1
|
Atherton OE, Willroth EC, Weston SJ, Mroczek DK, Graham EK. Longitudinal associations among the Big Five personality traits and healthcare utilization in the U.S. Soc Sci Med 2024; 340:116494. [PMID: 38101170 PMCID: PMC11065195 DOI: 10.1016/j.socscimed.2023.116494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/29/2023] [Accepted: 12/02/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE One critical component of individual and public health is healthcare utilization, or the extent to which individuals have routine check-ups, schedule treatments, or use emergency services. However, we know little about who uses healthcare services and what types, the conditions that exacerbate utilization, or the factors that explain why people seek out services. The present study fills these gaps in the literature by investigating the role of personality factors in predicting various forms of healthcare utilization, how these associations vary by age, socioeconomic resources, and chronic conditions, as well as one potential psychological mediating mechanism (i.e., sense of control). METHODS We use data from a large longitudinal sample of Americans (N = 7108), with three assessments spanning 20 years. Participants reported on their Big Five personality traits using the Midlife Development Inventory, healthcare utilization across three domains (routine visits, scheduled treatment, urgent care), age, income, insurance, chronic conditions, and sense of control. RESULTS Multilevel models showed that people who were more agreeable and neurotic tended to use more healthcare services. Moreover, on occasions when people were more extraverted and open, they tended to use more healthcare services. There were several nuances in personality-healthcare utilization associations depending on the type of healthcare service, age, and socioeconomic resources. Longitudinal mediation analyses demonstrated sense of control as one mechanism linking personality traits to healthcare utilization in the U.S. CONCLUSIONS We discuss the theoretical and practical implications of interactions between individuals and structural systems for promoting the health of aging U.S. Americans.
Collapse
Affiliation(s)
- Olivia E Atherton
- Department of Psychology, University of Houston, Houston, TX, USA; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Emily C Willroth
- Department of Psychological and Brain Sciences, Washington University in St. Louis, MO, USA
| | - Sara J Weston
- Department of Psychology, University of Oregon, Eugene, OR, USA
| | - Daniel K Mroczek
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Psychology, Northwestern University, Chicago, IL, USA
| | - Eileen K Graham
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| |
Collapse
|
2
|
O'Sullivan DJ, Bearne LM, Harrington JM, McVeigh JG. Can social prescribing put the 'social' into the biopsychosocial management of people with long-term musculoskeletal disorders? Musculoskeletal Care 2023; 21:1341-1352. [PMID: 37639305 DOI: 10.1002/msc.1810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/04/2023] [Accepted: 08/09/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Chronic musculoskeletal disorders (MSD) are a significant burden on individuals' quality of life and society and are made more complex by the presence of multimorbidity. It is recommended that interventions targeting MSD be sustainable, equitable and incorporate the biopsychosocial model of care (BPS). AIMS A criticism of the BPS approach is that the social component of this model is not addressed adequately during the management of people with long-term MSD and that a gap exists between theory and implementation. The use of social prescribing (SP) as an intervention to bridge this gap is discussed. RESULTS AND DISCUSSION Social prescribing is a holistic non-medical person-centered approach to well-being that utilizes link workers (LW) to support individuals with long-term conditions (LTC) in the community. Social prescribing referrals are received from primary healthcare practitioners to LW and range from light touch signposting for employment or financial advice to more intensive support for LTC such as obesity, decreased physical activity and mental health needs. CONCLUSION There is evidence to suggest that SP interventions are effective in the management of LTC; however, due to the paucity of high-quality evidence, it is difficult to be conclusive. Large-scale randomised controlled trials are recommended to support the use of SP interventions in the management of LTC.
Collapse
Affiliation(s)
- Declan J O'Sullivan
- Discipline of Physiotherapy, School of Clinical Therapies, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Lindsay M Bearne
- Population Health Research Institute, St George's, University of London, London, UK
| | - Janas M Harrington
- School of Public Health, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Joseph G McVeigh
- Discipline of Physiotherapy, School of Clinical Therapies, College of Medicine and Health, University College Cork, Cork, Ireland
| |
Collapse
|
3
|
Emmesjö L, Gillsjö C, Dahl Aslan AK, Hallgren J. Patients' and next of kin's expectations and experiences of a mobile integrated care model with a home health care physician - a qualitative thematic study. BMC Health Serv Res 2023; 23:921. [PMID: 37644455 PMCID: PMC10466758 DOI: 10.1186/s12913-023-09932-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND The organizational principle of remaining at home has offset care from the hospital to the home of the older person where care from formal and informal caregivers is needed. Globally, formal care is often organized to handle singular and sporadic health problems, leading to the need for several health care providers. The need for an integrated care model was therefore recognized by health care authorities in one county in Sweden, who created a cross-organisational integrated care model to meet these challenges. The Mobile integrated care model with a home health care physician (MICM) is a collaboration between regional and municipal health care. Descriptions of patients' and next of kin's experiences of integrated care is however lacking, motivating exploration. METHOD A qualitative thematic study. Data collection was done before the patients met the MICM physician, and again six months later. RESULTS The participants expected a sense of relief when admitted to MICM, and hoped for shared responsibility, building a personal contact and continuity but experienced lack of information about what MICM was. At the follow-up interview, participants described having an easier daily life. The increased access to the health care personnel (HCP) allowed participants to let go of responsibility, and created a sense of safety through the personalised contact and continuity. However, some felt ignored and that the personnel teamed up against the patient. The MICM structure was experienced as hierarchical, which influenced the possibility to participate. However, the home visits opened up the possibility for shared decision making. CONCLUSION Participants had an expectation of receiving safe and coherent health care, to share responsibility, personal contact and continuity. After six months, the participants expressed that MICM had provided an easier daily life. The direct access to HCP reduced their responsibility and they had created a personalised contact with the HCP and that the individual HCP mattered to them, which could be perceived as in line with the goals in the shift to local health care. The MICM was experienced as a hierarchic structure with impact on participation, indicating that all dimensions of person-centred care were not fulfilled.
