Volume 88, Issue 5 , Pages 583-588, May 2007
Association of Mobility Limitations With Health Care Satisfaction and Use of Preventive Care: A Survey of Medicare Beneficiaries
Article Outline
Abstract
Hoffman JM, Shumway-Cook A, Yorkston KM, Ciol MA, Dudgeon BJ, Chan L. Association of mobility limitations with health care satisfaction and use of preventive care: a survey of Medicare beneficiaries.
Objective
To examine the association between satisfaction with health care, the use of preventive health care, and mobility limitation.
Design
Cross-sectional analysis of survey data.
Setting
Community.
Participants
A total of 12,769 people, age greater than 65, who participated in the 2001 Medicare Current Beneficiary Survey.
Interventions
Not applicable.
Main Outcome Measures
Self-report of mobility limitation, satisfaction, and use of preventive health care (immunizations, cancer screening). Sampling weights were used in all analyses, including logistic regression for survey data, to calculate estimates for a Medicare population of 31 million.
Results
After controlling for sociodemographic characteristics, Medicare beneficiaries with mobility limitations were significantly more dissatisfied with their health care compared with beneficiaries without mobility limitations. Receipt of preventive care did not differ for those with and without mobility limitation on some preventive services.
Conclusions
Mobility limitation is highly associated with dissatisfaction with health care among older adult beneficiaries. Although Medicare beneficiaries may receive similar rates of preventive care, those with mobility limitation may have more difficulty accessing services and be more dissatisfied with their health care in general.
Key Words: Disabled persons, Medicare, Patient satisfaction, Rehabilitation
STUDIES HAVE SUGGESTED that physical disability is a risk factor for dissatisfaction with health care1, 2, 3 and access to preventive services, such as mammograms and Papanicolaou (Pap) smears for women.4, 5 Although people with limitations in activities of daily living (ADLs) may access specialty care to address their specific disabling condition, access to preventive care has been found to be limited.4, 5, 6 Iezzoni et al4 examined access to care for people who participated in the National Health Interview Survey (ages ≥18y) and found that those people with disability were less likely to receive preventive services. Chan et al5 found that Medicare beneficiaries with ADL limitations were at risk for not receiving mammograms and Pap smears, but that ADL limitations did not impact access to immunization. These researchers postulate that reduced access may be due to a variety of factors including providers who focus on the disabling condition to the exclusion of preventive services as well as transportation and accessibility issues.4 In addition, some health care providers may believe that such people do not merit these procedures.5
Satisfaction with health care has also been studied in the estimated 54 million Americans with disability. This issue is important because dissatisfaction with care has also been associated with noncompliance and poor follow-up.7 Dissatisfaction has been assessed by questioning respondents’ level of satisfaction with a variety of health care issues including overall quality, access, and out-of-pocket costs. Results suggest that, for Medicare beneficiaries, dissatisfaction increased as the level of ADL disability1 or functional limitations2 increased. Ease of getting to doctors, follow-up care, and access to specialists were the areas of most dissatisfaction for disabled older adults compared with those without ADL disability.1, 2, 8 In those with communication disability, results were similar except for less dissatisfaction with ease of getting to doctors.
One key factor that impacts access to health care is mobility, which has not been examined for its impact on dissatisfaction and access to preventive care. Mobility, defined as the ability to move independently around the environment, is an essential part of personal and instrumental ADLs.9 Mobility limitation significantly restricts participation and can lead to social isolation, anxiety, and depression in older adults10, 11 and is also the strongest predictor of self-perceived disability.12 National estimates suggests that functional mobility limitation is a significant problem for many older adults, and is associated with some modifiable characteristics.13 Among older adults, a decline in mobility often precedes the onset of disability in activities of daily life and may be the most important limitation in ADLs, contributing to dissatisfaction and lack of access to preventive care.14, 15, 16, 17 Restrictions in the ability to walk may place older adults at risk for less than optimal health care due to reduced access to needed services. This in turn may adversely impact patient satisfaction with health care.
