Exploring social determinants of healthcare and cognition levels among diverse older adults.
Zahra Rahemi, Juanita-Dawne R Bacsu, Sophia Z Shalhout and 3 others
PMID 39778423WHAT IT FOUND
In 17,698 older adults, those with dementia or impaired cognition had longer hospital, nursing home, and hospice stays; older age was linked with more hospital, nursing home, and doctor visit use, and Black and Hispanic participants with cognitive impairment used some services less.
Key findings
01In the analytic sample of 17,698 older adults, the dementia or impaired cognition group had longer hospital, hospice, and nursing home stays and lower levels of higher education (24.9% versus 55.8%) than the normal cognition group.
02Older age was associated with more hospital stays, nursing home stays, and doctor visits in both cognition groups, and with more hospice use in the dementia or impaired cognition group.
03Among older adults with dementia or impaired cognition, Black participants were less likely to have long nursing home stays, short or moderate hospice use, and moderate-to-high doctor visits, while Hispanic participants were less likely to have short or moderate hospital stays and short, moderate, or long nursing home stays.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study used existing survey data, so the researchers could not check whether reported hospital, nursing home, hospice, and doctor visit days were accurate. It compared groups at one point in time, so it cannot show that age, race, ethnicity, education, marital status, or rural location caused any difference in care use. It did not include income, insurance, comorbidities, or transportation, so differences in care use may be partly explained by access or health complexity. The dataset oversampled Black, Hispanic, and Florida residents, so patterns may not match all older adults. Everyday discrimination, spousal support, other family support, and loneliness were removed from the final models because they did not reach statistical significance, so the paper cannot say whether these experiences were linked with care use.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that Black or Hispanic older adults with cognitive impairment need less care because they used some services less. The study is cross-sectional, used self-reported survey data, and did not include income, insurance, comorbidities, or access barriers, so it cannot show why utilization differed.