Collapse
Affiliation(s)
- Lina Emmesjö
- School of Health Sciences, University of Skövde, P.O. Box 408, SE-541 28, Skövde, Sweden.
- School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - Catharina Gillsjö
- School of Health Sciences, University of Skövde, P.O. Box 408, SE-541 28, Skövde, Sweden
- College of Nursing, University of Rhode Island, Kingston, RI, USA
| | - Anna K Dahl Aslan
- School of Health Sciences, University of Skövde, P.O. Box 408, SE-541 28, Skövde, Sweden
| | - Jenny Hallgren
- School of Health Sciences, University of Skövde, P.O. Box 408, SE-541 28, Skövde, Sweden
| |
Collapse
|
4
|
Harber-Aschan L, Darin-Mattsson A, Fratiglioni L, Calderón-Larrañaga A, Dekhtyar S. Socioeconomic differences in older adults' unplanned hospital admissions: the role of health status and social network. Age Ageing 2023; 52:7127659. [PMID: 37079867 PMCID: PMC10118263 DOI: 10.1093/ageing/afac290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND the socioeconomic distribution of unplanned hospital admissions in older adults is poorly understood. We compared associations of two life-course measures of socioeconomic status (SES) with unplanned hospital admissions while comprehensively accounting for health, and examined the role of social network in this association. METHODS in 2,862 community-dwelling adults aged 60+ in Sweden, we derived (i) an aggregate life-course SES measure grouping individuals into Low, Middle or High SES based on a summative score, and (ii) a latent class measure that additionally identified a Mixed SES group, characterised by financial difficulties in childhood and old age. The health assessment combined measures of morbidity and functioning. The social network measure included social connections and support components. Negative binomial models estimated the change in hospital admissions over 4 years in relation to SES. Stratification and statistical interaction assessed effect modification by social network. RESULTS adjusting for health and social network, unplanned hospitalisation rates were higher for the latent Low SES and Mixed SES group (incidence rate ratio [IRR] = 1.38, 95% confidence interval [CI]: 1.12-1.69, P = 0.002; IRR = 2.06, 95% CI: 1.44-2.94, P < 0.001; respectively; ref: High SES). Mixed SES was at a substantially greater risk of unplanned hospital admissions among those with poor (and not rich) social network (IRR: 2.43, 95% CI: 1.44-4.07; ref: High SES), but the statistical interaction test was non-significant (P = 0.493). CONCLUSION socioeconomic distributions of older adults' unplanned hospitalisations were largely driven by health, although considering SES dynamics across life can reveal at-risk sub-populations. Financially disadvantaged older adults might benefit from interventions aimed at improving their social network.