The purpose of this study was to estimate the extent to which mobility limitation is associated with satisfaction with care and access to preventive services. If mobility limitation is similar to other types of disability, including ADLs and communication disability, it would suggest that presence of any type of disability is an important factor that needs to be considered by all health care providers to increase both access to preventive care and satisfaction with care. In addition, because mobility disability is usually the first activity limitation that a patient confronts, a strong relationship between mobility and satisfaction would suggest that a patient’s satisfaction is affected soon after they become disabled. Finally, mobility limitation is often a reversible problem. If it is related to satisfaction and access, perhaps addressing a patient’s mobility directly through treatment, adaptation or through the use of equipment, may lead to improvements in health care and quality of life.
Methods
Sampling Frame
Our analyses examined 12,769 Medicare beneficiaries (≥65y) sampled in the 2001 Medicare Current Beneficiaries Survey (MCBS). The MCBS is a longitudinal survey of the Medicare population publicly available from the Centers for Medicare and Medicaid Services through a data use agreement.18 It uses a complex, multistage, stratified sampling design to obtain a nationally representative sample of all Medicare beneficiaries. The United States is separated by counties into 107 primary sampling units, and then further divided into clusters by postal ZIP codes. Beneficiaries within each cluster are selected by systematic random sampling within age groups.19
Beneficiaries participating in the survey are interviewed in person and data are collected on a wide variety of items including use of health services, satisfaction with medical care, health status, and functioning, as well as demographic information such as income, education level, and living arrangements. Interviews with beneficiaries not living at home (eg, in skilled nursing facilities) were excluded.
Preventive Care
Survey respondents were asked a series of questions related to receipt of preventive care. The questions included whether a person had received a flu shot the previous winter and whether they had ever received a pneumonia shot. All women were asked if they had received a mammogram, and women under the age of 71 if they had received a Pap smear in the last year.20, 21 Men were asked if they had received a digital rectal prostate exam and a blood test for prostate cancer.
Dissatisfaction
The MCBS includes 10 items assessing satisfaction with health care: overall quality, availability of services during off hours, ease of access, out-of-pocket costs, information provided, follow-up care, physician’s concern, receiving care at 1 location, availability of specialists, and ease of obtaining answers on the telephone. Respondents were asked to rate their satisfaction as: 1, very satisfied; 2, satisfied; 3, dissatisfied; or 4, very dissatisfied. For all analyses, coding was collapsed into: satisfied (1, 2) and dissatisfied (3, 4).
Mobility Limitation
We defined and validated mobility limitation through a process described previously.13 Briefly, beneficiaries were categorized by their responses to 4 questions: Do you have any difficulty walking? Do you have difficulty walking a quarter mile—2 to 3 blocks? Do you need equipment to walk? Do you need personal assistance to walk? A person reporting no difficulty walking was classified as having no mobility limitation. A person reporting difficulty walking, but requiring no equipment or personal help or had difficulty walking 2 to 3 blocks was classified as having mild mobility limitation. A person reporting difficulty walking and who used equipment, but had no need of personal assistance was classified as having moderate mobility limitation, and a person needing personal assistance was classified as severely limited. A person reporting that they “do not walk” was classified separately and those people are presented as a group. Although specific causes of walking difficulty could not be determined, all were self-reported as being health related.
Sociodemographic Characteristics
Sociodemographic characteristics for the population are presented in table 1. Race was categorized into those who reported being white or nonwhite. Marital status was dichotomized to compare those currently married with everyone else (single, divorced, widowed). Socioeconomic status was categorized into income above versus below or equal to $25,000. Education was categorized as having less than graduation from high school compared with high school graduates or further education. Respondents living alone were compared with those living with others. Rural or urban status was determined by the county in which a respondent lived. Urban locations were defined by metropolitan statistical areas, which categorize counties based on whether they contain a city with a population greater than 50,000. Self-report of general health (reporting fair/poor health vs good/excellent health), and whether a person was currently a smoker (vs not) were also included. The number of comorbidities was determined by a count of the number of clinical conditions a respondent endorsed. Body mass index (BMI) was classified as overweight (BMI >30kg/m2), underweight (BMI <18kg/m2), or in the normative range (BMI range, 18−30kg/m2). Participation in a health maintenance organization (HMO) was also included.
