Table 2.
Key characteristics and main findings of studies included in the final synthesis (n = 10).
| First Author | Country | Assessment of Health Care Utilization | Waves and Duration | Sample Description | Sample Size; Age; Females in Total Sample |
Results: Predisposing Factors |
Results: Enabling Factors |
Results: Need Factors |
Results: Psychosocial Factors |
|---|---|---|---|---|---|---|---|---|---|
| Al Snih (2006) [12] | United States | Number of physician visits and hospitalizations during the last twelve months | Two waves from 1993 to 1996 | Hispanic Established Population from the Epidemiological Study of the Elderly |
n = 1987 M: 72.6 SD: 6.1 ≥65 59.5% |
According to multiple regression analysis, age (ß = 0.04, p < 0.05) and being female (ß = 0.97, p < 0.0001) were related to physician visits. Marital status, education and nativity remained insignificant. | Receiving Medicare only (ß = 0.89, p < 0.05) or Medicare and Medicaid (ß = 1.33, p < 0.001) was significantly associated with physician visits. Number of children, financial strain and having a usual source of care were not significant predictors. | Some medical conditions, such as diabetes, were significantly correlated with both physician visits (ß = 1.10, p < 0.0001) and number of hospitalizations (ß = 0.94, p < 0.001), as well as the number of medications (physician: ß = 0.65, p < 0.0001, hospital: ß = 0.33, p < 0.0001). Having a limitation in the activities of daily life was related to hospitalizations (ß = 2.74, p < 0.0001). Cognitive impairment and depressive symptoms remained insignificant. | Not applicable |
| Clay (2011) [13] | United States | Time since the last nonsurgical overnight hospital admission | Nine waves from 1999 to 2005 | Community-dwelling adults aged 65 years and older |
n = 942 M: 75.3 SD: 6.7 65–106 50.7% |
Univariate Cox proportional hazard ratios show that race (African American vs. Caucasian: OR: 0.74, 95% CI: 0.59–0.93) and age (OR: 1.03, 95% CI: 1.01–1.05) were significantly related to the outcome variable. Gender, marital status, education and residence were not. | Social support (OR: 1.04, 95% CI: 1.00–1.09) and perceived discrimination (OR: 0.88, 95% CI: 0.77–0.99) were significantly correlated with the time gap. Mental state and private insurance were not. | Physical health (OR: 0.97, 95% CI: 0.96–0.98), limitations among activities of daily life (OR: 1.19, 95% CI: 1.10–1.29) and physical performance (OR: 0.91, 95% CI: 0.89–0.95) were significantly associated with the time since the last nonsurgical overnight hospital admission.Depressive symptoms (OR: 1.09, 95% CI: 1.04–1.14), anxiety (OR: 0.96, 95% CI: 0.93–0.98) and mental health (OR: 0.98, 95% CI: 0.97–0.99) were significantly correlated with the time gap. | Not applicable |
| Gabet (2019) [14] | Canada | Having used an emergency department during the last twelve months | Two waves from 2017 to 2018 | Homeless people from Montreal |
n = 270 18–39: 5.2% 40–49: 38.2% ≥50: 56.6% 42.2% |
Not applicable | According to multiple logistic regression, specialized ambulatory service use (OR: 1.74, 95% CI: 1.00–3.01) and stigma (OR: 0.70, 95% CI: 0.56–0.89) were significantly associated with emergency department use. | Substance use disorders (OR: 1.70, 95% CI: 1.01–2.87) and perceived physical health (OR: 0.75, 95% CI: 0.58–0.98) were significantly correlated with emergency department utilization. | Not applicable |
| Hadwiger (2019) [15] | Germany | Six or more physician consultations during the last three months | Seven waves from 2002 to 2014 | German Socio-Economic-Panel |
n = 28,574 M: 53.6 SD: 16.7 17–102 55.6% |
The regression results show that being a frequent attender was significantly associated with lower age (OR: 0.95, 95% CI: 0.94–0.96), having a partner (OR: 1.22, 95% CI: 1.07–1.41) and non-working (OR: 1.35, 95% CI: 1.22–1.50). | Logarithmized equivalent income and having a private health insurance remained insignificant. | Frequent attenders were likely to have a lower physical health (reversed OR: 1.11, 95% CI: 1.11–1.12) and mental health composite score (reversed OR: 1.05, 95% CI: 1.05–1.05). | Not applicable |
| Hajek (2017a) [19] | Germany | Number of physician visits during the last three months | Two waves from 2005 to 2010 | German Socio-Economic-Panel |
n = 11,310 M: 51.8 SD: 16.4 17–100 55.4% |