Collapse
Affiliation(s)
- Lisa Harber-Aschan
- Demography Unit, Department of Sociology, Stockholm University, Universitetsvägen 10, 114 18 Stockholm, Sweden
- Stockholm University Demography Unit, Stockholm University, Stockholm, Sweden
| | - Alexander Darin-Mattsson
- Demography Unit, Department of Sociology, Stockholm University, Universitetsvägen 10, 114 18 Stockholm, Sweden
| | - Laura Fratiglioni
- Demography Unit, Department of Sociology, Stockholm University, Universitetsvägen 10, 114 18 Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Amaia Calderón-Larrañaga
- Demography Unit, Department of Sociology, Stockholm University, Universitetsvägen 10, 114 18 Stockholm, Sweden
| | - Serhiy Dekhtyar
- Demography Unit, Department of Sociology, Stockholm University, Universitetsvägen 10, 114 18 Stockholm, Sweden
| |
Collapse
|
5
|
Liljas AE, Agerholm J, Schön P, Burström B. Risk factors for infection in older adults who receive home healthcare and/or home help: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e31772. [PMID: 36397381 PMCID: PMC9666220 DOI: 10.1097/md.0000000000031772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The shift towards home-based care has resulted in increased provision of home healthcare and home help to older adults. Infections acquired in older adults while receiving home care have increased too, resulting in unplanned yet avoidable hospitalizations. In recent years, several studies have reported an array of factors associated with risk of infection; however, no previous systematic review has compiled such evidence, which is important to better protect older adults. Therefore, we have outlined the work of a systematic review that aims to identify risk factors for infection in older adults receiving home healthcare and/or home help. METHODS Searches for relevant studies will be conducted in five databases [MEDLINE, EMBASE (Excerpta Medica Database), Web of Science Core Collection, Cinahl (Cumulative Index to Nursing & Allied Health Literature) and Sociological Abstracts]. All types of studies will be included. Exposures considered refer to medical, individual, social/behavioral and environmental risk factors for infection (outcome). Two researchers will independently go through the records generated. Eligible studies will be assessed for risk of biases using the Cochrane risk of bias assessment tool and an overall interpretation of the biases will be provided. If the data allow, a meta-analysis will be conducted. It is possible that both quantitative and qualitative studies will be identified and eligible. Therefore, for the analysis, the Joanna Briggs Institute Reviewers' Manual for mixed methods systematic reviews will be used as it allows for two or more single method reviews (e.g., one quantitative and one qualitative) to be conducted separately and then combined in a joint overarching synthesis. RESULTS The findings of the planned systematic review are of interest to healthcare professionals, caregivers, older adults and their families, and policy- and decisions makers in the health and social care sectors as the review will provide evidence-based data on multiple factors that influence the risk of infection among older adults receiving care in their homes. CONCLUSION The results could guide future policy on effective infection control in the home care sector.
Collapse
Affiliation(s)
- Ann E.M. Liljas
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- * Correspondence: Ann E.M. Liljas, Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden (e-mail: )
| | - Janne Agerholm
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Pär Schön
- Institution for Social Work, Stockholm University, Stockholm, Sweden
| | - Bo Burström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
6
|
Pathways to reduced overnight hospitalizations in older adults: Evaluating 62 physical, behavioral, and psychosocial factors. PLoS One 2022; 17:e0277222. [DOI: 10.1371/journal.pone.0277222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/24/2022] [Indexed: 11/12/2022] Open
Abstract
As our society ages and healthcare costs escalate, researchers and policymakers urgently seek potentially modifiable predictors of reduced healthcare utilization. We aimed to determine whether changes in 62 candidate predictors were associated with reduced frequency, and duration, of overnight hospitalizations. We used data from 11,374 participants in the Health and Retirement Study—a national sample of adults aged >50 in the United States. Using generalized linear regression models with a lagged exposure-wide approach, we evaluated if changes in 62 predictors over four years (between t0;2006/2008 and t1;2010/2012) were associated with subsequent hospitalizations during the two years prior to t2 (2012–2014 (Cohort A) or 2014–2016 (Cohort B)). After robust covariate-adjustment, we observed that changes in some health behaviors (e.g., those engaging in frequent physical activity had 0.80 the rate of overnight hospital stays (95% CI [0.74, 0.87])), physical health conditions (e.g., those with cancer had 1.57 the rate of overnight hospital stays (95% CI [1.35, 1.82])), and psychosocial factors (e.g., those who helped friends/neighbors/relatives 100–199 hours/year had 0.73 the rate of overnight hospital stays (95% CI [0.63, 0.85])) were associated with subsequent hospitalizations. Findings for both the frequency, and duration, of hospitalizations were mostly similar. Changes in a number of diverse factors were associated with decreased frequency, and duration, of overnight hospitalizations. Notably, some psychosocial factors (e.g., informal helping) had effect sizes equivalent to or larger than some physical health conditions (e.g., diabetes) and health behaviors (e.g., smoking). These psychosocial factors are mostly modifiable and with further research could be novel intervention targets for reducing hospitalizations.
