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Che RP, Cheung MC. Factors Associated with the Utilization of Home and Community-Based Services (HCBS) Among Older Adults: A Systematic Review of the Last Decade. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2024; 67:776-802. [PMID: 38616618 DOI: 10.1080/01634372.2024.2342455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 04/09/2024] [Indexed: 04/16/2024]
Abstract
Home and community-based services (HCBS) for older adults have been promoted worldwide to address the growing problems of aging. This systematic review included 59 studies published from 2013 to 2023 to explore factors influencing the utilization of HCBS among older adults. The review identified 15 common factors grouped into four levels of influence: individual, inter-relationship, community, and social contextual levels. The findings suggest that HCBS utilization is a dynamic process influenced by multiple factors at different levels. Gerontological social work should incorporate ecological thinking to improve practice and strengthen caregiver-recipient relationships.
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Affiliation(s)
- Run-Ping Che
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Mei-Chun Cheung
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong SAR, China
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2
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Yu Y, Zhang J, Petrovic M, Zhang X, Zhang WH. Utilization of home- and community-based services among older adults worldwide: A systematic review and meta-analysis. Int J Nurs Stud 2024; 155:104774. [PMID: 38703696 DOI: 10.1016/j.ijnurstu.2024.104774] [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: 09/23/2023] [Revised: 03/29/2024] [Accepted: 04/09/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE To identify and categorize home- and community-based services used by older adults and the distribution of their utilization, and to examine their utilization patterns in terms of region, time trends, and older adults' characteristics. DESIGN Systematic review and meta-analysis. METHODS We conducted a systematic search of six databases for studies published up to January 12, 2023, and performed meta-analyses and subgroup analyses to identify the utilization of home- and community-based services and analyze utilization patterns concerning region, time trends, and individual characteristics. RESULTS We included 42 studies from 10 countries worldwide, involving a total of 2,942,069 older adults. Home- and community-based services were grouped into three categories: health services, social services, and family caregiver services. Regional differences were consistently evident across all three categories of services, reflecting diverse patterns of home- and community-based service adoption worldwide. Notably, there was a significant increase in the utilization of social services, as distinct from health services and family caregiver services, during the post-2010 period (2010-2018) in comparison with the pre-2010 period (before 2010). In addition, age and cognitive function also played an important role in the utilization of home- and community-based services. CONCLUSION These findings highlight the importance of tailoring home- and community-based services to specific populations and understanding the needs of older adults over time. Further research should be undertaken to gain a deeper understanding of the reasons behind these variations and differences and to provide more targeted and effective services to older adults worldwide.
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Affiliation(s)
- Yushan Yu
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium
| | - Jun Zhang
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium; The Research Center for Medical Sociology, Tsinghua University, Beijing 100084, China
| | - Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium
| | - Xudong Zhang
- Faculty of Management and Economics, Kunming University of Science and Technology, Kunming 650092, China
| | - Wei-Hong Zhang
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium; School of Public Health, Université libre de Bruxelles (ULB), Brussels 1070, Belgium.
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Bertuccio P, Vigezzi GP, Amerio A, Cavalieri D'oro L, Iacoviello L, Stuckler D, Signorelli C, Zucchi A, Gallus S, Odone A. Health and social home services among community-dwelling older people during COVID-19: Results from the cross-sectional LOST in Lombardia project. Scand J Public Health 2024; 52:262-270. [PMID: 37688313 DOI: 10.1177/14034948231184516] [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] [Indexed: 09/10/2023]
Abstract
BACKGROUND Few studies have focused on changes in health and social services access due to the COVID-19 pandemic. We aimed to describe changes in the use of selected health and social home services due to the pandemic and to investigate potential associated factors, including socio-demographic characteristics, number of chronic diseases and mental health indicators, among older Italian individuals. METHODS We analysed data from the LOST in Lombardia cross-sectional study conducted in November 2020 on a large representative sample of 4400 individuals aged ⩾65 years. To identify potential factors associated with the increased use of three selected health and social home services, we estimated odds ratios (OR) and confidence intervals (CI) using multivariable logistic regression models. RESULTS Compared to the year before, 5.0% of older adults increased help from domestic workers (vs. 6.9% reducing) during the pandemic, 4.4% increased help from non-familiar caregivers (vs. 1.3% decreasing) and 4.7% increased medical home visits (vs. 1.0% decreasing). An increase in the use of these services was more frequent among participants with co-morbidities (p for trend <0.001), especially with diabetes (for caregivers: OR=12.2, 95% CI 6.0-24.8), and worse mental health (for caregivers and for those with a GAD-2 score ⩾3 vs. <3: OR=10.6, 95% CI 5.8-19.4). Conversely, people living in more crowded households less frequently increased health and social services use during the pandemic. CONCLUSIONS Our results should inform targeted interventions for the identified vulnerable groups to close the gap in health and social inequities.