Table 1. Weighted Estimates of Proportion of Sociodemographic and Clinical Characteristics for 2001 Medicare Beneficiaries
| Characteristic | Proportion (95% Confidence Limits) | Estimated Population Size (millions) |
|---|---|---|
| Mobility limitation⁎ | ||
 None (n=6421) | 53.3(52.0–54.5) | 16.4 |
| Mild (n=4124) | 31.4(30.3–32.4) | 9.7 |
| Moderate (n=1496) | 10.5(9.9–11.2) | 3.3 |
| Severe (n=519) | 3.6(3.2–4.0) | 1.1 |
| Does not walk (n=177) | 1.2(0.9–1.4) | 0.4 |
| Mean age (y) | 75.3(75.2–75.4) | |
| Mean no. of comorbidities | 2.5(2.5–2.6) | |
| Sex (% women) | 57.8(57.0–58.6) | 17.8 |
| Race (% nonwhite) | 13.3(12.2–14.4) | 4.1 |
| Marital status (% married) | 55.4(54.2–56.6) | 17.1 |
| SES (% ≤$25,000) | 59.2(57.8–60.6) | 18.3 |
| Education (% <12y) | 31.5(30.1–32.9) | 9.7 |
| % living alone | 31.7(30.7–32.6) | 9.8 |
| General health (% fair/poor) | 22.8(21.8–23.7) | 7.0 |
| Current smoker (%) | 11.0(10.4–11.7) | 3.4 |
| Rural/urban status (% rural) | 23.2(20.6–25.8) | 7.2 |
| Participates in HMO (%) | 18.7(17.2–20.2) | 5.8 |
| BMI (kg/m2) | ||
| % underweight | 5.3(4.8–5.8) | 1.6 |
| % normal | 74.8(73.9–75.7) | 23.1 |
| % overweight | 19.9(19.0–20.7) | 6.1 |
⁎The n value is the number in the survey. |
Statistical Analysis
The MCBS survey must be weighted to make inferences about the entire Medicare population.22 The probability of being included in the survey is not the same for all beneficiaries but is determined by a beneficiary’s address and age. Use of the sampling weights minimized the sampling error and makes the estimates for the population more accurate. Sampling weights were used to calculate estimates of means (for continuous variables) and proportions (for categorical variables) of the entire Medicare population by each mobility limitation category.23
We studied the association between the 2 levels of dissatisfaction (satisfied, dissatisfied) or preventive care (yes, no) and mobility limitation using logistic regression.24 Because the level of dissatisfaction may be influenced by both person and environmental characteristics, the model included the following covariates: age, sex, race, marital status, socioeconomic (income and education) status, living arrangement, rural or urban status, self-perceived health, number of comorbid conditions, smoking status, BMI, and HMO participation. The results of logistic regression analysis are reported as odds ratios with no mobility limitation as the comparison group. All analyses were performed using SAS PROC SURVEYLOGISTIC,a which takes into account the complex sampling design and weighting of the MCBS.
Results
Preventive Care and Dissatisfaction With Health Care by Level of Mobility Disability
Table 2 shows the estimated use of preventive care for different levels of mobility limitation as well as the 95% confidence intervals. Results suggest that there is little variability in immunization rates. It is noteworthy, however, that more than 30% of respondents are not receiving immunizations regardless of mobility category. For women, the proportion of mammograms decreased as the level of mobility limitation increased, with those who do not walk reporting the lowest rates. For women under age 71, the proportion of Pap smears was below 50% for all categories. For men, the proportion of blood tests for prostate cancer and digital rectal prostate exams declined as mobility limitations increased; on average 30% of the men in this sample did not receive blood tests for prostate cancer screening and 45% did not receive digital rectal prostate exams.
