Factors Impacting Long-Term Proactive And Reactive Healthcare Utilization In Cognitively Healthy Older Adults

Abstract Objective Ongoing preventive healthcare is critical to support physical and cognitive health with aging. Several demographic factors have been identified as impacting older adult’s healthcare utilization (HCU), and cognitive training (CT) may prime for proactive (regular doctor’s visits) versus reactive (emergency department [ED] visits) HCU. This study sought to explore older adults’ HCU patterns, including predictors of CT and demographic factors, in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) data set. Method The full ACTIVE study included 2802 community-dwelling adults age 65+ without cognitive impairment. Available data were comprised of Nf909 across six US sites at baseline and five-year follow up. Multiple linear regression was used to predict five-year doctor’s visits and ED visits from age, race, gender, education, MMSE score, community type, and cognitive training group. Results The model significantly predicted doctor’s visits but accounted for a low amount of the total variance [R2 = 0.025, F(7,885) = 3.21, p = 0.002]. Rural setting (β = 0.090, p = 0.012), female gender (β = 0.086, p = 0.012), higher MMSE (β = 0.079, p = 0.031), and higher education (β = 0.076, p = 0.041) predicted more doctor’s visits. Similarly, the overall model accounted for limited variance in ED visits [R2 = 0.016, F(7,888) = 3.21, p = 0.044], and older age was the only significant predictor (β = 0.089, p = 0.009). Conclusions CT did not significantly predict HCU at five-year follow up. Those living in a rural setting, of female gender, and with higher MMSE score and education level had higher proactive HCU at five years, whereas only older age predicted higher ED visits. Additional exploration of factors impacting long-term HCU within a diverse sample of healthy older adults is needed.