title: Disability stage and receipt of recommended care among elderly medicare beneficiaries.
abstract: Receipt of recommended care among older adults is generally low. Findings regarding service use among persons with disabilities supports the notion of disparities but provides inconsistent evidence of underuse of recommended care.
  
  
  
  To examine the extent to which receipt of recommended care among older Medicare beneficiaries varies by disability status, using a newly developed staging method to classify individuals according to disability.
  
  
  
  In a cohort study, we included community-dwelling Medicare beneficiaries aged 65 and older who participated in the Medicare Current Beneficiary Survey between 2001 and 2008. Logistic regression modeling assessed the association of receiving recommended care on 38 indicators across different activity limitation stages.
  
  
  
  Nearly one out of every three elderly Medicare beneficiaries did not receive overall recommended care. Adjusted odds ratios (ORs) revealed a decrease in use of recommended care with increasing activity limitation stage. For instance, ORs (95% CIs) across mild, moderate, severe and complete limitation stages (stages I-IV) compared to no limitation (stage 0) in ADLs were 0.99 (0.94-1.05), 0.89 (0.83-0.95), 0.81 (0.75-0.89) and 0.56 (0.46-0.68). Disparities in receipt of recommended care by disability stage were most marked for care related to post-hospitalization follow-up and, to a lesser degree, care of chronic conditions and preventive care.
  
  
  
  Elderly beneficiaries at higher activity limitation stages experienced substantial disparities in receipt of recommended care. Tailored interventions may be needed to reduce disparities in receipt of recommended medical care in this population.
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Ling
authors.initials: L
authors.lastname: Na
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Center for Pharmacoepidemiology Research and Training, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Sean
authors.initials: S
authors.lastname: Hennessy
authors.affiliation: Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Hillary R
authors.initials: HR
authors.lastname: Bogner
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Jibby E
authors.initials: JE
authors.lastname: Kurichi
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Stineman
authors.affiliation: Geriatric Psychiatry Section of the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Joel E
authors.initials: JE
authors.lastname: Streim
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Pui L
authors.initials: PL
authors.lastname: Kwong
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Dawei
authors.initials: D
authors.lastname: Xie
authors.affiliation: Center for Patient Care and Outcomes Research (PCOR), Medical College of Wisconsin, Milwaukee, WI, USA; Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA. Electronic address: lpezzin@mcw.edu.
authors.forename: Liliana E
authors.initials: LE
authors.lastname: Pezzin
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D015331:Cohort Studies; D004185:Disability Evaluation; D006233:Persons with Disabilities; D006296:Health Services; D006297:Health Services Accessibility; D006304:Health Status; D054625:Healthcare Disparities; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D006278:Medicare; D051346:Mobility Limitation; D016017:Odds Ratio; D011314:Preventive Health Services; D011795:Surveys and Questionnaires; D014481:United States
keywords: Activity limitation stages; Disability; Health care quality; Medicare; Receipt of recommended care