Table 2. Weighted Estimate of Proportion of Preventative Care and Dissatisfaction With Health Care Reported by Respondents by Level of Mobility Limitation
| Items | Mobility Limitation | ||||
|---|---|---|---|---|---|
| None | Mild | Moderate | Severe | Does Not Walk | |
| Preventive care items | |||||
| 1. Received a flu shot in the past year. | 65.9(64.5–67.5) | 69.3(67.7–71.0) | 70.0(61.7–72.3) | 70.1(65.4–74.7) | 66.7(59.0–74.5) |
| 2. Received a pneumonia shot in the past year. | 60.8(59.2–62.4) | 68.1(66.3–69.9) | 72.0(69.5–74.5) | 64.9(60.5–69.4) | 66.8(58.4–75.2) |
| 3. Had a mammogram in the past year (n=7388). | 60.9(58.7–63.0) | 52.7(50.5–54.9) | 40.8(37.2–44.5) | 30.2(24.7–35.6) | 21.9(13.7–30.3) |
| 4. Had a Pap smear in the past year (women age <71 [n=1728]). | 48.9(45.2–52.7) | 39.1(34.1–44.0) | 31.7(22.1–41.25) | 34.6(17.1–52.2) | 32.7(12.3–53.1) |
| 5. Had a blood test for prostate cancer in the past year (n=5381). | 71.1(69.2–72.9) | 67.2(64.7–69.8) | 67.5(63.1–71.9) | 65.4(57.7–73.1) | 61.4(48.7–74.1) |
| 6. Had a digital rectal prostate exam in the past year. | 55.5(53.6–57.5) | 52.4(49.6–55.3) | 51.4(46.5–56.3) | 51.4(42.2–60.6) | 41.4(28.1–54.7) |
| Dissatisfaction items | |||||
| 1. The overall quality of the medical services you have received in the last year. | 2.5(2.0–2.9) | 4.3(3.6–5.0) | 5.7(4.4–7.0) | 8.2(5.6–10.9) | 8.2(4.5–11.9) |
| 2. The ease and convenience of getting to a doctor from where you live. | 2.9(2.4–3.5) | 5.0(4.2–5.8) | 9.8(8.0–11.6) | 10.8(7.9–13.7) | 11.5(6.6–16.4) |
| 3. Getting all your medical care needs taken care of at the same location. | 3.6(3.0–4.2) | 5.1(4.3–5.9) | 8.7(6.7–10.7) | 9.1(6.2–12.0) | 6.6(2.0–11.3) |
| 4. The concern of doctors for your overall health rather than just for an isolated symptom or disease. | 3.5(2.9–4.0) | 6.2(5.2–7.2) | 6.6(5.4–7.9) | 8.7(6.0–11.5) | 4.8(1.4–8.2) |
| 5. The availability of medical services at night and on weekends. | 4.6(3.8–5.4) | 6.6(5.3–7.9) | 8.5(6.5–10.5) | 9.9(6.5–13.2) | 10.2(4.8–15.6) |
| 6. The out-of-pocket cost you paid for medical services. | 12.0(10.9–13.1) | 15.4(14.2–16.7) | 20.2(17.8–22.6) | 20.0(16.1–23.9) | 14.2(8.6–19.7) |
| 7. The information given to you about what was wrong with you. | 3.1(2.6–3.5) | 6.0(5.0–7.0) | 8.3(6.6–10.0) | 9.6(6.7–12.5) | 8.9(4.9–12.8) |
| 8. The follow-up care you received after an initial treatment or operation. | 2.0(1.6–2.4) | 3.5(2.8–4.2) | 5.1(3.8–6.4) | 7.7(5.1–10.4) | 4.3(1.1–7.6) |
| 9. The availability of care by specialists when you feel you need it. | 3.0(2.1–3.9) | 4.1(3.1–5.2) | 5.5(4.0–7.0) | 5.6(3.3–7.9) | 4.2(0.5–7.9) |
| 10. The ease of obtaining answers to questions over the telephone about your treatment or prescriptions. | 6.5(5.5–7.5) | 8.6(7.3–9.8) | 11.4(8.9–13.9) | 12.2(8.7–15.7) | 10.3(5.7–15.0) |
Table 2 also shows the estimated proportion of respondents reporting dissatisfaction at different levels of mobility limitation. Results suggest that mobility limitation is strongly associated with dissatisfaction. Dissatisfaction with overall quality of health care and ease of getting to the doctor increased as the level of mobility limitation increased, with those who did not walk reporting the most dissatisfaction. In addition, for people with mobility limitation, dissatisfaction increased with level of severity for getting needs met at 1 location and concern of doctors for overall health, with those who do not walk reporting less dissatisfaction. For those who do not walk, rates varied, but were consistently above those who had no mobility limitation. Dissatisfaction with out-of-pocket costs for health care was highest for all groups ranging from 12.0% to 20.2%.
