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Moving beyond typical dichotomous rural-urban categorizations, this study examines older adults' likelihood of receiving home- and community-based services. Data from 1608 individuals aged 60+ who requested assistance from Area Agencies on Aging in Virginia in 2014-2015 were analyzed; 88% of individuals received at least one service. Receiving services was associated with geographic-based factors. Individuals living in completely rural areas were significantly less likely to receive any service compared to individuals in mostly rural (OR = 2.46, p = .003) and mostly urban (OR = 1.97, p = .024) areas. There were subtle but significant geographic-based differences in the likelihood of receiving specific services including food/meal, fresh food, information and referral, in-home care, utilities support, and transportation. Findings provide nuanced insights about geographic-based disparities in the receipt of services and suggest the need for new and modified service delivery strategies that maximize older adults' ability to live.

Accessible primary healthcare is important to national healthcare in general and for older persons in particular, in societies where the population is ageing rapidly, as in Singapore. However, although much policy and research efforts have been put into this area, we hardly find any spatial perspective to assess the accessibility of these primary healthcare services. This paper analyzes the geographical accessibility of one major healthcare service in Singapore, namely, General Practitioners (GPs) services under the Community Health Assist Scheme (CHAS) for older persons. A Python script was developed to filter the website data of the Housing Development Board (HDB) of Singapore. The data derived was comprehensively analyzed by an Enhanced 2-Step Floating Catchment Area (E2SFCA) method based on a Gaussian distance-decay function and the GIS technique. This enabled the identification of areas with relatively weak geographical accessibility of CHAS-GPs. The findings are discussed along with suggestions for health practitioners, service planners and policy makers. Despite its initial nature, this study has demonstrated the value of innovative approaches in data collection and processing for the elderly-related studies, and contributed to the field of healthcare services optimization and possibly to other human services.

Background: Unregulated care aides provide up to 80 % of direct resident care in nursing homes. They have little formal training, manage high workloads, frequently experience responsive behaviours from residents, and are at high risk for burnout. This affects quality of resident care, including quality of oral health care. Poor quality of oral health care in nursing homes has severe consequences for residents and the health care system. Improving quality of oral health care requires tailoring interventions to identified barriers and facilitators if these interventions are to be effective. Identifying barriers and facilitators from the care aide's perspective is crucial., Methods: We will systematically search the databases MEDLINE, Embase, Evidence Based Reviews-Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science. We will include qualitative and quantitative research studies and systematic reviews published in English that assess barriers and facilitators, as perceived by care aides, to providing oral health care to nursing home residents. Two reviewers will independently screen studies for eligibility. We will also search by hand the contents of key journals, publications of key authors, and reference lists of all the studies included. Two reviewers will independently assess the methodological quality of the studies included using four validated checklists appropriate for different research designs. Discrepancies at any stage of review will be resolved by consensus. We will conduct a thematic analysis of barriers and facilitators using all studies included. If quantitative studies are sufficiently homogeneous, we will conduct random-effects meta-analyses of the associations of barriers and facilitators with each other, with care aide practices in resident oral health care, and with residents' oral health. If quantitative study results cannot be pooled, we will present a narrative synthesis of the results. Finally, we will compare quantitative findings to qualitative studies to identify hypothesized associations or effects not yet tested quantitatively., Discussion: This review will advance the development of effective strategies for improving quality of oral health care and highlight gaps in research on barriers and facilitators to providing oral health care to nursing home residents, as perceived by care aides., Systematic Review Registration: PROSPERO CRD42015032454.

The access process is an important step in the care provision to independently living elderly. Still, little attention has been given to the process of access to long-term care for older clients. Access can be described by three dimensions: availability, affordability and acceptability (three A's). In this paper we address the following question: How do care providers take the three dimensions of access into account for the access process to their care and related service provision to independently living elderly? To answer this question we performed a qualitative study. We used data gathered in a multiple case study in the Netherlands. This study provides insight in the way long-term care organizations organize their access process. Not all dimensions were equally present or acknowledged by the case organizations. The dimension acceptability seems an important dimension in the access process, as shown by the efforts done in building a relationship with their clients, mainly through a strong personal relationship between client and care advisor. In that respect it is remarkable that the case organizations do not structurally evaluate their access process. Availability is compromised by practical issues and organizational choices. Affordability hardly seems an issue. Further research can reveal the underlying factors that influence the three A dimensions., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

For older Americans, accessing high-quality care can be a challenge. For those in rural communities, it's even harder., (Project HOPE—The People-to-People Health Foundation, Inc.)

