Social, cultural, and community engagement (SCCE) is associated with older adults utilizing more dental and outpatient care and the same population reducing their use of community and inpatient health care, according to new findings.

While previous studies have established the positive effects of SCCE on health, little was known about its impact on health care utilization. Therefore, this study sought to investigate the relationship between SCCE and utilization of health care.

The research was authored by Qian Gao, PhD, from the Institute of Epidemiology & Health Care at University College London.

“Further longitudinal investigations are needed to identify whether SCCE has the potential to address the unmet health needs of older populations, informing person-centered care and alleviating the burden of managing multiple health conditions,” Gao and colleagues wrote.

Background and Findings

The investigators used a population-based cohort approach, using data drawn from the Health and Retirement Study (HRS) in the period between 2008 and 2016. The HRS is known for being a nationally-representative, longitudinal panel study of Americans aged 50 years and older.

For inclusion in the study, the study participants were required to report social, cultural, and community engagement as well as health care utilization information in the necessary HRS waves. The team analyzed the data between July and September of 2022.

The investigators evaluated SCCE through the use of a 15-item Social Engagement scale that measured engagement in community, cognitive, creative, or physical activities at baseline (frequency) and longitudinally over the course of 4 years (no, consistent, increased, or decreased engagement).

The team assessed health care use and examined it in relation to SCCE, using 4 broad categories:

• Inpatient care (stays in hospital, readmissions, and length of stays)
• Outpatient care (outpatient surgeries, physician visits, and number of visits)
• Dental care (these included dentures)
• Community health care (healthcare at home, nursing home stays, and nights spent in nursing homes)

They recruited a total of 12,412 older adults, all with a mean age of 65.0 years, 54.3% of which were females. The researchers’ short-term analysis with 2 years of follow-up found that independent of confounding variables, higher levels of SCCE were associated with shorter hospital stays.

Additionally, they noted that higher SCCE levels were associated with higher odds of outpatient surgery and dental care , as well as lower odds of home health care use and stays in nursing homes.

The investigators’ longitudinal analysis ended up with 8,635 older adults who had a mean age of 63.7 years, with 55.4% being female. The data available on health care utilization could be found 6 years after baseline.

Compared to consistent SCCE, the team found that either reduced SCCE, or consistent nonparticipation in SCCE was associated with greater levels of inpatient care utilization, including hospital stays. They also noted lower levels of subsequent outpatient care, such as dental care utilization, physician visits, and consistent nonparticipation.

“Our results, in particular our comparisons of different types of SCCE, shed light on potential mechanisms underpinning the association,” they wrote. “Our longitudinal findings also indicate the importance of maintaining SCCE in older age, as decreased engagement and nonparticipation in SCCE had adverse associations with health care utilization.”

The researchers also emphasized the need for further experimental research regarding the mechanisms that underlie greater SCCE participation and utilization of health care. This may eventually help to facilitate preventive health behaviors.

References

1. ^{Gao Q, Bone JK, Bu F, Paul E, Sonke JK, Fancourt D. Associations of Social, Cultural, and Community Engagement With Health Care Utilization in the US Health and Retirement Study. JAMA Netw Open. 2023;6(4):e236636. doi:10.1001/jamanetworkopen.2023.6636.}