Functional status and use of health care services: longitudinal study on the older adult population in Spain.
BACKGROUND
Follow-up studies on the association between functional status and use of health care services among the older people are scarce and have studied only a few types of service.


OBJECTIVE
To examine prospectively the relationship between limitation in instrumental activities of daily living (IADL) and utilization of a wide variety of health care services among older adults in Spain.


METHODS
Prospective study from 2001 to 2003 of a cohort of 2806 persons, representative of the non-institutionalized Spanish population aged 60 years and over. Limitation in IADL was measured in 2001 using the Lawton and Brody's test. Data on the use of health care services were collected in 2003 and classified into home services (home visits by physicians and nurses) and non-home services (visits to primary care physicians, visits to hospital specialists, hospital admissions, emergency care, and influenza vaccination). Analyses were performed with logistic regression and adjusted for the main confounders.


RESULTS
Compared to men with no limitation in IADL, a higher percentage of those with limitation in one IADL in 2001 made use of both home (odds ratio [OR] 2.64; 95% confidence interval [95% CI] 1.73-4.03) and non-home services (OR 2.02; 95% CI 1.04-3.93) in the period 2001-2003. Limitation in one IADL among women was associated with a greater utilization of home services (OR 1.50; 95% CI 1.05-2.14) and visits to hospital specialists (OR 1.61; 95% CI 1.21-2.15). In women, however, a greater number of limited IADL at baseline was inversely associated with visits to primary care physicians in the 2-year follow-up (p for linear trend <0.001).


CONCLUSIONS
Population aging will increase the demand for health services in general, and for home services in particular.
León-Muñoz
Luz María
LM
Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
López-García
Esther
E
Graciani
Auxiliadora
A
Guallar-Castillón
Pilar
P
Banegas
José R
JR
Rodríguez-Artalejo
Fernando
F
D000203:Activities of Daily Living / Q000145:classification*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006296:Health Services / Q000706:statistics & numerical data*; D006699:Home Care Services / Q000706:statistics & numerical data; D006792:House Calls / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008511:Medicine / Q000706:statistics & numerical data; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012737:Sex Factors; D013030:Spain; D013038:Specialization; D014600:Utilization Review / Q000706:statistics & numerical data