Double Barriers to Health Care Services for Rural Older Adults with Functional Disabilities

Background and Purpose

            Rural older adults with functional disabilities deal with various difficulties in using health care services. Functional disabilities limit older adults from access to health care services. Rural areas are supposed to be lacking in health services and health care professionals, which results in a long distance to access to health care facilities. Therefore, it can be expected that rural older adults with functional disabilities experience double barriers in using health care services. In this study, relationships among functional disabilities, geographical characteristics, and health care use was explored. In addition, the interaction effects of functional disabilities and rural area on health care use was tested. 

Methods

            This study used the data from the National Survey of the Actual Living Condition of the Elderly in Korea (2014). A total of 9,768 older adults aged 65 and over were included in the present study.

Influential factors in access to health care services were categorized into personal characteristics (age, sex, education, working status, marriage status, living status), enabling factors (household income, number of family, number of friends, frequency of family visit, frequency of friend visit, distance to health care facility, distance to public transportation, rural and urban), and need factors (self-rated health, number of chronic diseases, functional disability) based on a health behavioral model introduced by Andersen (1995). The dependent variable was measured by use of health care service (hospital, clinic, community health center) in the last month. Logistic regression was conducted to identify the influential variables using health care services and test the interaction effect of functional disabilities.

Results

The results suggested that enabling and need factors were significantly associated with use of health care services. Older adults who have more friend visits have greater odds in using health care services than those who have friends visit rarely (p< .01). Among need factors, health status and number of chronic diseases were significantly associated with the use of health care services (p < .001). Older adults with difficulties in IADL only were more likely to use health care services than those who had no difficulties (OR = 1.34, p<.05). Rural older adults have 1.24 times greater odds of health care service use compared with their urban counterparts (p<.01). However, rural older adults with difficulties in ADL and IADL (interaction effect) were significantly less likely to use health care services compared to their counterparts (OR = .51, p<.05). 

Conclusions and Implications

            Without considering interaction effects between functional disability and rural area, results might be misinterpreted as better accessibility of rural older adults to health care services. Once functional disability and rural area were considered, rural older adults with ADL and IADL difficulties were less likely to use health care services than urban counterparts. Rural older adults are more likely to suffer from functional status and accessibility to health care services. Accessibility to health care is essential to improving health status. In particular, accessibility to health care for older adults is a key factor in reducing health disparities (Carter-Pokras, & Baquet, 2002).