Pneumonia and influenza outcomes in elderly with dementia: The effect of proximity to healthcare facilities

Inadequate or inaccessible health care services increase the vulnerability of elderly patients and elevate the risk of complications associated with viral infections. Elderly with dementia can be at high risk for influenza induced pneumonia, due to communication difficulties that may prevent timely diagnoses. We used geographic mapping technology to investigate the effect of geographic proximity from place of residence to healthcare facilities on P&I outcomes in elderly with dementia. We abstracted 43,812 hospitalization records with an indication of P&I (ICD 9 codes: 480-487) and dementia (ICD 9 codes: 290-294, 331, 797) from the Centers for Medicare and Medicaid Services (CMS) database between 1998-2002 for New England (NE) residents and estimated the mean length of hospital stay by county of the residence. We also abstracted geographic positioning data for Medicare and Medicaid-certified nursing homes. We quantified absolute and average proximity to health care facilities by measuring geo-spatial distance between nursing homes and neighboring hospitals using ESRI's ArcGIS software. Our preliminary results indicate that in Massachusetts, the average distance varied with regards to county rurality. Rural Berkshire and Franklin counties have the highest mileage to neighboring hospitals (10.5-20.7 miles), whereas urban Suffolk County has the lowest average mileage (0.7-2.3 miles). Overall, the mean length of stay was greater for rural counties (ranging from 7.0-8.65 days) than for urban counties (6.1-6.74 days), suggesting rural elderly may have experienced delayed access to health care. Urban versus rural proximity by county and zip code will be further explored throughout the New England region.