Contact with Health and Social Services, Hospital Admission, Contact with Medical Specialists

Contact with Health and Social Services, Hospital Admission, Contact with Medical Specialists

LASA filenames:
LASA044
LASA045 / LASA245
LASA603 / LASA703

Contact: Marjolein Broese van Groenou

Background
The health care system in the Netherlands covers a broad range of services, which can be differentiated in health services for acute care (e.g. GP and hospital), community social services (e.g. meals on wheels) and services for long term care (e.g. residential care). Many older adults will use one or more of the acute care services in later life. Access to these health care services is guaranteed by health care insurance, which is obligatory in the Netherlands. Community social services are designed for people who need help with instrumental activities (e.g. chores around the house), social needs (e.g. social work) or with mental needs (e.g. due to substance abuse). These services can be provided in the home of the older adult or in a location in the community. The access to community social services is defined by local government since the Social Support Act (Wmo) was installed in 2007. Access to community mental health is organized under the Mental Health Act (GGZ). Finally, long term care services are available for the very old and the most impaired. Temporary or permanent residential care are arranged under the National Act of Exceptional Medical Expenses (AWBZ). Since 2015 the AWBZ has been split into the Chronic Care Act (Wlz) for residential care, and the Care Insurance Act (Zvw) for home care. The Social Support Act has extended the coverage since 2015 and now includes household help, transportation, mobility devices and guidance. Since 1992 the laws and systems for acute and long term care have changed considerably, which is reflected in the use of these services over time. According to the Behavioral Model of service use (Andersen & Newman 2005), both societal and individual factors determine the use of health and social services. Societal factors are reflected in the allocation and accessibility of services and care. Individual factors entail the need, disposition and factors enabling the use of care. This model has been used in a large number of papers and reports to explain variability in the use of care among older adults and over time. See the section on previous use in LASA and the references.

Measurement instruments in LASA

Use of health and social services
Respondents are provided with two lists of health and social services and indicate whether they had contact with one of these persons or services in the past six months. The first list was presented to all respondents and included the following variables of social services at each wave, see Table 1 (pdf).

The second list included different services for mental health and residential care. Until wave H, this list was given to respondents living in a residential care home or in a nursing home, in later waves this was given to all respondents. Respondents were asked if they had had contact with the following services over the past six months, see Table 2 (pdf).

In addition, telephone interviews were done if respondents could or would not complete the regular main interview. These were done at C, D, E, F, G, H, I, J and K, and only included a question regarding contact with the family physician.

At LASA-I, -J and -K, no more questions regarding indication for and use of residential care were asked, as another (new) section of the medical interview was dedicated to residential care  (Section Needs assessment).

Questionnaires
LASAB044 / LASAC044 / LASAD044 / LASAE044 / LAS2B044 / LASAF044 / LASAG044 / LASAH044 / LAS3B044 / LASMB044 / LASAI044 / LASAJ044 / LASAK044
(main interview, in Dutch)

Variable information
LASAB044 / LASAC044 / LASAD044 / LASAE044 / LAS2B044 / LASAF044 / LASAG044 / LASAH044 / LAS3B044 / LASMB044 / LASAI044 / LASAJ044 / LASAK044
(pdf)

Use of medical services (hospitalization, contact with specialists)
During the main face-to-face interview, respondents were asked if they had contact for themselves with medical services over the past 6 months. Table 3 (pdf) demonstrates what medical services were included in the interview at each wave.

Questionnaires
LASAB045 / LASAC045 / LASAD045 / LASAE045 / LAS2B045 / LASAF045 / LASAG045 / LASAH045 / LAS3B045 / LASMB045 / LASAI045 / LASAJ045 / LASAK045 (main interview, in Dutch)

LASAC603 / LASAD603 / LASAE603 / LASAF603 / LASAG603 / LASAH603 / LASAI603 / LASAJ603 / LASAK603
(telephone interview with PROXY, in Dutch)
LASAC703 / LASAD703 / LASAE703 / LASAF703 / LASAG703 / LASAH703 / LASAI703 / LASAJ703 / LASAK703
(telephone interview with RESP, in Dutch)

Variable information
LASAB045 / LASAC045 / LASAD045 / LASAE045 / LAS2B045 / LASAF045 / LASAG045 / LASAH045 / LAS3B045 / LASMB045 / LASAI045 / LASAJ045 / LASAK045 ;
LASAB245 / LASAC245 / LASAD245 / LASAE245 / LAS2B245 / LASAF245 / LASAG245 / LASAH245 / LAS3B245 / LASMB245 / LASAI245 / LASAJ245 / LASAK245 (MB and J not available yet)
(specification of medical specialist over the last 6 months)
(pdf);
LASAC603 / LASAD603 / LASAE603 / LASAF603 / LASAG603 / LASAH603 / LASAI603 / LASAJ603 / LASAK603 (K not available yet)
(pdf);
LASAC703 / LASAD703 / LASAE703 / LASAF703 / LASAG703 / LASAH703 / LASAI703 / LASAJ703 / LASAK703 (K not available yet)
(pdf)

Availability of information per wave ¹

¹ More information about the LASA data collection waves is available here.

