Blending resources: Informal networks and health care utilization by frail male veterans.

摘要

Social networks play an important role in monitoring symptoms and managing chronic conditions for frail elders. Elderly veteran populations are unique because they have an increased risk of chronic conditions and fewer barriers to health care treatment through the Veteran's Affairs Medical Centers. This research focuses on the role of lay consultants in veterans' management of their health using the concept of social networks. The purposes of this research are to; describe the characteristics of frail veterans' informal networks, examine if there are differences between White and African-American frail male veterans' networks, and to explore the relationship between lay health consultant network characteristics and health care utilization.; Using a cross-sectional design, data were collected at the twelve-month time point of an ongoing longitudinal study. Two-hundred frail male community dwelling veterans over the age of 55 with at least 2 activities of daily living impairments were interviewed by phone. Medical chart reviews were conducted to collect data on chronic disease conditions and utilization.; Socio-demographic, physical, and psychological health variables were measured as well as network structure (size and composition), network function, (instrumental aid, emotional support, health appraisal, and health monitoring), and network satisfaction. Outcome measures include days hospitalized, emergency department visits, and the receipt of home health care.; Based upon logistic and maximum likelihood regression analysis, veterans with more chronic conditions were more likely to be hospitalized, but those having a larger social network were less likely to be hospitalized. Veterans having family-only social networks were more likely to be hospitalized than those who have a mixed network (family, friends, and neighbors) controlling for veteran demographics, depression, and functional health. Being African American and having a larger instrumental support network were predictive of emergency department use. Being African American, having greater functional limitations, and being in the intervention group were predictive of home care use. No moderating relationships were found.; Ways in which network members impact utilization are discussed. The opportunity to identify 'at risk' veterans with multiple chronic conditions and few network resources can enable formal care providers to assist with monitoring or appraisal support that may prevent hospitalization.