Personality a key factor in health care use

(Press-News.org) Psychiatrists and psychologists have long understood that an individual's personality can define how he or she views the world around them, reacts to situations, and interacts with others. It now appears that personality traits can be linked to the frequency with which older adults use expensive health care services.

A study, published today in the journal The Milbank Quarterly, finds that certain measurable personality characteristics can be correlated to health care consumption, in some instances increasing use high cost health care services such as emergency room visits and nursing home stays by 20 to 30 percent and even higher.

"This is the first study to show that personality traits predispose some older adults to use several expensive acute and long-term care services," said Bruce Friedman, M.P.H., Ph.D., an associate professor in the University of Rochester Medical Center (URMC) Department of Public Health Sciences and lead author of the study. "It is important for health care systems to recognize that personality characteristics are associated with how individuals use health care services, and design interventions that redirect patients towards lower cost solutions to their health problems that are just as effective."

The study was based on data collected from 1,074 individuals over the age of 65 who participated in study funded by the Centers for Medicare and Medicaid Services (CMS). The study, called the Medicare Primary and Consumer-Directed Care Demonstration, involved participants from upstate New York, West Virginia, and Ohio who were deemed likely to be high cost patients.

Participants completed a questionnaire which assigns a score for each of the "big five" personality traits: neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness. The survey, called the NEO-FFI, asks individuals to respond to questions about their thoughts, feelings, and behaviors, such as whether they are easy to laugh, are courteous to others, get into arguments easily, feel inferior, or like to be around other people.

The survey results enable researchers to understand each individual's personality profile and how these traits may impact their health care decisions. For example, people on the high end of the neuroticism scale tend to be more likely to feel angry, anxious, depressed, or vulnerable. An individual with a high score in openness to experience is generally more intellectually curious, imaginative, and creative. People who are high in agreeableness are compassionate, altruistic, and cooperative. Those who score low tend to be suspicious or antagonistic. People who score on the high end of the conscientiousness scale are dependable, reliable, and goal-oriented.

The researchers then looked at which health care services these individuals utilized over a two year period. This information was recorded in daily logs kept by the study participants. The study focuses on seven high cost health care services: emergency department (ED) visits, hospital stays, hospital-based rehabilitation, skilled nursing home care, custodial nursing home care, home-based skilled nurse and therapist care, and home-based custodial care.

They found correlations between several personality traits and health care service utilization. People who scored high in neuroticism were 24 percent more likely to visit the ED and more than twice as likely to spend time in a nursing home for long term care as individuals low in neuroticism. Among users of care, those with lower openness scores were admitted more frequently to EDs (16 percent) and spent more days in nursing homes that provide long term care (30 percent).

The researchers believe that these findings could potentially be used to help lower health care costs – one of the central objectives of the Affordable Care Act – based on an assessment of individuals' personality profiles. Health care providers could develop forecasts of the overuse and underuse of health care services by personality trait and then use interventions to, for example, prevent unnecessary ED visits among patients who are high in neuroticism.

"These finding have a range of potential implications in terms of how clinicians and health systems deliver patient-centered care," said Friedman. "Customizing interventions to a person's personality profile could be one of the keys to ensuring the appropriate use of health services and containing the continuing rise in health care costs."

### Additional co-authors include Paul Duberstein, Peter Veazie, and Benjamin Chapman with URMC and Willard Manning with the University of Chicago. The study was supported with funded from the National Institute on Aging and CMS.