title: Self-reported delay in seeking care has poor validity for predicting adverse outcomes.
abstract: OBJECTIVE
  To determine whether self-reports of delayed care predict increased mortality and functional decline in community-dwelling elderly.
  
  
  METHODS
  Longitudinal cohort study.
  
  
  METHODS
  Five counties in North Carolina.
  
  
  METHODS
  A total of 4,162 randomly sampled individuals aged 65 and older.
  
  
  METHODS
  The primary outcome was the proportional hazard ratio (HR) for death in cohorts stratified by self-reports of delayed or foregone care. A secondary outcome, functional decline, measured the cohorts' odds of developing increased dependency in activities of daily living (ADLs). Control variables included predisposing, enabling, and need factors.
  
  
  RESULTS
  Of 3,964 eligible participants reporting, 61% never, 27% once in a while, and 12% quite often delayed care. Over 3 years, 13% of participants died, and 17% developed increased ADL dependency. Nevertheless, in unadjusted and adjusted models, neither 3-year mortality HRs nor the odds of functional decline differed between cohorts reporting varying degrees of delayed care. Survival probabilities remained higher for 15 years among those reporting delaying care often.
  
  
  CONCLUSIONS
  The inability of self-reported delay to predict adverse outcomes in community-dwelling elderly suggests the need for better understanding and support of the care-seeking process and additional measures of timeliness of access.
authors.affiliation: Geriatric Research Education and Clinical Center, Salt Lake City, Utah 84148, USA. randall.rupper@hsc.utah.edu
authors.forename: Randall W
authors.initials: RW
authors.lastname: Rupper
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Konrad
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Garrett
authors.forename: William
authors.initials: W
authors.lastname: Miller
authors.forename: Dan G
authors.initials: DG
authors.lastname: Blazer
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D005260:Female; D005544:Forecasting; D006297:Health Services Accessibility; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009026:Mortality; D009657:North Carolina / Q000453:epidemiology; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010342:Patient Acceptance of Health Care; D016016:Proportional Hazards Models; D011446:Prospective Studies; D015203:Reproducibility of Results; D012306:Risk; D016019:Survival Analysis