Adjusted Odds Ratios for Access to Preventive Care and Dissatisfaction With Health Care
Table 3 presents adjusted odds ratios for preventive care for each level of mobility limitation compared with those having no mobility limitation. The model of association included age, sex, race, marital status, income, education, living arrangement, health status, smoking status, number of comorbidities, BMI, rural or urban status, and participation in an HMO. This table displays the odds that a person in a certain mobility limitation category received preventive care compared to a person without mobility limitation when the values of all other variables are the same for each person. Given this, the level of mobility impairment was not associated with receipt of flu vaccines or rectal prostate exam. In addition, respondents with mild mobility limitations had higher odds and those with severe mobility limitation had lower odds of receiving pneumonia vaccinations compared with those with no mobility limitation.
Table 3. Adjusted Odds Ratios for Preventive Care and Dissatisfaction With Health Care for Each Mobility Limitation Level as Compared With No Disability
| Items | Significance Level of Mobility Limitation | Mobility Limitation | |||
|---|---|---|---|---|---|
| Mild | Moderate | Severe | Does Not Walk | ||
| Preventive care items | |||||
| 1. Received a flu shot in the past year. | .10 | 1.02(0.92–1.14) | 0.90(0.85–1.05) | 0.88(0.67–1.16) | 0.72(0.50–1.15) |
| 2. Received a pneumonia shot in the past year. | <.001 | 1.13(1.02–1.26) | 1.08(0.93–1.27) | 0.76(0.59–0.98) | 0.77(0.49–1.21) |
| 3. Had a mammogram in the past year. | <.001 | 0.83(0.73–0.95) | 0.58(0.47–0.72) | 0.38(0.28–0.51) | 0.25(0.14–0.43) |
| 4. Had a Pap smear in the past year (women <71 only). | .06 | 0.71(0.53–0.95) | 0.51(0.30–0.86) | 0.59(0.26–1.32) | 0.60(0.22–1.64) |
| 5. Had a blood test for prostate cancer in the past year. | .02 | 0.80(0.68–0.94) | 0.76(0.59–0.97) | 0.69(0.45–1.06) | 0.53(0.28–1.01) |
| 6. Had a digital rectal prostate exam in the past year. | .33 | 0.92(0.80–1.05) | 0.87(0.68–1.10) | 0.87(0.59–1.28) | 0.64(0.36–1.13) |
| Dissatisfaction items | |||||
| 1. The overall quality of the medical services you have received in the last year. | <.001 | 1.44(1.08–1.92) | 1.74(1.25–2.44) | 2.56(1.62–4.05) | 2.51(1.45–4.35) |
| 2. The ease and convenience of getting to a doctor from where you live. | <.001 | 1.23(0.94–1.59) | 2.15(1.63–2.82) | 2.30(1.56–3.78) | 2.27(1.36–3.82) |
| 3. Getting all your medical care needs taken care of at the same location. | <.001 | 1.40(1.10–1.77) | 2.56(1.89–3.47) | 2.58(1.75–3.81) | 1.73(0.76–3.95) |
| 4. The concern of doctors for your overall health rather than just for an isolated symptom or disease. | <.001 | 1.73(1.38–2.18) | 1.88(1.44–2.46) | 2.51(1.73–3.65) | 1.28(0.60–2.71) |
| 5. The availability of medical services at night and on weekends. | <.001 | 1.49(1.11–2.02) | 2.05(1.49–2.82) | 2.34(1.45–3.76) | 2.17(1.14–4.10) |
| 6. The out-of-pocket cost you paid for medical services. | <.001 | 1.18(1.02–1.37) | 1.62(1.33–1.98) | 1.62(1.22–2.17) | 0.98(0.62–1.55) |
| 7. The information given to you about what was wrong with you. | <.001 | 1.75(1.39–2.20) | 2.38(1.77–3.22) | 2.70(1.83–3.98) | 2.28(1.32–3.92) |
