Issues of accessibility to health services by older Australians: a review

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Abstract

Background

This review provides an in-depth investigation into the difficulties facing older Australians when accessing health care services.

Methods

A literature search was conducted in December 2016 using Academic Premier to identify relevant publications. Key search terms were accessibility, health service, older people and Australia. Papers published between 1999 and 2016 were included. Statements of accessibility were extracted and then grouped using the five dimensions of accessibility by Penchansky and Thomas (1981): availability, accessibility, accommodation, affordability and acceptability.

Results

Forty-one papers were included. Availability issues identified were inadequate health care services, particularly for culturally and linguistically diverse (CALD) populations and those residing in rural areas. Accessibility issues included difficulties accessing transport to health care services, which in turn restricted choice of appointment time. Issues of accommodation identified were long waiting times for appointments with both general practitioners and medical specialists. Affordability was a common problem, compounded by multi-morbidity requiring high health care use. Issues of acceptability centred on the role of the family, feelings of shame when receiving care from a non-family member, traditional practices and gender sensitivity.

Conclusions

The contribution of factors to health service accessibility varies according to an older person’s geographical local and their accessibility to transport, as well as their level of multi-morbidity and cultural background. Improving access to health services could be improved by matching services to the population that they serve.

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Most cited references 34

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Challenges in health and health care for Australia.

Meagan J Gillespie, Bruce Armstrong, Stephen R Leeder … (2007)

The next Australian Government will confront major challenges in the funding and delivery of health care. These challenges derive from: Changes in demography and disease patterns as the population ages, and the burden of chronic illness grows; Increasing costs of medical advances and the need to ensure that there are comprehensive, efficient and transparent processes for assessing health technologies; Problems with health workforce supply and distribution; Persistent concerns about the quality and safety of health services; Uncertainty about how best to balance public and private sectors in the provision and funding of health services; Recognition that we must invest more in the health of our children; The role of urban planning in creating healthy and sustainable communities; and Understanding that achieving equity in health, especially for Indigenous Australians, requires more than just providing health care services. The search for effective and lasting solutions will require a consultative approach to deciding the nation's priority health problems and to designing the health system that will best address them; issues of bureaucratic and fiscal responsibility can then follow.

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Barriers to accessing health care services for West African refugee women living in Western Australia.

Ayse Mizan, D. Drummond, Katie Brocx … (2011)

Help-seeking pathways and barriers to accessing health care services were surveyed in 51 West African refugee women who had settled recently in Perth, Western Australia, and in 100 Australian women. Shame or fear of what family and friends might think, fear of being judged by the treatment provider, fear of hospitalization, and logistical difficulties were significant impediments to accessing health care services for the refugee women. Surprisingly, barriers often were greater for the more-educated refugee women and strengthened with years of residence in Australia. Strategies to help at-risk women overcome these barriers need to be implemented to ensure appropriate access to health care services.

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Community-based palliative care is associated with reduced emergency department use by people with dementia in their last year of life: A retrospective cohort study

Lorna Rosenwax, Katrina Spilsbury, Glenn Arendts … (2015)

Objective: To describe patterns in the use of hospital emergency departments in the last year of life by people who died with dementia and whether this was modified by use of community-based palliative care. Design: Retrospective population-based cohort study of people in their last year of life. Time-to-event analyses were performed using cumulative hazard functions and flexible parametric proportional hazards regression models. Setting/participants: All people living in Western Australia who died with dementia in the 2-year period 1 January 2009 to 31 December 2010 (dementia cohort; N = 5261). A comparative cohort of decedents without dementia who died from other conditions amenable to palliative care (N = 2685). Results: More than 70% of both the dementia and comparative cohorts attended hospital emergency departments in the last year of life. Only 6% of the dementia cohort used community-based palliative care compared to 26% of the comparative cohort. Decedents with dementia who were not receiving community-based palliative care attended hospital emergency departments more frequently than people receiving community-based palliative care. The magnitude of the increased rate of emergency department visits varied over the last year of life from 1.4 (95% confidence interval: 1.1–1.9) times more often in the first 3 months of follow-up to 6.7 (95% confidence interval: 4.7–9.6) times more frequently in the weeks immediately preceding death. Conclusions: Community-based palliative care of people who die with or of dementia is relatively infrequent but associated with significant reductions in hospital emergency department use in the last year of life.

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Author and article information

Contributors

Deborah van Gaans:

ORCID: http://orcid.org/0000-0001-8725-5310

Deborah.vangaans@unisa.edu.au

Elsa Dent: Elsa.dent@laureate.edu.au

Journal

Journal ID (nlm-ta): Public Health Rev

Journal ID (iso-abbrev): Public Health Rev

Title: Public Health Reviews

Publisher: BioMed Central (London )

ISSN (Print): 0301-0422

ISSN (Electronic): 2107-6952

Publication date (Electronic): 16 July 2018

Publication date PMC-release: 16 July 2018

Publication date Collection: 2018

Volume: 39

Electronic Location Identifier: 20

Affiliations

[1 ]ISNI 0000 0000 8994 5086, GRID grid.1026.5, Centre for Population Health Research, School of Health Sciences, , University of South Australia, ; GPO Box 2471, Adelaide, South Australia Australia

[2 ]ISNI 0000 0004 4654 2104, GRID grid.449625.8, Centre for Positive Ageing and Wellbeing, , Torrens University Australia, ; Adelaide, South Australia Australia

[3 ]Baker Heart and Diabetes Research Institute, Melbourne, Victoria Australia

Author information

Deborah van Gaans http://orcid.org/0000-0001-8725-5310

Article

Publisher ID: 97

DOI: 10.1186/s40985-018-0097-4

PMC ID: 6047130

PubMed ID: 30027001

SO-VID: 35baa6e8-50c3-464c-8be9-dcc44f5cfd77

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 29 November 2017

Date accepted : 18 April 2018

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Keywords: accessibility,aged,older people,health services,public health,equity

Data availability:

Keywords: accessibility, aged, older people, health services, public health, equity

Issues of accessibility to health services by older Australians: a review

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Most cited references 34

Challenges in health and health care for Australia.

Barriers to accessing health care services for West African refugee women living in Western Australia.

Community-based palliative care is associated with reduced emergency department use by people with dementia in their last year of life: A retrospective cohort study

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