Access to Care

Rural elderly with dementia are hospitalized more often for conditions that primary care visits might have caught

Seniors who suffer from dementia and live in rural areas are more likely than city dwellers to end up hospitalized for conditions that could have been prevented if better outpatient care were available near their pastoral surroundings, a new study finds. Researchers linked survey data from the 1998 National Longitudinal Caregiver Survey with Medicare and Veterans Affairs claims data from 1,186 U.S. veterans who suffer from dementia. They found that 13 percent of veterans had at least one "ambulatory-care-sensitive hospitalization." This term refers to a condition in which timely primary care in an outpatient setting would have reduced the need for a hospitalization.

Veterans with dementia who lived in rural areas were at higher risk for an ambulatory-care-sensitive hospitalization than veterans in metropolitan areas (22.6 percent vs. 12.8 percent). When ample community health clinics and primary care providers were available, rural residents' chance of having ambulatory-care-sensitive hospitalizations decreased.

Although public policy initiatives often focus on helping people with dementia age in place for as long as possible, those policies present difficulties for rural residents if they have limited access to primary, specialty, and home health services to help manage their condition. This study's findings highlight the need to bring appropriate care to medically underserved populations to prevent costly, unnecessary hospitalizations by providing better primary care services closer to home. This study was funded in part by the Agency for Healthcare Research and Quality (T32 HS00032).

See "Rural-urban differences in preventable hospitalizations among community-dwelling veterans with dementia," by Joshua M. Thorpe, Ph.D., Courtney H. Van Houtven, Ph.D., Betsy L. Sleath, Ph.D., and Carolyn T. Thorpe, Ph.D., in the March 2010 The Journal of Rural Health 26(2), pp. 146-155.

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