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Health Aff (Millwood). 2018 Jan;37(1):15-21. doi: 10.1377/hlthaff.2017.1346.

Cross-Sectoral Partnerships By Area Agencies On Aging: Associations With Health Care Use And Spending.

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Amanda L. Brewster ( ) is an associate research scientist in the Department of Health Policy and Management at the Yale School of Public Health, in New Haven, Connecticut.
Suzanne Kunkel is a professor in the Department of Sociology and Gerontology and executive director of the Scripps Gerontology Institute, both at Miami University, in Oxford, Ohio.
Jane Straker is director of research at the Scripps Gerontology Center.
Leslie A. Curry is a senior research scientist in the Department of Health Policy and Management and the Yale Global Health Leadership Institute, Yale School of Public Health.


Area Agencies on Aging (AAAs)-which coordinate social services for older adults in communities across the US-regularly address social determinants of health, sometimes in partnership with other social services and health care organizations. Using data from a 2013 national survey of these agencies, we examined whether their partnership activities were associated with 2014 levels of avoidable health care use and spending for older adults in counties served by each AAA. Multivariate regression models adjusted for agency characteristics, county demographic characteristics, and health care supply factors. We found that counties whose AAAs maintained informal partnerships with a broad range of organizations in health care and other sectors had significantly lower hospital readmission rates, compared to counties whose AAAs had informal partnerships with fewer types of organizations. Counties whose AAAs had programs to divert older adults from nursing home placement had significantly lower avoidable nursing home use, compared to counties whose AAAs lacked such programs. Our findings suggest that AAAs may be a promising source of leadership for cross-sectoral partnerships that effectively address both social and medical determinants of health for older adults, who account for a substantial share of overall health care spending.


Area Agencies on Aging; Crosssectoral Partnership; Determinants Of Health; Older Adults


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