SERVICE UTILIZATION AMONG RURAL ELDERS (ELDERLY).
Contributors: University of Virginia.
Published: 1994
Number of pages: 218
Subjects: Gerontology.; Health Sciences, Nursing.; Sociology, Public and Social Welfare.
Description: Approximately one fourth of rural Americans are aged 65 years and over. Rural elders are an underserved and highly at-risk population with documented compromised access to health and human services and a greater likelihood for premature institutionalization. Even though elders living in rural areas have both physical and psychiatric illnesses that would prompt them to use health and social services, their service utilization remains surprisingly low.

This investigation focused on development of models of health and social services utilized by rural elders participating in an outreach case management program and classification of the population based on their risk for heavy service use. This predictive study included 152 rural elders, age 60 and above, who participated in the Jefferson Area Rural Elder Health Outreach Program. A combination of demographic, health status, and organizational variables were used in stepwise multiple regression to determine the variables that best explained the variance in overall service utilization and specific types of health and social services utilization. Only four (health services, home health, crisis intervention, and meals) of the fourteen services were found to have models that accounted for 50% or more of the variances.

To classify groups within the outreach program, cluster analysis was performed to differentiate subjects into groups and ascertain which groups were at-risk for heavy service use. Three distinct groups emerged from the cluster analysis with a 92% accuracy rate for group membership. The two groups who were at-risk for heavy service use differed on seven variables: age, cognition, gender, perception of general health, physical ADLs, instrumental ADLs, and whether the subject had a regular source of care.

Most of the predictive models of service utilization developed using multiple regressions were weak, with small F values and low percentages of prediction. Since elders, whether rural or urban, are not a heterogeneous group, studies using multiple regression statistics have revealed weak prediction ability and have not produced robust models to explain the service utilization among this population. Therefore, future studies need to focus on individuals' patterns of behavior using statistical methods that profile patterns of service use.
Notes: Source: Dissertation Abstracts International, Volume: 55-07, Section: A, page: 2099.

Thesis (PH.D.)--UNIVERSITY OF VIRGINIA, 1994.

School code: 0246.