Department of Population Health & Health Disparities, The University of Texas Medical Branch at Galveston, 301 University Boulevard, Galveston, TX, 77555, USA.
Department of Management, Policy & Community Health, UTHealth Houston School of Public Health, 1200 Pressler Street, Houston, TX, USA.
BMC Geriatr. 2024 Aug 2;24(1):652. doi: 10.1186/s12877-024-05247-z.
Older adults with cognitive impairment exhibit different patterns of healthcare utilization compared to their cognitively healthy counterparts. Despite extensive research in high-income countries, similar studies in low- and middle-income countries are lacking. This study aims to investigate the population-level patterns in healthcare utilization among older adults with and without cognitive impairment in Mexico.
Data came from five waves (2001-2018) of the Mexican Health and Aging Study. We used self-reported measures for one or more over-night hospital stays, doctor visits, visits to homeopathic doctors, and dental visits in the past year; seeing a pharmacist in the past year; and being screened for cholesterol, diabetes, and hypertension in the past two years. Cognitive impairment was defined using a modified version of the Cross Cultural Cognitive Examination that assessed verbal memory, visuospatial and visual scanning. Total sample included 5,673 participants with cognitive impairment and 34,497 without cognitive impairment interviewed between 2001 and 2018. Generalized Estimating Equation models that adjusted for time-varying demographic and health characteristics and included an interaction term between time and cognitive status were used.
For all participants, the risk for one or more overnight hospital stays, doctor visits, and dental visits in the past year, and being screened for diabetes, hypertension, and high cholesterol increased from 2001 to 2012 and leveled off or decreased in 2015 and 2018. Conversely, seeing a homeopathic doctor decreased. Cognitive impairment was associated with higher risk of hospitalization (RR = 1.13, 1.03-1.23) but lower risk of outpatient services (RR = 0.95, 0.93-0.97), cholesterol screening (RR = 0.93, 0.91-0.96), and diabetes screening (RR = 0.95, 0.92-0.97). No significant difference was observed in the use of pharmacists, homeopathic doctors, or folk healers based on cognitive status. Interaction effects indicated participants with cognitive impairment had lower risk for dental visits and hypertension screening but that these trajectories differed over time compared to participants without cognitive impairment.
We identified distinct population-level trends in self-reported healthcare utilization and differences according to cognitive status, particularly for elective and screening services. These findings highlight the necessity for policy interventions to ensure older adults with cognitive impairment have their healthcare needs met.
与认知健康的同龄人相比，认知障碍的老年人的医疗保健利用模式不同。尽管在高收入国家进行了广泛的研究，但在中低收入国家类似的研究却很少。本研究旨在调查墨西哥认知障碍和非认知障碍老年人的人口水平医疗保健利用模式。
数据来自墨西哥健康与老龄化研究的五个波次（2001-2018 年）。我们使用过去一年中一次或多次过夜住院、看医生、看顺势疗法医生和看牙医、过去一年看药剂师以及过去两年检查胆固醇、糖尿病和高血压的自我报告措施来评估认知功能。认知障碍使用修改后的跨文化认知测验（Cross Cultural Cognitive Examination）定义，该测验评估了言语记忆、视空间和视觉扫描能力。总样本包括 2001 年至 2018 年间接受访谈的 5673 名认知障碍患者和 34497 名无认知障碍患者。使用调整了随时间变化的人口统计学和健康特征的广义估计方程模型，并包括时间和认知状态之间的交互项。
对于所有参与者，过去一年中一次或多次住院、看医生和看牙医的风险，以及接受糖尿病、高血压和高胆固醇检查的风险，从 2001 年到 2012 年增加，然后在 2015 年和 2018 年趋于平稳或下降。相反，看顺势疗法医生的次数减少了。认知障碍与更高的住院风险相关（RR=1.13，1.03-1.23），但与更低的门诊服务风险相关（RR=0.95，0.93-0.97），胆固醇检查（RR=0.93，0.91-0.96）和糖尿病检查（RR=0.95，0.92-0.97）。根据认知状态，未观察到药剂师、顺势疗法医生或民间治疗师的使用存在显著差异。交互效应表明，认知障碍患者的牙科就诊和高血压筛查风险较低，但与无认知障碍患者相比，这些轨迹随时间而变化。
我们确定了自我报告的医疗保健利用的不同人群水平趋势，并根据认知状态存在差异，特别是对于选择性和筛查服务。这些发现强调了政策干预的必要性，以确保认知障碍的老年人的医疗保健需求得到满足。