The closing of hospitals has exacerbated challenges for older adults in accessing healthcare, especially those living in economically underserved settings. Through focus groups and a community-engaged approach, our study examined and documented the emergent health needs of older adults following the closing of a local hospital in an economically disadvantaged community. Focus groups were reconvened to assess progress and health needs over time. Analyses of the focus groups (n=37, mean age 77, 84% female) illustrated the impact of the closure and the emergence of the following dominant themes: perceptions of the hospital system, including feelings of abandonment and social isolation; transportation challenges in accessing health care resources; and lack of knowledge and literacy regarding available health care and obtaining health services. Discussion sessions with hospital administrators and participants afforded an opportunity for sharing data and additional assessment. The data and relationships developed with community participants and health system representatives resulted in the production of an information resource about access to health services, tailored for older adults., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

The Canadian Health Measures Survey, conducted between March 2007 and February 2009, revealed unmet dental needs among older adults in Canada. This article, the second of a 3-part series, explains that the inequity in oral care faced by elderly Canadians is due largely to the current fee-for-service dental service system. However, the inequity has arisen because of financial, behavioural and physical barriers, and both the community at large and the dental profession have a social responsibility to reduce this unfairness and provide equitable access to oral care for older people.

This is an integrative literature review of studies on physically disabled elder's access to primary health care, published between 1998 and 2008. The research was performed in: databases, virtual documents from the Health Ministry Library (Brazil), the catalogs of the Nursing Research and Study Center (CEPEN), the Brazilian Nursing Association (ABEn), and through e-mail consultation of experts. Sixty studies were selected and subjected to thematic analysis. The following categories emerged: The history of disability in Brazil, Accessibility and social inclusion, Disability and the elderly. Articles from different scenarios, subjects and methodologies show similar conditions experienced by people with disabilities when accessing health care systems. Scarcity of resources and and the indifference of the public administration were the most evident conditions.

Background: Increasingly aged care services are shifting from residential to community care. As a result, systems of access to services for older persons in Australia have become more complex. It is important for general practitioners to know how to navigate these systems., Objective: To provide a practical guide for the GP on available aged care community services; how to refer to them, how to recognise their limitations, and how to build partnerships to improve care., Discussion: There is a range of affordable community services for older Australians. However, the system has limitations including long waiting lists in some areas and lack of continuity of care. Improvement of communication between medical practitioners and community services is required.

This article, brought to you in association with Help the Aged, highlights the problem of older people's access to goods, facilities and services and looks at how age discrimination impacts on it.

The graying of our population has created a need for elder-friendly communities, but this concept has not been consistently defined nor applied in community assessments. Studies of the topic have examined a range of phenomena--physical environments, religious communities, and access to services--in an attempt to develop a comprehensive model for community assessment. This article describes an elder-friendly community model developed by The AdvantAge Initiative, discusses how it was used to identify assets and areas for improvement in one Western Washington community and how this assessment is informing strategies to improve older adults' quality of life.

Safegarding health has been an objective of every learned civilization, ancient and modern. In modern times, at least in the western world, the increase in longevity associated with social isolation has created further vu1nerability for the older individua1. Today, healthcare is a social burden of extremely high cost. Among us this service is provided by the National Health Service in accordance to the Constituição da República Portuguesa (Constitution of the Portuguese Republic). Despite the constitutional guarantees of equa1ity in health there are obvious discrepancies in access to health care and the conditions that promote health such as education and wealth. In a poor country, even with limited resources, inequa1ity can be minimized via policies and practical measures founded in equa1ity and social responsibility, not only the principles of economic efficiency. Only in this way can we guarantee equa1 access to health and the distribution of available resources in accordance to health care necessities. Yet, the investment in high technology among us seems out of fase with the investment in the area concerning functional recovery from high morta1ity illness, such as stroke. In Portugal the problem is extremely bad. Life expectancy has been extended but qua1ity of life is still very low. Victims of the social order, the elderly live alone without family who can care for them; on the other hand, the lack of investment in recovery and social integration of individua1s with disabling scars, Turns the ends of their life's into a nightmare for themselves and their kin. It follows stating the necessity to analyse and define the criteria to be used when allocating resources in order to guarantee equality in health and relief from suffering and also to stop discrimination of vu1nerable populations in access to healthcare. Whatever the criteria, it must be pre-defined and its principles widely discussed, reiterating, only that longevity cannot be an acceptable criteria to value life. The article concludes drawing attention to the need to invest in health education, which is just as important as the fair distribution of precious health care resources in reducing harmful risks to the most vulnerable patients.

