Barriers to and Facilitators of Outpatient Health Services Utilization by Older Adults: A Systematic Reviews

Introduction: Increasing care needs for the elderly are of concern in different countries, especially in countries where their population is aging. It is important to understand the factors that influence the use of health services in the elderly for health policy making in identifying potential problems and developing appropriate interventions to improve their utilization and increase access. Therefore, the purpose of this study was to identify the barriers and facilitators of the outpatient health services utilization in the elderly. Methods: In the current systematic review, published English studies from 1996 to 2018 were searched and reviewed electronically from the Web of Science, PubMed and Scopus databases using PRISMA guidelines and related keywords. After eliminating duplicate and irrelevant articles, the quality of articles was evaluated by two evaluators independently, based on STROBE checklist. Narrative synthesis method was used to combine the data. Results: Forty-four eligible studies were included in this review and the determinants of health service utilization were categorized into three categories as predisposing (age, gender, marital status, ethnicity), enabling (income, insurance coverage, education level, employment status, social network, social support), and need related factors (having chronic illness, self-assessment status, severity of illness, number of illnesses, having two or more diseases at the same time, physical disability and unhealthy lifestyle). Findings showed that over age 80, ethnic minority, unemployed and retired, low level of education, small and limited social network, disability were identified as barriers to accessing health services, and being female, married, having insurance, social support, having a companion, spouse or child, high income levels, shorter distances to the health care center were identified as facilitators of outpatient health services utilization in the elderly. Conclusion: This systematic review revealed that a set of factors is consistently associated with health services utilization in the elderly. The present study identified the factors affecting the utilization of elderly health services in the framework of Anderson Health Services Behavioral Model. Overall, evidence has shown that single, male, over 80s, educated and low income, unemployed or retired people with chronic illness should be high on the health policy priorities of the elderly to prevent the burden of health services resulting from diseases.