* 2B=baseline second cohort;
3B=baseline third cohort;
MB=migrants: baseline first cohort

Ma=data collected in main interview;
Tr=data collected in telephone interview with respondent;
Tp=data collected in telephone interview with proxy

Previous use in LASA
Many papers are concerned with period/cohort comparisons of the use of care, because this reflects in potential developments in access and allocation of health care over time. Other papers focus on specific groups, and a third line of papers uses a longitudinal design to study changes in health care and service use over time. There are about four lines of studies to distinguish:

1. Differences by socio-economic status
2. Differences relating to health and mental functioning
3. Transitions in use of care, including residential care
4. Historic developments in use of care

References

Publications in peer-reviewed journals

1. Beekman, A.T.F. (2000). Depression and medical illness in later life. Primary Care Companion. Journal of Clinical Psychiatry, 2,Suppl 5, 9-16.
2. Beekman, A.T.F., Penninx, B.W.J.H., Deeg, D.J.H., De Beurs, E., Geerlings, S.W., Van Tilburg, W. (2002). The impact of depression on the well-being, disability and use of services in older adults: A longitudinal perspective. Acta Psychiatrica Scandinavica, 105, 20-27. (2002)
3. Comijs, H.C., Dik, M.G., Aartsen, M.J., Deeg, D.J.H., Jonker, C. (2005). The impact of change in cognitive functioning and cognitive decline on disability, well-being, and the use of healthcare services in older persons: results of the Longitudinal Aging Study Amsterdam. Dementia and Geriatric Cognitive Disorders, 19, 316-323.
4. De Beurs, E., Beekman, A.T.F., Van Balkom, A.J.L.M., Deeg, D.J.H., Van Dyck, R., Van Tilburg, W. (1999). Consequences of anxiety in older persons: its effect on disability, well-being and use of health services. Psychological Medicine, 29, 583-593.
5. Deeg, D.J.H. & Broese van Groenou, M.I. (2007). Zorggebruik door ouderen na opname in het ziekenhuis: Ontwikkelingen in 1992-2002. Tijdschrift voor Gezondheidswetenschappen, 85, 3, 174-182.
6. Galenkamp H, Deeg DJH, de Jongh RT, et al. (2016). Trend study on the association between hospital admissions and the health of Dutch older adults (1995-2009). BMJ Open, 6.
7. Portrait, F.R.M., Lindeboom, M., Deeg, D.J.H. (2000). The use of long-term care services by the Dutch elderly. Health Economics, 9, 513-531.
8. Pot, A.M., Portrait, F.R.M., Visser, G., Puts, M.T.E., Broese van Groenou, M.I., Deeg, D.J.H. (2009). Utilization of acute and long-term care in the last year of life: comparison with survivors in a population-based study. BMC Health Services Research, 9, 139.
9. Prina, A.M., Deeg, D.J.H., Brayne, C., Beekman, A.T.F., Huisman, M. (2012). The association between depressive symptoms and non-psychiatric hospitalisation in older adults. Journal PLoS ONE, 7, 4, e34821.
10. Schuster, N.A., de Breij, S., Schaap, L.A. et al. Older adults report cancellation or avoidance of medical care during the COVID-19 pandemic: results from the Longitudinal Aging Study Amsterdam. Eur Geriatr Med 12, 1075–1083 (2021). https://doi.org/10.1007/s41999-021-00514-3
11. Van Vliet, M.J.G., Huisman, M., Deeg, D.J.H. (2017). Decreasing Hospital Length of Stay: Effects on Daily functioning in Older Adults. Journal of the American Geriatrics Society, 65, 6, 1214-1221.
12. Van Zelst, W.H., De Beurs, E., Beekman, A.T.F., Van Dyck, R., Deeg, D.J.H. (2006). Well-being, physical functioning, and use of health services in the elderly with PTSD and subthreshold PTSD. International Journal of Geriatric Psychiatry, 21, 180-188.
13. Wouterse, B., Huisman, M., Meijboom, B.R., Deeg, D.J.H., Polder, J.J. (2015). The effect of trends in health and longevity on health services use by older adults. BMC Health Services Research, 15, 1, 574.

Reports for the Netherlands Institute for Social Research

1. Campen, C. van, Broese van Groenou, M.I., Deeg, D.J.H. & Iedema, J. (2013). Met zorg ouder worden. Zorgtrajecten van ouderen in tien jaar [Ageing with care. Care trajectories over a decade]. Den Haag: SCP.
2. Campen, C. van, Iedeman, J., Broese van Groenou, M.I. & Deeg, D.J.H. (2017). Langer zelfstandig. Ouder worden met hulpbronnen, ondersteuning en zorg. Den Haag: SCP.

Reports for the Ministry of Health, Welfare and Sport  by  LASA VU/VUmc (in Dutch)

1. Comijs, H.C. (2013). Somatische en psychische problematiek bij ouderen; samenhang en zorggebruik (LASA-rapport 2012).
2. Plaisier, I., Broese van Groenou, M.I. & Deeg, D.J.H. (2012). Kwetsbare ouderen: zorg of geen zorg? (LASA-rapport 2011).
3. Plaisier, I., van Tilburg, T.G. & Deeg, D.J.H. (2011). Mogelijkheden voor preventie van AWBZ-gebruik: netwerken van zelfstandig wonende ouderen. [Opportunities for prevention of publicly paid care: social networks of independently living older adults]. LASA-rapport 2010.
4. Thomese, F. & Tolkacheva, N. (2013). Verhuizing naar (semi)residentiële woonvormen. [Moving into (semi)residential care]. LASA-rapport 2013.
5. Van Vliet, M.G., Broese van Groenou, M.I. & Deeg, D.J.H. (2010). Extramurale zorgpakketten. Verleende zorg aan thuiswonende ouderen in onderscheidende pakketten. LASA-rapport 2010.
6. Broese van Groenou, M.I & Deeg, D.J.H. (2007). Gebruik van thuiszorg en welzijnsvoorzieningen door 55-plussers tussen 1992 en 2006. Een onderzoek naar individuele en historische ontwikkelingen. Onderzoek uitgevoerd in opdracht van ministerie VWS.

Date of last update: January, 2024 (MBvG)