Collapse
|
7
|
Hovlin L, Hallgren J, Dahl Aslan AK, Gillsjö C. The role of the home health care physician in mobile integrated care: a qualitative phenomenograpic study. BMC Geriatr 2022; 22:554. [PMID: 35787260 PMCID: PMC9252081 DOI: 10.1186/s12877-022-03211-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 06/14/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND An increasing older population, along with the organizational principle of remaining at home, has moved health care from institutions into the older person's home, where several health care providers facilitate care. The Mobile Integrated Care Model strives to provide cost-efficient, coherent, person-centered health care in the home. In the integrated care team, where the home health care physician is the medical authority, several health care professions work across organizational borders. Therefore, the aim of this study was to describe Home Health Care Physicians perceptions of working and providing health care in the Mobile Integrated Care Model, as well as perceptions of participating in and forming health care. METHODS A phenomenographic qualitative study design, with semi-structured interviews using an interview guide. RESULTS Working within Mobile Integrated Care Model was a different way of working as a physician. The physicians' role was to support the patient by making safe medical decisions. Physicians described themselves as a piece in the team puzzle, where the professional knowledge of others was crucial to give quality health care. Being in the patients' homes was expressed as adding a unique dimension in the provision of health care, and the physicians learned more about the patients by meeting them in their homes than at an institution. This aided the physicians in respecting patient autonomy in medical decision making, even though the physicians sometimes disregarded patient autonomy in favor of their own medical experience. There was a divided view on next of kin participation among the home health care physicians, ranging from always including to total absence of involving next of kin in decision making. CONCLUSIONS The home health care physicians described the Mobile Integrated Care Model as the best way to work, but there was still a need for additional resources and structure when working in different organizations. The need for full-time employment, additional time or hours, more equipment, access to each other's medical records, and additional collaboration with other health care providers were expressed, which could contribute to increased work satisfaction and facilitate further development of person-centered care in the Mobile Integrated Care Model.
Collapse
Affiliation(s)
- Lina Hovlin
- School of Health Sciences, University of Skövde, P.O. Box 408, SE-541 28 Skövde, Sweden
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Jenny Hallgren
- School of Health Sciences, University of Skövde, P.O. Box 408, SE-541 28 Skövde, Sweden
| | - Anna K. Dahl Aslan
- School of Health Sciences, University of Skövde, P.O. Box 408, SE-541 28 Skövde, Sweden
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Catharina Gillsjö
- School of Health Sciences, University of Skövde, P.O. Box 408, SE-541 28 Skövde, Sweden
- College of Nursing, University of Rhode Island, Kingston, RI USA
| |
Collapse
|
8
|
Varavithya V, Tirapat C, Rojpibulstit P, Poovichayasumlit P, Prasert V, Vatcharavongvan P. Potentially inappropriate medication use and the hospitalization rate among Thai elderly patients: a retrospective cohort study. Eur J Clin Pharmacol 2022; 78:847-855. [DOI: 10.1007/s00228-021-03269-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/18/2021] [Indexed: 11/03/2022]
|
9
|
Health care utilization in very advanced ages: A study on predisposing, enabling and need factors. Arch Gerontol Geriatr 2021; 98:104561. [PMID: 34706319 DOI: 10.1016/j.archger.2021.104561] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/11/2021] [Accepted: 10/16/2021] [Indexed: 12/21/2022]
Abstract
This study aims to examine the effects of predisposing, enabling, and need factors on healthcare utilization in advanced age. Data from a sample of 270 Portuguese community-dwelling persons aged ≥80 years was used. Face-to-face interviews were conducted and included the application of a research protocol addressing a set of sociodemographic and health-related variables that expressed the Andersen Behavioral model (i.e., predisposing, enabling, and need factors). Predictors of visits to general practitioners (GP) and specialist physicians, as well as emergency department (ED) use and hospitalizations were investigated. Multivariate linear and logistic regression analyzes were used to model the effects of predictor factors specified in the Andersen Behavioral model. Our findings underscore that younger age and having multimorbidity were significantly associated with having GP visits. Specialist physician visits were associated with younger age and a higher number of daily medications. ED use was associated with being male, having formal social support and a higher number of daily medications. Hospitalizations were associated with being younger, being male and having multimorbidity. Our findings revealed that need and predisposing factors determined the most healthcare use.
Collapse
|
10
|
Sagie S, Na'amnih W, Frej J, Alpert G, Muhsen K. Associations of psychosocial factors, knowledge, attitudes and practices with hospitalizations in internal medicine divisions in different population groups in Israel. Int J Equity Health 2021; 20:105. [PMID: 33879185 PMCID: PMC8056509 DOI: 10.1186/s12939-021-01444-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 04/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inequalities in healthcare utilization exist across ethnic groups; however, the contributions of health-related knowledge and psychosocial factors to these inequalities remain unclear. We examined associations of social determinants of health, psychological factors, knowledge, attitudes and health practices, with hospitalizations in internal medicine divisions, among Israeli adults, Jews and Arabs, with non-communicable diseases, in a setting of universal health insurance. METHODS A retrospective study was undertaken among 520 Jews and Arabs aged 40 years or older with non-communicable diseases, members of a large health maintenance organization. Hospitalization (at least once during 2008) in an internal medicine division was determined based on documentation in electronic health records. Participants were randomly selected in strata of sex, population-group and hospitalization status (yes/no). Data were collected from medical records and via face-to-face interviews using a structured questionnaire. Main independent variables included comorbidity burden, health behaviors, mental health wellbeing and self-rated health. Scales measuring health knowledge and attitudes/beliefs were constructed using factor analysis. RESULTS Comorbidity burden (OR 1.41 [95% CI 1.24-1.61]) and self-rated health (not good vs. good) (OR 1.88 [95% CI 1.13-3.12]) were positively associated with hospitalizations in an internal medicine division, while an inverse association was found with better mental health wellbeing (OR 0.98 [95% CI 0.96-0.99, for each 1-point score increase). Among Jewish participants, positive associations were found of the number of offspring, comorbidity burden and perceived difficulty, with hospitalizations. No significant associations were found with hospitalizations of other sociodemographics, health behaviors, knowledge and attitudes/beliefs. CONCLUSIONS Comorbidity burden was the main risk factor of hospitalizations in internal medicine divisions. Psychosocial factors, such as self-rated health, a complex variable affected by social capital, mental wellbeing, the number of offspring, and perceived burden and difficulty, seem also to contribute. These findings suggest the involvement of broad family and social factors, beyond individual level characteristics and medical needs, in hospitalizations in internal medicine divisions. Interventions to reduce hospitalizations should be comprehensive and integrate aspects of mental health wellbeing; they should build on familial characteristics (e.g., number of offspring), factors related to social capital such as self-rated health, and perceived burden and difficulty.
