Healthcare Utilization for Balance Problems In Community-Dwelling Adults In the United States of America

Abstract

This dissertation addresses healthcare utilization for balance problems in community-dwelling adults in the United States of America. Balance problems are one of the major risk factors for falls. Falls are the leading cause of mortality and chronic disability in elderly adults. The first project (review article) presented in this dissertation explored factors associated with healthcare utilization for balance problems as guided by the Andersen Healthcare Utilization Model. This model is frequently used to examine the factors leading to the use of health services. Age, sex, race/ethnicity, BMI, and comorbidities were identified as some of the factors that pre-disposed the underutilization of healthcare services for balance problems. Socioeconomic status, health insurance, and access to primary care could enable or disable healthcare utilization. The severity of balance problems, perceived illness, and its impact on daily activities were the factors that could affect the need for care. The second study used real-world nationally representative data from the National Health and Nutrition Examination Survey (NHANES) to investigate the associations suggested by the literature review. A total of 1834 adults who self-reported having balance problems in the past 12 months were included in this study. Outcome measure was whether the individual ever saw a health professional for balance problems. Only 32.13 of the individuals who reported having balance problems sought healthcare services for balance problems. Older age, lack of health insurance, not seeing a healthcare provider in the past year, and not experiencing any fall(s) in the past year had a significant association with reduced healthcare utilization for balance problems. These findings can help identify populations at increased risk of underutilization. The third study investigated the congruency between self-reported balance information and performance-based balance measures (Romberg Test of Standing Balance on Firm and Compliant Support Surfaces, RTSBFCSS), along with exploring the predictors of congruency between these balance measures. A nationally representative sample of 4939 community-dwelling adults (≥40 years) for whom self-reported balance status responses and performance-based balance examination results were available was used for this study. Of the 4939 study participants, 36.9 had evidence of balance problems on RTSBFCSS. About 7 in 10 adults with performance-based balance deficits reported no balance problems on the self-reported question. Sole reliance on self-reported information for balance screening may be inadequate. Results can help identify populations more likely to have discrepancies between balance measures.