Is Personality Associated with Health Care Use by Older Adults?
Article first published online: 13 SEP 2013
© 2013 Milbank Memorial Fund
The Milbank Quarterly
Volume 91, Issue 3, pages 491–527, September 2013
How to Cite
FRIEDMAN, B., VEAZIE, P. J., CHAPMAN, B. P., MANNING, W. G. and DUBERSTEIN, P. R. (2013), Is Personality Associated with Health Care Use by Older Adults?. Milbank Quarterly, 91: 491–527. doi: 10.1111/1468-0009.12024
- Issue published online: 13 SEP 2013
- Article first published online: 13 SEP 2013
- National Institute on Aging. Grant Number: NIA R03 AG033296
- Centers for Medicare and Medicaid Services. Grant Number: CMS # 95-C-90467
- health policy;
- health services research;
- nursing homes;
- home care services
The patterns of health care utilization in the United States pose well-established challenges for public policy. Although economic and sociological research has resulted in considerable knowledge about what influences the use of health services, the psychological literature in this area is underdeveloped. Importantly, it is not known whether personality traits are associated with older adults’ use of acute and long-term care services.
Data were collected from 1,074 community-dwelling seniors participating in a Medicare demonstration. First they completed a self-report questionnaire measuring the “Big Five” personality traits: Neuroticism, Extraversion, Openness to Experience, Agreeableness, and Conscientiousness. During the next two years, the participants maintained daily journals of their use of health care services. We used regression models based on the Andersen behavioral model of health care utilization to test for associations.
Our hypothesis that higher Neuroticism would be associated with greater health care use was confirmed for three services—probability of any emergency department (ED) use, likelihood of any custodial nursing home use, and more skilled nursing facility (SNF) days for SNF users—but was disconfirmed for hospital days for those hospitalized. Higher Openness to Experience was associated with a greater likelihood of custodial home care use, and higher Agreeableness and lower Conscientiousness with a higher probability of custodial nursing home use. For users, lower Openness was associated with more ED visits and SNF days, and lower Conscientiousness with more ED visits. For many traits with significant associations, the predicted use was 16 to 30 percent greater for people high (low) versus low (high) in specific traits.
Personality traits are associated with Medicare beneficiaries’ use of many expensive health care services, findings that have implications for health services research and policy. Accordingly, person-centered interventions, population-based translational effectiveness programs, and other personalized approaches that leverage the profound advances in personality psychology in recent decades should be considered.