Collapse
Affiliation(s)
- Shira Sagie
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, 6139001, Tel Aviv, Israel. .,Department of Oncology, Sheba Medical Center, 52621, Ramat Gan, Israel.
| | - Wasef Na'amnih
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, 6139001, Tel Aviv, Israel
| | - Juda Frej
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, 6139001, Tel Aviv, Israel
| | | | - Khitam Muhsen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, 6139001, Tel Aviv, Israel
| |
Collapse
|
11
|
Correlates of hospitalization among the oldest old: results of the AgeCoDe-AgeQualiDe prospective cohort study. Aging Clin Exp Res 2020; 32:1295-1301. [PMID: 31422564 DOI: 10.1007/s40520-019-01315-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 08/08/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hospitalization is a key driver of health care costs. Thus far, there are only a few longitudinal studies investigating whether changes in explanatory variables lead to hospitalization. Moreover, these longitudinal studies did not focus on individuals in highest age. AIM The purpose of the current study was to examine the correlates of hospitalization among the oldest old in Germany longitudinally. METHODS A multicenter prospective cohort study ["Study on Needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (85+)", AgeQualiDe]. Primary care patients ≥ 85 years took part [n = 861 at follow-up (FU) 7, average age of 89.0 years; 85-100 years]. Two waves were used. Hospitalization in the last 6 months was used as outcome measure. Well-established scales were used to quantify the independent variables such as Instrumental Activities of Daily Living Scale, Global Deterioration Scale or Geriatric Depression Scale. RESULTS Logistic random effects regressions showed that the probability of hospitalization in the preceding 6 months significantly increased with increases in the social network, more depressive symptoms, functional decline, and increase in chronic conditions, whereas it was not significantly associated with age, sex, marital status, education, and cognitive impairment. Social networks moderate the relationship between functional decline and hospitalization. DISCUSSION The results of the present longitudinal study emphasize the association of depressive symptoms, functional decline, more social networks, and chronic conditions with hospitalization among the oldest old. CONCLUSIONS Treatments with the aim to reduce or postpone these factors might also help to reduce hospitalization.
Collapse
|
12
|
Hallgren J, Johansson L, Lannering C, Ernsth Bravell M, Gillsjö C. Health- and social care in the last year of life among older adults in Sweden. BMC Palliat Care 2020; 19:90. [PMID: 32576290 PMCID: PMC7313197 DOI: 10.1186/s12904-020-00598-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/17/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In the last years of life, burden of disease and disability and need of health- and social care often increase. Social, functional and psychological factors may be important in regard to social- and health care utilization. This study aims to describe use of health- and social care during the last year of life among persons living in ordinary housing or in assisted living facilities. METHODS A retrospective study examining health- and social care utilization during their last year of life, using a subsample from the Swedish twin registries individually linked to several Swedish national quality registries (NQR). Persons that died during 2008-2009 and 2011-2012 (n = 1518) were selected. RESULTS Mean age at death was 85.9 ± 7.3 (range 65.1-109.0). Among the 1518 participants (women n = 888, 58.5%), of which 741 (49%) were living in assisted living facilities and 1061 (69.9%) had at least one hospitalization during last year of life. The most common causes of death were cardiovascular disease (43.8%) and tumors (15.3%). A multivariable logistic regression revealed that living in ordinary housing, younger age and higher numbers of NQR's increased the likelihood of hospitalization. CONCLUSIONS Persons in their last year of life consumed high amount of health- and social care although 12% did not receive any home care. Married persons received less home care than never married. Persons living in ordinary housing had higher numbers of hospitalizations compared to participants in assisted living facilities. Older persons and persons registered in fewer NQR's were less hospitalized.
Collapse
Affiliation(s)
- Jenny Hallgren
- School of Health Sciences, University of Skövde, Skövde, Sweden.