| 8. The follow-up care you received after an initial treatment or operation. | <.001 | 1.82(1.31–2.52) | 2.89(2.01–4.16) | 4.37(2.62–7.29) | 2.46(1.06–5.69) |
| 9. The availability of care by specialists when you feel you need it. | <.001 | 1.45(1.07–1.95) | 2.18(1.48–3.20) | 2.28(1.39–3.75) | 1.58(0.58–4.28) |
| 10. The ease of obtaining answers to questions over the telephone about your treatment or prescriptions. | <.001 | 1.43(1.14–1.78) | 1.99(1.47–2.71) | 2.29(1.59–3.28) | 1.83(1.06–3.16) |
Women with any mobility limitation had significantly lower odds of receiving mammograms. For women under age 71 there was no association between mobility limitation and receipt of Pap smears. For men, those with mild and moderate mobility limitation had significantly lower odds of receiving blood tests for prostate cancer than those without mobility limitation, whereas those with severe mobility limitation or those who do not walk did not differ from those without mobility limitation.
Table 3 also presents the odds ratios for dissatisfaction for each level of mobility limitation. The association between dissatisfaction and mobility limitation (after adjusting for all covariates) was statistically significant for all 10 dissatisfaction items (P≤.001). Of note, those with mild mobility limitation were similar in level of dissatisfaction compared with those without mobility limitation in ease of getting to a doctor. People with moderate and severe mobility limitation and those who do not walk, however, were significantly more dissatisfied with ease of getting to the doctor compared to those without mobility limitation. Overall, even when controlling for a variety of sociodemographic variables, respondents reporting mild, moderate, and severe mobility limitation are more dissatisfied with health care than those without mobility limitations.
Older adults who did not walk (n=177) were similar in reports of dissatisfaction to those without mobility limitation in out-of-pocket costs, concern of doctors with overall health, getting all medical care at the same location, and availability of care by specialists. This may be due to the small sample size of the group and to the variability in responses seen in the confidence intervals. These adults may also have compensated for any mobility limitation that interfered with their health care, however.
Discussion
Results of the current study show that 46.7% of Medicare beneficiaries have some level of mobility limitation. Although increasing mobility limitation was not associated with immunization for flu or pneumonia, it is associated with undergoing fewer mammograms for women and having fewer blood tests for prostate cancer for men. In addition, mobility limitation was highly related to dissatisfaction with a wide range of health care domains, from quality of care, to information received, even after controlling for sociodemographic characteristics. People who were categorized as nonwalkers showed some similarities to those with no mobility limitation in dissatisfaction, which suggests that this group is different from those with other levels of mobility limitation. Perhaps this is due to the fact that these people may have compensated for their significant limitations through the use of wheelchairs.