According to Poisson regression, age, marital status, education and employment status were not significantly related to the number of physician visits. | The logarithmized equivalent income remained insignificant. | The number of physician visits was positively associated with decreased self-rated health (ß = 0.40, p < 0.001) and being severely disabled (ß = 0.18, p < 0.001). | An external locus of control was positively correlated with higher levels of physician visits (ß = 0.00, p < 0.05). Internal locus of control was not significant. |
| Hajek (2017b) [16] | Germany | Number of GP visits, specialist visits and having had a hospital stay during the last twelve months | Two waves from 2008 to 2011 | German Ageing Survey |
n = 1372 M: 64.3 SD: 11.2 40–95 52.2% |
Regarding fixed-effects regression, being retired (ß = 0.17, p < 0.05) or not employed (ß = 0.18, p < 0.05) was related to more physician visits. A higher age was associated with a having a hospital stay (OR: 0.91, 95% CI: 0.84–0.98), as well as not being employed (OR: 2.37, 95% CI: 1.01–5.56). Marital status remained insignificant. | Logarithmized equivalent income and self-rated accessibility of doctors were not significant predictors. | Self-rated health was associated with all GP visits (ß = 0.11, p < 0.001), specialist visits (ß = 0.20, p < 0.001) and a hospital stay (OR: 1.77, OR: 1.34–2.32). The number of chronic diseases was related to more GP visits (ß = 0.04, p < 0.01) and specialist visits (ß = 0.06, p < 0.01). Overweight (ß = −0.16, p < 0.05) and obesity (ß = 0.24, p < 0.05) were related to a lower number of specialist visits. Underweight, currently smoking and physical activity remained insignificant. | Not applicable |
| Hajek (2018) [18] | Germany | Number of GP visits and specialist visits during the last three months | Two waves during a ten-month period | AgeQualiDe |
n = 861 M: 89.0 SD: 2.9 85–100 69.0% |
Poisson fixed-effects regression did not detect age or marital status as significant correlates. | Social network was not significantly correlated with GP visits. | Increasing cognitive impairment (ß = 0.17, p < 0.05) and increasing depressive symptoms (ß = 0.04, p < 0.1) were significantly related to GP visits, while functional impairment and the number of chronic conditions were not. | Not applicable |
| Hajek (2020) [17] | Germany | Having had a hospital visit during the last six months | Two waves during a ten-month period | AgeQualiDe |
n = 861 M: 89.0 SD: 2.9 85–100 69.0% |
According to random-effects regression, age, sex and marital status were not associated with hospitalization. | A higher social network (OR: 1.15, 95% CI: 1.06–1.25) was associated with a higher likelihood of hospitalization. Education remained insignificant. | A higher number of chronic conditions (OR: 1.06, 95% CI: 1.02–1.10) and increased depressive symptoms (OR: 1.11, 95% CI: 1.05–1.18) were significantly related to hospitalization. Moreover, the interaction between social network and functioning (OR: 0.98, 95% CI: 0.97–0.99) was associated with hospitalization.Cognitive impairment and functioning were not. |
Not applicable |
| Kim (2016) [20] | South Korea | Any outpatient health services utilization during the last twelve months | Two waves from 2010 to 2012 | Korea Health Panel |
n = 11,362 M: 51.1 SD: 17.8 57.1% |
Respecting logistic regression, outpatient health services utilization was related to being female (OR: 3.12, p < 0.1), age (OR: 0.95, p < 0.05) and being married (OR: 8.3, p < 0.05). | Education, household income, economic activity and insurance were not related to outpatient health services use. | Having a chronic disease was correlated with service utilization (OR: 2.81, p < 0.05), but not with disability. | Not applicable |
| Stein (2000) [21] | United States | Having had a hospital visit or an outpatient visit during the last twelve months | Two waves from 1990 to 1991 | Homeless people living in Los Angeles County |
n = 363 M: 38.1 18–70 30.0% |
According to the pathway model, hospitalizations were significantly related to education (ß = −0.10, p < 0.05), being African American (ß = 0.09, p < 0.05) and drug use (ß = 0.13, p < 0.05). Ambulatory office visits were associated with alcohol problems (ß = −0.10, p < 0.05) and drug use (ß = 0.18, p < 0.01). Poor housing remained insignificant. | Having a place to go for health care was related to increased levels of ambulatory office visits (ß = 0.32, p < 0.001) and community support (ß = 0.10, p < 0.05). Hospitalizations were related to community support (ß = 0.10, p < 0.05) and barriers (ß = 0.17, p < 0.001). Health insurance and social support were not significant predictors. | Having a poor health was related both to ambulatory office visits (ß = 0.09, p < 0.05) and hospitalizations (ß = 0.12, p < 0.05). Psychotics and depression remained insignificant. |
Not applicable |