- Institute of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - Linda Johansson
- Institute of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Christina Lannering
- Institute of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Futurum, Ryhov, Region Jönköping County, Jönköping, Sweden
| | - Marie Ernsth Bravell
- Institute of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Catharina Gillsjö
- School of Health Sciences, University of Skövde, Skövde, Sweden
- College of Nursing, University of Rhode Island, Kingston, USA
| |
Collapse
|
13
|
Determinants of Overnight Stay in Health Centres and Length of Admission: A Study of Canadian Seniors. Can J Aging 2020; 39:533-544. [PMID: 32089138 DOI: 10.1017/s0714980819000771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This study examines the influence of chronic health conditions and socio-economic status on overnight admission and length of stay among Canadian seniors. Incremental multivariate logistic and zero-inflated negative binomial regression models assessed the relationship between selected predictors, overnight admission, and duration of stay. The findings show that all chronic health conditions and socio-economic factors examined were significantly associated with overnight hospital admission. However, seniors with cardiovascular health conditions, the very old, and seniors living in lower-income households had a greater risk of longer stays. Canadian seniors diagnosed with hypertension, cancer, diabetes, and stroke had greater risk of longer overnight hospital stays. Seniors aged 75 to 79 years, 80 years or older, and those living in lower-income households (≤ $39,999) were more likely to have a longer overnight hospital stay. Findings suggest that improving seniors' health and socio-economic status may reduce the risk of overnight admission and longer stays of hospitalisation.
Collapse
|
14
|
Straatmann VS, Dekhtyar S, Meinow B, Fratiglioni L, Calderón-Larrañaga A. Unplanned Hospital Care Use in Older Adults: The Role of Psychological and Social Well-Being. J Am Geriatr Soc 2020; 68:272-280. [PMID: 31956993 DOI: 10.1111/jgs.16313] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/08/2019] [Accepted: 11/17/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To explore the association of psychological and social well-being with unplanned hospital utilization in an older Swedish population. DESIGN Data for this study were gathered from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K). Information on hospital care use was extracted from the Stockholm County Council Inpatient Register for up to 4 years after the baseline SNAC-K assessment (2001-2007). Participants with dementia or living in institutions were excluded from the study sample. SETTING Community-based study of randomly selected adults, aged 60 years or older, living in the Kungsholmen district of Stockholm. PARTICIPANTS A complete case analysis was performed on 2139 individuals. MEASUREMENTS We created standardized indexes of psychological well-being (integrating life satisfaction and positive and negative affect) and social well-being (integrating social connections, support, and participation). Negative binomial models were used to estimate the association of psychosocial well-being with unplanned admissions, hospital days, and 30-day readmissions, considering potential sociodemographic, lifestyle, personality, and clinical confounders. RESULTS Individuals with psychological well-being scores above the median had lower rates of unplanned hospital admissions (incidence rate ratio [IRR] = 0.67; 95% confidence interval [CI] = 0.55-0.82) and hospital days (IRR = 0.67; 95% CI = 0.49-0.92) compared to those with scores below the median. High levels of social well-being were also protective for unplanned admissions and hospital days, but the statistical significance was lost in the fully adjusted models. Relative to individuals with low well-being on both indexes, the rate of unplanned admissions and hospital days was lowest in those with both high psychological and social well-being (IRR = 0.72; 95% CI = 0.55-0.93; and IRR = 0.57; 95% CI = 0.39-0.85, respectively). For 30-day readmissions, a statistically significant negative association was found with psychological well-being, but only when operationalized as a continuous variable. CONCLUSION Given their association with unplanned admissions and hospital days, targeting aspects of psychosocial well-being could be a viable strategy for reducing healthcare use and, eventually, costs. J Am Geriatr Soc 68:272-280, 2020.
Collapse
Affiliation(s)
- Viviane S Straatmann
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm University, Solna, Sweden
| | - Serhiy Dekhtyar
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm University, Solna, Sweden
| | - Bettina Meinow
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm University, Solna, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm University, Solna, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm University, Solna, Sweden
| |
Collapse
|
15
|
Brandão D, Ribeiro O, Teixeira L, Paúl C. Perceived risk of institutionalization, hospitalization, and death in oldest old primary care patients. Arch Gerontol Geriatr 2019; 87:103974. [PMID: 31786410 DOI: 10.1016/j.archger.2019.103974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/05/2019] [Accepted: 11/06/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVES This study aims to analyze the accuracy and predictive ability of the Risk Instrument for Screening in the Community (RISC) scored by general practitioners (GPs) in a sample of primary care patients aged 80+ with perceived mental health concerns. METHOD GPs ranked the perceived risk of the three adverse outcomes (hospitalization, institutionalization and death) at 1 year in a five Likert scale (RISC score), where 1 is the lowest risk and 5 is the highest. Follow up contacts were conducted after 1 year of assessment in order to collect data on the three outcomes. RESULTS The 1-year proportion of institutionalization, hospitalization and death were 12.1 %, 25.2 % and 19.0 % respectively. Based upon the sensitivity and specificity from the Receiver Operating Characteristic (ROC) curves, we found an optimal cut-off point of ≥4 for the RISC. The RISC had fair accuracy for 1-year risk of institutionalization (Area Under the ROC curve (AUC) = 0.75, 95% CI 0.43-0.68) and hospitalization (AUC = 0.65, 95% CI 0.52-0.78), but not for death (AUC = 0.55, 95% CI 0.43-0.68). CONCLUSIONS The RISC as a short global subjective assessment is to be considered a reliable tool for use by GPs. Our results showed that RISC seems to be a good instrument to triage very old people at risk for institutionalization but with poor accuracy at predicting hospitalization and limited predictive ability for death, suggesting further research and caution on this instrument's use.