Although mobility limitation did not have a consistent relationship with use of preventive care, it is notable that up to 35% of older adults did not receive flu shots and up to 40% did not receive pneumonia vaccination. In addition, for women under age 71, receipt of Pap smears was below 50% even for those with no mobility limitation suggesting that the majority of older women who are Medicare beneficiaries are not receiving this type of preventive care. This same general lack of preventive care was also seen for men receiving digital rectal prostate exams, because up to 59% of men did not receive this preventive examination.
These results are consistent with prior research conducted on other ADL limitations, and suggest that disability in general leads to reduced access to preventive care.1, 3, 5 Mobility limitation, like ADL disability, may have a direct impact on certain preventive procedures that can be difficult to conduct in those with disability. Iezzoni et al4 suggested that reduced access may be due to a variety of factors including the fact that providers may focus on the disabling condition to the exclusion of preventive services and transportation or accessibility issues. Similarly, Chan et al5 suggest that some health care providers may believe that older adults do not merit these procedures. Alternatively, both the person with a disability and their health care provider may be overly focused on services specific to their disabling condition at the expense of preventive and other health care services.
Similar to access to preventive care, the current results showing increased dissatisfaction for persons with mobility limitations are consistent with research conducted on other disability groups. After controlling for similar sociodemographic factors, people with mild and moderate cognitive disability were significantly more dissatisfied with many areas of their health care than those without disability.3
Iezzoni et al2 examined variables that may impact satisfaction for people with disabilities who participated in the National Health Survey and found that poor communication and lack of thorough care were issues that people were most concerned about. In their earlier analysis of satisfaction, they found that older adults with disability had the greatest dissatisfaction in overall quality, access to specialists, follow-up, and ease of getting to doctors compared with those without disability. Taken together, results of the current study and prior research suggest that people with any type of disability tend to be more dissatisfied with their health care. People who live in the community with mobility and ADL limitations appear to have the most consistent dissatisfaction with health care. In addition, this dissatisfaction likely happens soon after the patient confronts disability, because mobility disability is usually the first activity limitation to appear.
Study Limitations
This study has limitations. First, only community-dwelling Medicare beneficiaries, 65 years and older, were included and therefore we cannot generalize to persons with mobility limitation under age 65 or those living in skilled nursing facilities. In addition, we may have been unable to account for the influence of all older adults’ expectations.1 People who report less satisfaction with health care may also report less satisfaction with their life in general.25 People with psychologic distress may be less satisfied with their care because they cannot get relief from their distress or because providers may mismanage them.26 We attempted to control for this potential bias by accounting for a person’s perceived health. It is possible, however, that some of our findings were due to psychologic distress and general life dissatisfaction in the persons with mobility disabilities.
Future research is needed to examine the group of older adults who “did not walk” in order to determine whether they differ significantly from others with mobility limitation or have been able to compensate for their limitation through the use of wheelchairs or other assistive technology. Study of this group may provide ideas and suggestions for potential interventions that would improve the satisfaction with care and access to preventive services for those with less significant mobility limitation. At present, Medicare provides funding for wheelchairs only if they are required to function in the home setting. If improved accessibility leads to improved access to health care and satisfaction, review of this policy may be needed.
Conclusions
Our results suggest that mobility limitation is associated with less use of some preventive care and highly associated with dissatisfaction with health care. Mobility limitation is a major factor in quality of life and is found in nearly 15 million Medicare beneficiaries. Because mobility limitation has been found to be associated with several reversible patient characteristics: smoking, obesity, social isolation, poverty, and poor education,13 some of these associated variables warrant further evaluation. Development of interventions to improve mobility limitations, whether therapeutic, technologic, or policy changes, may also help maximize patient access to and satisfaction with health care.
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Supported by the Centers for Disease Control and Prevention (grant no. MM-0625-04/04) through the Association of Academic Medical Centers.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.
Reprints are not available from the author.
PII: S0003-9993(07)00102-5
doi:10.1016/j.apmr.2007.02.005
© 2007 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
Volume 88, Issue 5 , Pages 583-588, May 2007
