthcare utilization was found to be associated primarily with health and functional status.
  
  
  CONCLUSIONS
  In a system of free and equal access to healthcare services, the demand for health services by a population with high levels of chronic disease and disability is driven primarily by health needs, rather than by extraneous factors such as income and education. The study indicates that equity in the provision of health services is attainable. Policy makers should provide for actual need, remove artificial barriers, and prepare accurate estimates of future needs.
authors.affiliation: Geriatric Institute for Education and Research, Kaplan Hospital, Rehovot, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Walter-Ginzburg
authors.forename: A
authors.initials: A
authors.lastname: Chetrit
authors.forename: C
authors.initials: C
authors.lastname: Medina
authors.forename: T
authors.initials: T
authors.lastname: Blumstein
authors.forename: J
authors.initials: J
authors.lastname: Gindin
authors.forename: B
authors.initials: B
authors.lastname: Modan
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over / Q000523:psychology* / Q000706:statistics & numerical data*; D015984:Causality; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D015577:Geriatric Assessment; D015438:Health Behavior; D019538:Health Care Surveys; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006304:Health Status; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007557:Israel / Q000453:epidemiology; D007585:Jews / Q000523:psychology / Q000706:statistics & numerical data; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008960:Models, Psychological; D020380:Needs Assessment; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data*; D010820:Physicians / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires