Self-reported delay in seeking care has poor validity for predicting adverse outcomes.
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.
Rupper
Randall W
RW
Geriatric Research Education and Clinical Center, Salt Lake City, Utah 84148, USA. randall.rupper@hsc.utah.edu
Konrad
Thomas R
TR
Garrett
Joanne M
JM
Miller
William
W
Blazer
Dan G
DG
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