title: Living Alone and Patient Care Experiences: The Role of Gender in a National Sample of Medicare Beneficiaries.
abstract: BACKGROUND
  Seniors who live alone are a large, growing population with poorer health outcomes. We examine the little-studied health care experiences and immunizations of older adults who live alone.
  
  
  METHODS
  We use regression-based case-mix adjustment to compare immunizations and health care experiences of 325,649 adults aged 65 and older who lived alone to those who did not, overall and by gender and health status, using nationally representative data from the Medicare Consumer Assessment of Healthcare Providers and Systems (MCAHPS) surveys. Outcomes were five global care ratings (health plan, drug plan, doctor, specialists, all care), six composite care measures (getting needed care, getting care quickly, doctor communication, customer service, getting needed drugs, getting information from drug plan), and two immunization measures (influenza, pneumonia).
  
  
  RESULTS
  About 30.3% of respondents lived alone. Women, older beneficiaries, and low income (Medicaid eligible) beneficiaries reported living alone at substantially higher rates than their counterparts. Care experiences for 8 of the 13 measures were significantly worse for those who lived alone than for others. The association differed significantly in magnitude by gender for 10 measures, with larger average differences for men. The largest disadvantages for those living alone were for immunization measures (eg, influenza -6 percentage points, for men living alone vs other men). The disadvantages of living alone were not consistently greater for those in worse health.
  
  
  CONCLUSIONS
  Living alone is associated with worse care experiences and immunization, especially for men. Health plans should target quality improvement and outreach efforts to beneficiaries who live alone, especially men.
authors: RAND, Santa Monica, California.
authors: Megan K
authors: MK
authors: Beckett
authors: RAND, Santa Monica, California. elliott@rand.org.
authors: Marc N
authors: MN
authors: Elliott
authors: RAND, Santa Monica, California. Carnegie Mellon University, H. John Heinz III College of Public Policy and Management, Pittsburgh, Pennsylvania.
authors: Amelia M
authors: AM
authors: Haviland
authors: RAND, Santa Monica, California.
authors: Q
authors: Q
authors: Burkhart
authors: Centers for Medicare & Medicaid Services, Division of Consumer Assessment & Plan Performance, Baltimore, Maryland.
authors: Sarah
authors: S
authors: Gaillot
authors: RAND, Santa Monica, California.
authors: Daisy
authors: D
authors: Montfort
authors: RAND, Santa Monica, California. U.S. Department of Veterans Affairs, Geriatrics Research Education and Clinical Center, Los Angeles, California. Borun Center, UCLA Department of Medicine, University of California, Los Angeles.
authors: Debra
authors: D
authors: Saliba
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003953:Diagnosis-Related Groups; D005260:Female; D006304:Health Status; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D007182:Income / Q000706:statistics & numerical data; D057187:Independent Living; D008297:Male; D006278:Medicare; D012737:Sex Factors; D012847:Single Person; D014481:United States
keywords: Gender; Living arrangements; Medicare; Patient experience