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Affiliation(s)
- Paola Bertuccio
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
| | - Giacomo Pietro Vigezzi
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
- Collegio Ca' della Paglia, Fondazione Ghislieri, Italy
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Italy
- IRCCS San Martino Polyclinic Hospital, Italy
| | | | - Licia Iacoviello
- Department of Medicine and Surgery, Research Centre in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, Italy
- Department of Epidemiology and Prevention, IRCCS Neuromed, Italy
| | - David Stuckler
- Department of Social and Political Sciences, Bocconi University, Italy
| | | | - Alberto Zucchi
- Epidemiology Unit, Bergamo Health Protection Agency, Italy
| | - Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Italy
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
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Wagner A, Brach M, Scheel-Sailer A, Friedli M, Hund-Georgiadis M, Jordan X, Schubert M, Gemperli A. Use of professional home care in persons with spinal cord injury in Switzerland: a cross-sectional study. BMC Health Serv Res 2023; 23:1393. [PMID: 38087349 PMCID: PMC10714621 DOI: 10.1186/s12913-023-10429-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/04/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Persons with spinal cord injury (SCI) living in the community often require care. The boundaries between professional home care and informal care are blurred, and it is unclear who the typical user of home care is. The objective of this study was to describe the characteristics of persons with SCI using professional home care in Switzerland, determine the frequency of home care visits, and investigate the association of sociodemographic factors, SCI-specific characteristics, secondary health conditions, and functional independence with the use of home care. METHODS We used cross-sectional data from the 2017 community survey of the Swiss Spinal Cord Injury Cohort Study (SwiSCI). Out of 3,959 eligible individuals 1294 completed the questionnaire and were included in the analysis (response rate 33%). Using descriptive statistics, differences between home care users and non-users as well as the frequency of home care visits were investigated. The association between sociodemographic factors, SCI-specific characteristics, secondary health conditions, functional independence and the use of home care was analyzed using multivariable logistic regression. Multiple imputation was used to account for missing data. RESULTS Of 1,294 participants, 280 (22%) used professional home care. The median weekly professional home care duration was 6 h (Q1 = 2, Q3 = 12). More home care was used in persons with lower functional independence (Odds ratio (OR) 0.30 per 10 unit decrease in the Spinal Cord Independence Measure, 95%-Confidence interval (CI) 0.24-0.37), fewer secondary health conditions (OR 0.96 per unit Spinal Cord Injury Secondary Conditions Scale, 95%-CI 0.94-0.99), tetraplegia (OR 2.77, 95%-CI 1.92-4.00), women (OR 2.42, 95%-CI 1.70-3.43), higher age (OR 1.22 per 10 years increase, 95%-CI 1.06-1.39), living alone (OR 2.48, 95%-CI 1.53-4.03), and those receiving support from an informal caregiver (OR 1.88, 95%-CI 1.27-2.77). CONCLUSIONS This is the first study to examine the use of professional home care from the perspective of persons with SCI in Switzerland. Lower functional independence strongly predicts increased home care use. The findings showed that professional home care complements informal care and is more likely to be used by individuals with SCI who live alone, have tetraplegia, and are female.
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Affiliation(s)
| | | | - Anke Scheel-Sailer
- Swiss Paraplegic Centre, Nottwil, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | | | | | | | - Armin Gemperli
- Swiss Paraplegic Research, Nottwil, Switzerland.
- Center of Primary and Community Care, University of Lucerne, Lucerne, Switzerland.
