Geographic Distribution of Aging and Health-Related Resources in Urban Neighborhoods: Implications for Health Care Delivery to Community-Dwelling Older Adults with Physical and/or Cognitive Impairment
Kim, Min Hee
2019
Abstract
The number of older adults using home and community-based services funded by federal and state governments has increased over the last two decades. This has occurred largely due to a growth in beneficiary preferences for home and community-based services (HCBS) over institution-based care, and U.S. Supreme Court's 1999 landmark decision in Olmstead v. L.C. (Olmstead), which found unjustified segregation of people with disabilities in institutions is a form of unlawful discrimination under the Americans with Disabilities Act (ADA). Previous research on HCBS users, or the community-dwelling long-term care population, have tended to focus on their service utilization and its consequences, rather than whether and how social and built environmental conditions influence their health and health care outcomes. Limited research on this topic stems in part from an underappreciation of the heterogeneity across places, difficulty of gaining access to data on both social and built environmental contexts and residents, and methodological challenges such as spatial correlation in the outcome variable of interest or attrition bias. My dissertation aims to address these gaps, using the case of the U.S. state of Michigan. First, I document the geographic distribution of aging and health-related resources, with a specific focus on social service organizations for older adults and persons with disability. Second, I examine the association between living in a neighborhood with dense social service organizations and two of the most prominent indicators of independent living for community-dwelling older adults: cognitive health and hospitalization. I leverage a US census and administrative data to provide new evidence on the association between aging and health-related resources and health and health care outcomes among urban community-dwelling older adults, who are using home and community-based services and are physically and/or cognitively impaired. Analyses offer several key findings. First, net of key predictors of formal care demands, socio-economically disadvantaged neighborhoods tend to have a high density of social service organizations. This counters previous findings suggesting that living in socioeconomically disadvantaged neighborhoods was associated with a lack of formal resources supporting aging in place. Second, residing in an urban area with more restaurants, recreation centers, or social services for older adults and persons with disability, was associated with slower cognitive decline among older adults who were initially cognitively intact. This protective effect was not found in already cognitively impaired older adults, and this study is one of few that has uncovered such variation by initial cognitive status group. Finally, dense social service organizations in a neighborhood were associated with better health care management outcomes in this community-dwelling long-term care sample. Results from multinomial logistic regression models predicting hospitalization trajectories over a 15-month period show that living in a neighborhood with a higher number of social service organizations lowered the expected risk of being in a group whose hospitalization risk was consistently high over time, as compared to being in a group whose hospitalization risk significantly decreased over the same period. This study highlights the potential role social service infrastructure plays in post-hospitalization care management. My dissertation provides new evidence on neighborhood resources that could accommodate the needs of a growing population of community-dwelling older adults in the United States public long-term care system.Subjects
Aging in Place Health Service Utilization Cognitive Decline Community-dwelling Long Term Care Population
Types
Thesis
Metadata
Show full item recordCollections
Remediation of Harmful Language
The University of Michigan Library aims to describe library materials in a way that respects the people and communities who create, use, and are represented in our collections. Report harmful or offensive language in catalog records, finding aids, or elsewhere in our collections anonymously through our metadata feedback form. More information at Remediation of Harmful Language.
Accessibility
If you are unable to use this file in its current format, please select the Contact Us link and we can modify it to make it more accessible to you.