Exploring the relationship between access to social care and healthcare utilisation by older adults

Abstract

Poor access to social care for older adults is increasingly cited as a key factor driving healthcare demand, yet these claims are often made without evidence. This thesis explored the relationship between access to social care and healthcare utilisation by older adults. A lack of evidence about inequitable access to social care warranted a focus on the role of older adults’ financial resources in this relationship. Two systematic reviews examined evidence about the relationship between access to social care and healthcare utilisation by older adults. An analysis of cohort data from England (Newcastle 85+) explored the role of financial resources in this relationship. A critical scoping review of applying measures of socioeconomic status in older populations supplemented this work. Studies were carried out between 2016 and 2019. Findings confirmed that greater access to social care was associated with lower healthcare utilisation. The findings from the main analysis also hinted that older adults’ financial resources may, to a small degree, moderate this relationship. That is, healthcare use was lower for those with the most financial resources using community social care (coefficient= -0.12, CI:-1.50, 1.26) or living in a care home (coefficient= -1.08, CI:-3.69, 1.52), compared to non-social care users, adjusting for covariates. However, there was much statistical uncertainty in these estimates. The relationship between access to social care and healthcare utilisation may be best understood as a reflection of the mechanisms of care (prevention and substitution), and the conditions of access imposed on each sector (e.g. universalism). These interpretations are located within a theoretical framework that builds upon Andersen’s (1995) model of access to care. The challenges of measuring financial resources in older populations may partly account for why it appeared to exert only a modest influence on this relationship. Further research is needed to understand inequity at the interface between access to social care and healthcare utilisation by older adults.