Collapse
Affiliation(s)
- Daniela Brandão
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal; Faculty of Medicine, University of Porto (FMUP), Porto, Portugal.
| | - Oscar Ribeiro
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal; Department of Education and Psychology, University of Aveiro (DEP.UA), Aveiro, Portugal
| | - Laetitia Teixeira
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal; Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal; EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
| | - Constança Paúl
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal; Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| |
Collapse
|
16
|
Hanson S, Brabrand M, Lassen AT, Ryg J, Nielsen DS. What Matters at the End of Life: A Qualitative Study of Older Peoples Perspectives in Southern Denmark. Gerontol Geriatr Med 2019; 5:2333721419830198. [PMID: 30815513 PMCID: PMC6381425 DOI: 10.1177/2333721419830198] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/02/2019] [Accepted: 01/07/2019] [Indexed: 11/16/2022] Open
Abstract
What matters at the end of life (EOL) among the older population in Denmark is poorly investigated. We used focus groups and in-depth interviews, to identify perspectives within the EOL, along with what influences resuscitation, decision making, and other treatment preferences. We included eligible participants aged ≥65 years in the Region of Southern Denmark. Five focus groups and nine in-depth interviews were conducted, in total 31 participants. We found a general willingness to discuss EOL, and experiences of the process of dying were present among all participants. Three themes emerged during the analysis: (a) Being independent is crucial for the future, (b) Handling and talking about the EOL, and (c) Conditions in Everyday Life are Significant. Life experiences seemed to affect the degree of reflection of EOL and the decision-making process. Knowing your population of interest is crucial, when developing an approach or using an advance care plan from another setting.
Collapse
Affiliation(s)
- Stine Hanson
- University of Southern Denmark, Esbjerg, Denmark.,Hospital of South West Jutland, Esbjerg, Denmark
| | - Mikkel Brabrand
- University of Southern Denmark, Esbjerg, Denmark.,Hospital of South West Jutland, Esbjerg, Denmark
| | | | - Jesper Ryg
- University of Southern Denmark, Esbjerg, Denmark.,Odense University Hospital, Denmark
| | - Dorthe S Nielsen
- University of Southern Denmark, Esbjerg, Denmark.,Odense University Hospital, Denmark.,University College Lillebaelt, Denmark
| |
Collapse
|
17
|
Melo-Silva AMD, Mambrini JVDM, Souza Junior PRBD, Andrade FBD, Lima-Costa MF. Hospitalizations among older adults: results from ELSI-Brazil. Rev Saude Publica 2018; 52Suppl 2:3s. [PMID: 30379289 PMCID: PMC6255366 DOI: 10.11606/s1518-8787.2018052000639] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 03/09/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To examine the factors associated with hospital use and their frequency in a nationally representative sample of the Brazilian population aged 50 years or older. METHODS Data from the baseline of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), conducted in 2015-2016, were used. Predisposing, enabling and need factors for the use of health services were considered. The analyzes were based on the Hurdle regression model and on estimates of population attributable risks. RESULTS Among 9,389 participants, 10.2% had been hospitalized in the previous 12 months. After adjusting for potential confounding variables, statistically significant associations (p < 0.05) were observed for need factors (previous medical diagnosis for chronic diseases and limitation to perform basic activities of daily living) and for enabling factors (living in a rural area and in the North and Midwest regions of the country). The analysis of population attributable risks (PAR) showed a hierarchy of the need factors for the occurrence of hospitalizations, with higher contributions by stroke (PAR = 10.7%) and cardiovascular disease (PAR = 10.0%), followed by cancer (PAR = 8.9%), difficulty to perform basic activities of daily living (PAR = 6.8%), depression (PAR = 5.5%), diabetes (PAR = 4.4% ) and hypertension (PAR = 2.2%). CONCLUSIONS Four of the major diseases associated with hospitalizations (stroke, cardiovascular disease, diabetes and hypertension) are part of the Brazilian list of primary care-sensitive hospitalizations. These results show that there is a window of opportunity to reduce unnecessary hospitalizations among older Brazilian adults through effective primary care actions.
