“System” of social supports and services and the relationship with hospital utilization

Objective: Social support exists in many forms from many sources and theoretically has been modeled as the social-environment into levels of influence including informal, formal, community, and societal support. This study explored the relationship of each level and all levels collectively with hospital utilization for non-working older adults with chronic conditions.

Methods: Hospital utilization was assessed for 2,285 non-working adults aged 60+ (mean 73.2 years) who reported at least one chronic condition or condition requiring medical treatment on a regular basis in the 2006 Southeastern Pennsylvania Household Health Survey. After adjusting for person-level factors, logistic regression modeling was used to assess support including informal (marital status, household composition, assistance with ADLs, social contact), formal (home-based or community-level care/services), community (social capital), and societal (regular source of care, health insurance, government aid) and the association with hospital utilization in the preceding year.

Results: Person-level factors (older age, race other than Caucasian, poor-fair perception of health, signs of major depression, basic or instrumental ADL limitations, and use of an assistive device) were strongly associated with hospital utilization. Despite several supports with independent associations or significant within a level, few characteristics of the social environment remained significant in the full model. Those who received formal care or meal services or did not have a regular source of care were more likely to be hospitalized (p<0.05).

Conclusions: Findings highlight the relationship of specific social supports and services with hospital utilization but the relationship of these factors as a dynamic interacting system needs further investigation.