The Relationship Between Health Care Utilization and Social Engagement Among Aging Populations in Urban and Non-urban Communities

For aging populations age 65 years and older, lack of social engagement, or social isolation, is a public health issue that can have serious health implications. The ability to engage socially can decrease with aging populations due to many factors, such as health status and mobility. As social engagement decreases, the potential for serious diseases, such as dementia, increases. Limited social connections and engagement can be linked to healthcare utilization through increased rates of re-hospitalization as well as potentially decreased ability to and increased need to regularly access physician services. The aim of this research is to expand on the existing body of work in the area of care access and social isolation among aging populations, to examine the relationship between physician office visits and social activity and what differences may exist between those who live in urban and non-urban settings. A cross-sectional analysis was conducted using data from the Fall 2019 Medicare Current Beneficiary Survey (MCBS). The number of physician office visits participants have annually was the variable of primary interest. Physician visits were categorized dichotomously into moderate or no use and high use. Individuals with 11 or more visits were considered to be high utilizers within this data set and those with 10 visits or less as low. The key independent variables in this analysis are social activities and geography of the respondent. Social activities are defined has having social limitations, from respondents indicating limited activities most or all of the time in the past month, or low limitations, indication of some or no limitation of activities within the past month. Metropolitan Statistical Area (MSA) was used to categorize respondents as residing in an urban or rural community. The study population included 11,670 individuals over the age of 65. Approximately 15% of respondents were categorized as high health service utilizers and 85% were low or average. Only 7% of respondents were noted as having high levels of restrictions on social activities. The majority (81%) of respondents were classified as residing in a metro area compared to 19% residing in non-metro areas. High restrictions on social activities were associated with higher numbers of physician visits Approximately 10.6% of individuals with high social restrictions were also categorized as having higher numbers of physician visits compared to 6.6% among those with low social restrictions (OR=1.667; 95%CI: 1.47-1.89). No associations between geography and physician visits were noted. This study found a relationship between restricted social engagement and higher utilization of physician services. These findings were not consistent when adjusting for additional covariates of interest. Because poor general health can play a large part in both the ability to engage socially and high utilization of physician visits in aging populations, these findings underscore the importance of enhancing community services and opportunities for social engagement as health policy tools for improving health and quality of life for aging individuals