Collapse
Affiliation(s)
- Alexandre Moreira de Melo-Silva
- Fundação Oswaldo Cruz. Instituto René Rachou. Programa de Pós-Graduação em Saúde Coletiva. Belo Horizonte, MG, Brasil.,Fundação Oswaldo Cruz. Instituto René Rachou. Núcleo de Estudos em Saúde Pública e Envelhecimento. Belo Horizonte, MG, Brasil
| | - Juliana Vaz de Melo Mambrini
- Fundação Oswaldo Cruz. Instituto René Rachou. Programa de Pós-Graduação em Saúde Coletiva. Belo Horizonte, MG, Brasil.,Fundação Oswaldo Cruz. Instituto René Rachou. Núcleo de Estudos em Saúde Pública e Envelhecimento. Belo Horizonte, MG, Brasil
| | | | - Fabíola Bof de Andrade
- Fundação Oswaldo Cruz. Instituto René Rachou. Programa de Pós-Graduação em Saúde Coletiva. Belo Horizonte, MG, Brasil.,Fundação Oswaldo Cruz. Instituto René Rachou. Núcleo de Estudos em Saúde Pública e Envelhecimento. Belo Horizonte, MG, Brasil
| | - Maria Fernanda Lima-Costa
- Fundação Oswaldo Cruz. Instituto René Rachou. Programa de Pós-Graduação em Saúde Coletiva. Belo Horizonte, MG, Brasil.,Fundação Oswaldo Cruz. Instituto René Rachou. Núcleo de Estudos em Saúde Pública e Envelhecimento. Belo Horizonte, MG, Brasil
| |
Collapse
|
18
|
Risk factors for hospital readmission among Swedish older adults. Eur Geriatr Med 2018; 9:603-611. [PMID: 30294396 PMCID: PMC6153697 DOI: 10.1007/s41999-018-0101-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 08/21/2018] [Indexed: 11/12/2022]
Abstract
Introduction Hospital readmissions of older persons are common and often associated with complex health problems. The objectives were to analyze risk factors for readmission within 30 days from hospital discharge. Methods A prospective study with a multifactorial approach based on the population-based longitudinal Swedish Adoption/Twin Study of Aging (SATSA) was conducted. During 9 years of follow-up, information on hospitalizations, readmissions and associated diagnoses were obtained from national registers. Logistic regression models controlling for age and sex were conducted to analyze risk factors for readmissions. Results Of the 772 participants, [mean age 69.7 (± 11.1), 84 (63%)] were hospitalized and among these 208 (43%) had one or several readmissions within 30 days during the follow-up period. Most of the readmissions (57%) occurred within the first week; mean days from hospital discharge to readmission was 7.9 (± 6.2). The most common causes of admission and readmission were cardiovascular diseases and tumors. Only 8% of the readmissions were regarded as avoidable admissions. In a multivariate logistic regression, falling within the last 12 months (OR 0.57, p = 0.039) and being a male (OR 1.84, p = 0.006) increased the risk of readmission. Conclusions Most older persons that are readmitted return to hospital within the first week after discharge. Experiencing a fall was a particular risk factor of readmission. Preventive actions should preferably take place already at the hospital to reduce the numbers of readmission. Still, it should be remembered that most readmissions were considered to be necessary.
Collapse
|
19
|
Dahlberg L, Agahi N, Schön P, Lennartsson C. Planned and Unplanned Hospital Admissions and Their Relationship with Social Factors: Findings from a National, Prospective Study of People Aged 76 Years or Older. Health Serv Res 2018; 53:4248-4267. [PMID: 29952093 PMCID: PMC6232498 DOI: 10.1111/1475-6773.13001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To examine the relationship between social factors and planned and unplanned hospital admissions among older people. DATA SOURCES/STUDY SETTING 2011 data from the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) and data from the Swedish National Patient Register until December 31, 2012. STUDY DESIGN The study had a prospective design. Data were analyzed via Cox proportional hazard regressions with variables entered as blocks (social factors, sociodemographic and ability factors, health factors). DATA COLLECTION Data were collected via interviews with people aged 76+ (n = 931). PRINCIPAL FINDINGS Living in institutions was negatively associated with planned admissions (hazard ratio (HR): 0.29; confidence interval (CI): 0.09-0.88), while being in receipt of home help was positively associated with unplanned admissions (HR: 1.57; CI: 1.15-2.14). Low levels of social contacts and social activity predicted unplanned admissions in bivariate analyses only. Higher ability to deal with public authorities was positively associated with planned admissions (HR: 1.77; CI: 1.13-2.78) and negatively associated with unplanned admissions, although the latter association was only significant in the bivariate analysis. CONCLUSIONS Hospital admissions are not only due to health problems but are also influenced by the social care situation and by the ability to deal with public authorities.
Collapse
Affiliation(s)
- Lena Dahlberg
- Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Neda Agahi
- Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden
| | - Pär Schön
- Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden
| | - Carin Lennartsson
- Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden
| |
Collapse
|