The role of social and community engagement and its associations with healthcare utilization and depressive symptoms among older adults: A longitudinal panel data analysis.
Abstract
Background
Social and community engagement is a modifiable factor that may influence healthcare use and mental health in older adults. However, existing evidence has rarely integrated the examination of association, mechanism, and population heterogeneity within a single analytical framework. From a nursing perspective, understanding these relationships is crucial for developing holistic care plans that address the social determinants of health.
Aim
This study aimed to investigate the association between the intensity of social and community engagement and key health-related outcomes, including healthcare utilization and depressive symptoms, from a nursing-centric viewpoint.
Methods
The study utilized linked data from the RAND Health and Retirement Study Core (2004-2022) and the Consumption and Activities Mail Survey (2003-2021), which comprised 47,604 person-wave observations. Two-part models were employed to estimate associations with healthcare utilization (doctor contacts, hospital admissions, and hospital nights). As exploratory secondary analyses, mediation by depressive symptoms (Center for Epidemiologic Studies Depression scale) was tested using a product-of-coefficients framework, and a random-forest T-learner was used to describe individual-level heterogeneity in the estimated associations. Both analyses are interpreted as descriptive given timing limitations and the absence of cross-validation.
Results
Higher social and community engagement was associated with a greater likelihood of initiating any doctor contact (odds ratio = 1.09) but was not associated with the number of visits. It was also linked to lower depressive symptoms (β = -0.043). No significant mediation by depressive symptoms was detected for the relationship between engagement and healthcare utilization.
Conclusion
Social and community engagement is associated with the initiation of healthcare contact and better mental health but not with the intensity of healthcare use or inpatient services. The benefits of engagement appear to be greater for individuals with more significant health challenges and those from specific ethnic groups, suggesting that nurse-led interventions to promote engagement could be a valuable strategy for improving well-being in vulnerable populations.