Objective: The authors sought to determine whether integrated mental health services or enhanced referral to specialty mental health clinics results in greater engagement in mental health/substance abuse services by older primary care patients., Method: This multisite randomized trial included 10 sites consisting of primary care and specialty mental health/substance abuse clinics. Primary care patients 65 years old or older (N=24,930) were screened. The final study group consisted of 2,022 patients (mean age=73.5 years; 26% female; 48% ethnic minority) with depression (N=1,390), anxiety (N=70), at-risk alcohol use (N=414), or dual diagnosis (N=148) who were randomly assigned to integrated care (mental health and substance abuse providers co-located in primary care; N=999) or enhanced referral to specialty mental health/substance abuse clinics (i.e., facilitated scheduling, transportation, payment; N=1,023)., Results: Seventy-one percent of patients engaged in treatment in the integrated model compared with 49% in the enhanced referral model. Integrated care was associated with more mental health and substance abuse visits per patient (mean=3.04) relative to enhanced referral (mean=1.91). Overall, greater engagement was predicted by integrated care and higher mental distress. For depression, greater engagement was predicted by integrated care and more severe depression. For at-risk alcohol users, greater engagement was predicted by integrated care and more severe problem drinking. For all conditions, greater engagement was associated with closer proximity of mental health/substance abuse services to primary care., Conclusions: Older primary care patients are more likely to accept collaborative mental health treatment within primary care than in mental health/substance abuse clinics. These results suggest that integrated service arrangements improve access to mental health and substance abuse services for older adults who underuse these services.

Objective: Under-treatment of depression in late-life is a subject of rising public health concern throughout Europe. This study investigates and compares the availability of services for depressed elderly persons in Denmark, France, Germany, Sweden, Switzerland and the UK. Additionally, it explores factors that might contribute to an adequate services supply for depressed elderly people., Method: Review of the literature and guide supported expert interviews. Analysis of the practice of care provision for depressed elderly persons and of indicators for political and professional awareness, such as university chairs, certification processes and political programmes in gerontopsychiatry., Results: Only Switzerland and the UK offer countrywide community-oriented services for depressed elderly persons. Clinical experience in treating depression in late-life is not regularly acquired in the vocational training of the concerned professionals. Indicators suggest that the 'medical society' and health politics in Switzerland and the UK regard psychiatric disease in the elderly more importantly than it is the case in the other investigated countries., Conclusions: Service provision for depressed elderly persons seems to be more elaborated and better available in countries where gerontopsychiatry is institutionalised to a greater extend in the 'medical society' and health politics., (Copyright 2003 John Wiley & Sons, Ltd.)

This article reports on a workshop in which the major focus was a review of the barriers that prevent access to the array of community-based services available to the rural elderly. The demographics of the elderly were outlined and key components of the service system described. Attention was given to access hospital-based care, the closing of hospitals and the reasons for bypassing rural hospitals for those in large towns or cities. Special emphasis also was given to mental health services and their uneven accessibility. A review of the policy implications closed the workshop.

Objective: This study examined three dimensions of access to medical services that contribute to social equity in distribution--availability, accessibility, and acceptability--in order to examine the equity of two medical system arrangements in the United States of America: the traditional fee-for-services scheme and the newer, health maintenance organization (HMO) approach. Equity was compared among three racial/ethnic groups of older adults in the country: European-Americans (the majority in the United States), African-Americans, and Latin Americans (Latinos)., Methods: The data came from a representative national survey that included 858 Latinos, 970 African-Americans, and 8,622 European-Americans. All the survey participants were 65 years of age or older, living in urban areas, and using services through the United State Government's Medicare program for older persons. The three groups were compared through chi-square tests and logistic regression analysis., Results: The data indicated that the older persons belonging to minority groups--who have fewer economic resources but a greater need for medical services--benefit more from HMOs, which provide them with greater availability and access to medical services than does the fee-for-services system. This difference is due to the fact that HMOs reduce the economic barriers for patients. However, the Latinos in HMOs reported lower satisfaction with their HMOs' primary-care physicians than did the European-Americans., Conclusions: The HMO approach increases access to medical care but does not necessarily improve the quality of the patient-physician interpersonal relationship for older minority persons in the United States. This study demonstrates that in health systems that are going through a reform process it is possible to monitor equity in medical care, and that an accurate assessment needs to focus on vulnerable populations as well as to distinguish between different dimensions of access.

