Older Adults Spend 3 Weeks of the Year Receiving Out-of-Home Healthcare

Ishani Ganguli, MD, MPH

Credit: Harvard Medical School

A new study found the average older adults will spend the equivalent of 3 weeks each year receiving healthcare outside of their home.^1,2

Transporting to and from the doctor’s office, as well as paying for appointment after appointment, is not only time-consuming but a financial burden—and puts a strain on older adults, according to the results of the study.

“Conceptually, contact days capture how much of a person’s year is consumed by receiving health care outside of the home, often at the expense of other pursuits,” wrote investigators. “These days can carry clear clinical and social benefits (and importantly, underuse undoubtedly contributes to the variation we find), and also potential direct and indirect burdens of varying degrees for patients and their often-unpaid care partners.”

The study, led by Ishani Ganguli, MD, MPH, from the division of general internal medicine and primary care at Brigham and Women’s Hospital in Boston, wanted to assess patterns of contact days among older adults. Contact days can be anything from ambulatory days—primary care or specialty care office visits, tests, imaging, procedures, or treatment—or institutional days in a hospital, emergency department, skilled-nursing facility, or hospice facility.

The team conducted a cross-sectional study, using nationally representative 2019 Medicare Current Beneficiary Survey data. For inclusion, patients needed to be considered if they were community-dwelling adults aged ≥ 65 years with Medicare as of January 1, 2019.

The primary outcome of interest was total contact days. Using multivariable mixed-effects Poisson regression, the team found 6619 older adults had a mean of 17.3 ambulatory contact days and a total of 20.7 contact days in a year.

“A striking 11% of beneficiaries had 50 or more contact days in the year, or roughly 1 contact day per week,” investigators wrote. “The number of contact days varied widely across the population and was associated with clinical as well as sociodemographic factors, geography, and care-seeking behaviors, though most variation remained unexplained.”

Older adults spent most of their contact days on ambulatory care, such as primary care visits (mean: 3.5), specialty care visits (mean: 5.7), tests (mean: 5.3), and treatments (mean: 5.7). The investigators observed 48.6% of the test and 50.1% of the imaging days were not on the same days as office visits.

The most common specialty care visits in the cohort were ophthalmology (12%), followed by cardiology (9%). Additionally, the most common service subtypes were general laboratory tests (72.6% of test days); standard radiographs (52.9% of imaging days); skin procedures (50.5% of procedure days); and physical, occupational, and speech therapy (43.7% of treatment days)/

The investigators assessed when contact days occurred on the calendar year and found appointments were less frequent on weekends and holidays, but institutional contact days were much more evenly distributed. Having ambulatory contact varied significantly during the weekday for all types of ambulatory service types (P < .001) with Fridays being a less common appointment day. Specialist visits varied during the week even more, with 20% to 23% of specialist visit days on Mondays through Thursdays and 13% on Fridays.

The team noted older adults who had difficulty getting to places had a mean of 31.4 contact days and 24.1 ambulatory contact days. Furthermore, older adults with a usual provider had more ambulatory days (mean: 18 days) than those without a usual provider. However, they had fewer ambulatory contact days if their usual provider was in primary care instead of specialty care or was male.

Additionally, Ganguli and colleagues found younger age, female sex, White race, non-Hispanic ethnicity, higher income, higher educational attainment, urban residence, more chronic conditions, and the tendency to go to the doctor as soon as they feel bad were linked to more ambulatory contact days.

“The authors also found significantly fewer health care contact days among Black, Hispanic, and lower-income adults—groups that experience the highest mortality rates in the country —highlighting the well documented systemic inequities they face in accessing needed health care,” wrote Madeline R. Sterling,MD, MPH, MS and Rishi K.Wadhera,MD, MPP, MPhil in their editorial.

The team stated multiple limitations, including not deciding the value of individual contact days, not weighing contact days, not covering in-home care, and not being able to generalize to the growing number of older adults in Medicare Advantage.

The investigators emphasized how half of the test days and imaging days were not on the same day as office visits, which can put a burden on patients.

“Although there are many clinical reasons for separating services (for example, a fasting lipid panel drawn in advance to review during a visit, a repeated potassium test to follow-up an abnormal result), this finding also suggests opportunities for clinicians to avoid low value services when possible and to consolidate care, for example, through point-of-care testing or addressing multiple patient needs in a given encounter,” investigators concluded.

References

1. Ganguli I, Chant ED, Orav EJ, Mehrotra A, Ritchie CS. Health Care Contact Days Among Older Adults in Traditional Medicare: A Cross-Sectional Study. Ann Intern Med. Published online January 23, 2024. doi:10.7326/M23-2331
2. Older Adults Spend 3 Weeks Each Year Receiving Health Care Outside of The Home. EurekAlert! January 22, 2024. https://www.eurekalert.org/news-releases/1031441. Accessed January 23, 2024.