Multiple sclerosis, aging and support service utilization

Journal of Rehabilitation,  Oct-Dec, 2007  by Michelle Putnam,  Fengyan Tang

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These fears and concerns by persons aging with MS are supported by research. Minden (2004) profiled a national sample of individuals with MS using the Sonya Slifka Longitudinal Multiple Sclerosis Study and found that individuals with MS sixty-five and older were more likely to be widowed, live alone, have lower average family incomes, have a progressive form of MS, have higher levels of functional disability, and receive more home services. Klewer, Pohlau, Nippert, Haas & Kugler, 2001) found similar population characteristics regarding increased likelihood to live alone and experience functional limitation, decreased mobility, and increased need for assistance. Additionally, the authors identified limitations in social contacts, increases in secondary conditions such as spasticity and incontinence, and substantial prevalence of clinical depression combined with suicidal thoughts. These studies began uncovering the unique characteristics of the MS aging process. In addition, they provided empirical support to Stem's (2005) theory that the interactions between MS and aging increase the complexity if MS and the individual's life. To date, there are no specific theories or models of independent living and long-term care service utilization. Commonly, theoretically grounded service utilization research focusing on people with disabilities (older adults included) employs Aday & Andersen's (1974) behavioral model which identifies predisposing, need, and enabling individual characteristics as they relate to health care access and outcomes. A revision of this model does specifically discuss access of "safety net populations" to health care services; persons with disabilities are included in the safety category under "vulnerable populations" (Davidson, Andersen, Wyn & Brown, 2004, p.23). However, the biases of the original and revised models towards acute health care services make them less relevant for understanding independent living and long-term care service use which often include non-medical supports such as chore services.

Barriers preventing access to health and support services are known. They include cost, coverage, and availability of medical services (Hagglund, Clark, Hilton & Hewett, 2005; Hagglund, Clark, Conforti & Shigaki, 1999), patient access to health care specialists and rehabilitation services (Beatty et al., 2003), and transportation to, and physical accessibility of medical services (O'Day, Palsbo, Dhont, & Sheer, 2002). Satisfaction with health care services is often a barrier to continued use of services particularly among individuals with greater severity of disability (Iezzoni, Davis, Soukup & O'Day, 2002). One noted area of dissatisfaction among persons with MS (Somerset, Campbell, Sharp & Peters, 2001) and people with disabilities in general (Kroll, Beatty, & Bingham, 2003) is the lack of disability-specific practice knowledge among health care providers. This perception is validated by physicians who report low levels of training in chronic illness care (Darer, Hwang, Hoangmai, Bass & Anderson, 2004).