This research was conducted with the purpose of analyzing the programs and services available to the aged population in the municipalities of Puerto Rico during 1999 and 2000. The analysis was performed using an evaluation instrument which collected data of the programs and services directed exclusively to the aged population, such as: senior centers, foster homes, institutions, independent living, employed and/or volunteer people, geriatric services, adult education (literacy), recreation, discounts, corporations and/or associations that benefit the aged population, aging offices, support groups, social services, home meal services, and financial aid. Data was also collected from programs and services that benefit diverse aged populations in areas such as: health, housing, employment and social welfare. The sources for the collection of data were directories available to government and private agencies, telephone directories, telephone interviews, and personal visits. The municipalities were divided into two zones, the Northern zone, constituted by 40 municipalities and the Southern zone, constituted by 38 municipalities, for a total of 78 evaluated municipalities. In the Northern region, which accounted to approximately 295,938 aged persons, 18 types of programs or services were found to serve the aged population directly and 50 types were aged-related programs or services. In the Southern region, which accounted for approximately 169,798 aged persons, 13 types of programs or services served the aged exclusively and 43 were aged-related services. The following were among the principal programs or services available: senior centers, foster homes and/or institutions, employment programs, home care services and hospices, independent living, and agricultural extension services. Among the least available programs or services were private home meal services, literacy and retraining, arts and travel services, corporations or associations for the benefit of the aged, geriatric evaluation programs, home repair services, home-assistance programs, support and respite programs, adequate or specialized transportation services, diverse housing models, different types of senior centers, and programs for psychological or psychiatric assistance. In conclusion, the availability of the programs and services in this study and the evaluation of the services needed for a community of aged persons indicate the need for increasing and developing services considered essential in accordance to the population demands.

Objectives: This study examined whether the extra-individual factors of better access to care and supplementary health insurance coverage can prevent, delay, or reverse transitions from functional independence to disability over time., Methods: Six years of the Medicare Current Beneficiary Survey were pooled, yielding 40,793 transition periods for community residents aged 66 or older. Multinomial logit models of transitions among functional states were estimated, with functional improvement, functional decline, and mortality as outcomes., Results: Insurance coverage and better access to care increased survival chances and reduced the odds of transitions from independence to disability by roughly 30%. Access and supplementary insurance did not appear to affect transitions from less disabled to more disabled states or affect functional improvement., Discussion: The findings support the hypothesized role of extra-individual environmental factors in Verbrugge and Jette's conceptual scheme of the disablement process. Access to care is suggested to make the most difference in delaying or slowing down functional decline among functionally independent elderly persons. Transitions from less severe to more severe states of disability or to death appear to be influenced more by the natural course of chronic diseases, underlying health status, and medical instability.

This article analyzes the supply of residential care facilities for old people in Germany with the aim to discover regional disparities. The analysis is based on the directory of residential institutions for old people (Altenheimadressbuch). On a national level the supply of residential care facilities in this data base is comparable with the results of the national statistic (Heimplatzstatistik). The results show considerable disparities that only to a minor extent coincide with the regional distribution of older people. Although there is no definite coherence between the supply of residential care facilities and the family care potential, there is a significant negative correlation between both.

Due to the Contract of Maastricht, the members of the European Community are obliged to an open-market system with free competition. Essential for the system is the freedom of movement for goods, persons, services, and capital. The consequences of the realization of the contract for institutionalized help for the elderly are tested. Objects of the investigation are the "four basic freedoms", as well as the positions of the institutions for the elderly in the market. Changes are to be expected for the free trade in pharmaceuticals, medicine technology, goods for production and consumption, and capital. The structure of personnel, of junior staff, and of the clients of the institutions for the elderly will be affected. The open-door policy for commercial activities promotes the establishment of profitable nursing care, senior homes, etc. Nevertheless, the institutions for the elderly in the Federal Republic of Germany and in all other member states of the European Community are, because of their special situation, only in limited areas open to free competition. Conclusions are drawn from the expected changes for owners, management, and staff of the institutions for the elderly, as well as for their representatives in social and economic policy.

