NEIGHBORHOOD FACTORS RELATED TO FUNCTIONAL LIMITATIONS AMONG OLDER ADULTS IN MEDICARE ADVANTAGE

Over 90% of older adults in the US report that they wish to age in place. Preventing and mitigating functional limitations is important for maintaining independence, but identifying those who needs services and supports to remain independent is challenging for health plans. The Area Deprivation Index (ADI) is a validated neighborhood-level measure of socioeconomic disadvantage that has been associated with mortality and hospital readmissions. The ADI could potentially be harnessed to target those at risk for functional limitations, yet the relationship between the ADI and functional limitations has not previously been examined. This study includes 182,796 Medicare Advantage beneficiaries aged 65 or older who participated in the Medicare Health Outcome Survey in 2013. We used a multivariate linear probability model accounting for the complex survey design to examine the association of high neighborhood-level disadvantage (defined as ADI≥85th percentile) and any functional limitations (1 or more difficulty with an activity of daily living (ADL) or an instrumental ADL). We also examined whether health, measured by number of chronic conditions, mediated this relationship. In 2013, 1.3 million Medicare Advantage beneficiaries were living in a high-disadvantaged neighborhood, and these individuals were significantly more likely to report any functional limitation compared to individuals living in a less-disadvantaged neighborhood. Among individuals in high-disadvantaged neighborhoods, the probability of reporting a functional limitation was significantly greater in individuals with multiple chronic conditions, but the neighborhood-level affect attenuated somewhat as the number of reported chronic conditions increased. Health plans should consider using a neighborhood-level measure of disadvantage to target independent living interventions.