Objective: This article uses geographic information systems and their related tools to empirically measure and display the geographic accessibility of the aged population to hospital facilities within Illinois., Data Sources and Study Setting: Geographic accessibility of Illinois' aged population is measured from each of the state's 10,796 census block groups to the state's 214 hospital facilities. Block group demographic compositions and centroids are obtained from 1990 census files. Hospital coordinates are obtained by the authors., Study Design: Of five alternative measures of accessibility considered, empirical estimates are obtained for two: choice set and minimum distance. Access to both general hospitals and the subset having specialized geriatric facilities is measured with special attention to differences in accessibility between the aged within metropolitan statistical areas (MSAs) and those outside MSAs. Cumulative accessibility distributions and their summary statistics provide a basis of comparison among subgroups. DATA COLLECTION AND EXTRACTION: Geographic information systems (GIS) and their related tools are used as a means of efficiently capturing, organizing, storing, and retrieving the required data. Hospitals and census block groups are geocoded to specific locations in the database, and aspatial attributes are assigned to the hospitals and block groups. The GIS database is queried to produce shaded isarithm and point distribution maps that show the location of hospitals relative to surrounding aged populations., Conclusion: The vast majority of Illinois' aged population is within close proximity to hospital facilities. Eighty percent (1,147,504 persons) of the aged in Illinois are within 4.8 miles (7.7 km) of a hospital and 11.6 miles (18.7 km) of two hospitals. However, geographic accessibility differences between the aged living in MSAs and those living outside MSAs to hospitals offering geriatric services are substantial; but there is no evidence that the aged's geographical accessibility to hospitals is less favorable than that of the general population. Detailed accessibility measures permitted by geographic information system technology call into question the continued use of crude empirical accessibility measures.

Background: Conventional wisdom holds that the elderly living in rural areas suffer poor health and have limited access to health care compared with their urban peers. The relation between poor health and limited access, however, has yet to be adequately defined., Methods: We conducted a telephone survey of 1000 elderly persons living in four rural northeastern Ohio counties using a proportional random-digit dialing method., Results: Many rural elderly respondents appeared to suffer poor health and have limited access to medical care. However, a detailed analysis revealed that poor health and limited access were more perceptual than actual., Conclusions: Elderly persons living independently in rural northeast Ohio have much better health and access to care than suggested by the literature.

Availability, defined as a measure of the supply of services relative to the needs in the community, is critical to older people, particularly the socially isolated and frail elderly who are less mobile than most of the population. This research proposes an interaction potential model to examine variation in availability of services by considering the capacity and location of service providers and demand for these services. The model does not constrain older people to meet their demand within their towns' borders. Several measures of availability are calculated for nutrition services in an area agency on aging region of Connecticut, using different beta values to represent varying levels of mobility for the total older population; considerable variation exists, depending on mobility assumptions. Availability measures can be used as independent variables in analyses of variation in actual use of services; a strong correlation exists between use and availability in Connecticut.

We examined the availability of services for the developmentally disabled elderly and the concerns expressed by the service provider. We compared agencies which traditionally served individuals with developmental disabilities versus those serving the elderly populations. Although both types of agencies recognized the need for services, concern was raised as to who would provide them and how the two groups would blend.

Elderly people, particularly those over age 75, are subject to problems of access to needed health services, of the appropriateness of these services in relation to their needs, and of increasing infirmity, disability and dependency, with loss of their natural support systems. The proportion of health expenditures deployed to deal with the institutionalization and long-term requirements of elderly people is increasing in a national climate characterized by tightening constraints on public expenditures for health care under Medicare and Medicaid. The Robert Wood Johnson Foundation has accepted objectives and roles to find better ways to use what we already know to improve elderly people's access to health care, to improve their functional effectiveness, and to make their health care more affordable. The results of some of the programs it has supported represent innovative approaches and demonstrate ways in which we may accomplish these objectives.

Access to medical care of 492 black urban respondents 60 years of age and older was measured in a house-to-house survey in a large midwestern city. Of those in this study, 93 percent indicated that they had a regular source of medical care, and 88 percent reported a visit to a physician or clinic within the past year. These percentages are higher than those reported for the general population of elderly people in the United States. Physical limitation, general health, and mental health were related to access to medical care. Respondents who reported poorer physical and mental health were more likely to have a regular source of care and to have seen a physician in the past year.

In the United States elderly persons are the least likely of any age group to utilize dental services. With the increase in the elderly population and expansion of interest in their dental care, our understanding of the barriers to that care is particularly important. Studies have indicated that cost of treatment, fear of dentistry, functional independence and poor general health are of little significance in explaining the low utilization patterns of this age group. Perceived need seems to be the strongest predictor in deciding whether dental services are sought by an individual. Two programmes established by The University of Washington aimed to enhance the utilization of dental services by the elderly. One provided free screenings for over 65's on low incomes, coupled with a low cost dental care scheme. Although it was found that the convenient location of a dental clinic was a valuable incentive for the increased uptake of services, the difficulty remained one of patient perception of need. The second programme sought to overcome this latter problem by providing information on the importance of oral health to the independent elderly. This included a weekly class for small groups conducted by a health educator over a 6-week period together with a self-monitoring chart for each participant. It is anticipated that the heightened awareness aroused by this education programme will translate into perceived need and thus greater dental service utilization by the participants.