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Li Y. Social care for disabled elderly women in urban China: The roles of the community. Soc Sci Med 2022; 314:115473. [PMID: 36332530 DOI: 10.1016/j.socscimed.2022.115473] [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: 07/14/2022] [Revised: 09/22/2022] [Accepted: 10/20/2022] [Indexed: 11/05/2022]
Abstract
This article analyses the provision of community care for urban disabled elderly women. With the emergence of an aging society in China and the empty nest syndrome in Chinese families, the number of elderly people who cannot take care of themselves is increasing. With the reduction in family size and the weakening of the home care function, traditional family care in China is facing immense challenges. On the one hand, a growing number of disabled elderly women are in urgent need of care; they encounter many difficulties in daily life, including poor health status, the loss of their spouse and living alone, an inability to support themselves economically, the lack of a spiritual life, and a significant reliance on their children to take care of them. On the other hand, the family's function of providing for the elderly has been weakened, and the traditional way of care is affected by the changes in modern society. Based on a qualitative study in Beijing, this article examines the demand for care from disabled elderly women and the current supply of community care. It puts forward a community-centred and targeted assistance model and social work intervention. This study argues that the community care system for disabled elderly women in urban areas should focus on four aspects, namely living care, medical care, spiritual consolation, and emergency assistance; and the protection mechanism should be improved to support disabled elderly women from three aspects: a protection system, a fund guarantee and services from health and social cafe staff and social workers.
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Affiliation(s)
- Yan Li
- School of Government, Nanjing University, Nanjing, Jiangsu, China.
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Che RP, Cheung MC. Community-Dwelling Older Adults' Intended Use of Different Types of Long-Term Care in China and Its Associated Factors Based on the Andersen Behavioral Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11626. [PMID: 36141900 PMCID: PMC9517182 DOI: 10.3390/ijerph191811626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
In light of the increased demand for long-term care services in China, there is an ongoing discussion on what factors contribute to older adults' intended use of long-term care services. This study empirically recruited 239 community-dwelling older adults aged ≥60 years in China and explored factors influencing their intended use of four types of long-term care (basic life care, basic medical care, rehabilitation care, and psychological care) based on the Andersen behavioral model (i.e., predisposing characteristics, enabling resources, and need factors). The results showed that older adults were most likely to use psychological care. Age (as the predisposing characteristic) was the significant predictor of the intended use of four types of care. Regarding the intended use of basic life care, the enabling resources of marital status, household composition, income, as well as need factors of preference for the care setting, were influential. Moreover, income and need factors of self-rated physical health status were only two variables associated with the intended use of basic medical care. Concerning the intended use of rehabilitation care, household composition, income, self-rated physical health status, and preference for the care setting were significant predictors. The intended use of psychological care was influenced by enabling resources of marital status, household composition, and need factors of self-rated physical health status, preference for the care setting, and preference for the caregiver. These results can promote the sensitivity of policymakers and caregivers to the community-dwelling older adults' intended use of long-term care and contribute to the delivery of appropriate care services by public policy.
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Burton E, Horgan NF, Cummins V, Warters A, Swan L, O’Sullivan M, Skelton DA, Townley B, Doyle F, Jabakhanji SB, Sorensen J, Rooney D, Murphy L, Galvin R. A Qualitative Study of Older Adults’ Experiences of Embedding Physical Activity Within Their Home Care Services in Ireland. J Multidiscip Healthc 2022; 15:1163-1173. [PMID: 35615293 PMCID: PMC9126230 DOI: 10.2147/jmdh.s351714] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/07/2022] [Indexed: 12/25/2022] Open
Abstract
Purpose Materials and Methods Results Conclusion
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Affiliation(s)
- Elissa Burton
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
- enAble Institute, Curtin University, Perth, Western Australia, Australia
- Correspondence: Elissa Burton, Curtin School of Allied Health, Curtin University, GPO Box U1987, Bentley, Western Australia, 6845, Australia, Tel +61 8 9266 4926, Fax +61 8 9266 3699, Email
| | - N Frances Horgan
- School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Vanda Cummins
- School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Primary Care Physiotherapy Services CHO9, Health Service Executive (HSE), Dublin, Ireland
| | - Austin Warters
- Older Person Services CHO9, Health Service Executive (HSE), Dublin, Ireland
| | - Lauren Swan
- North Dublin Home Care (NDHC), Dublin, Ireland
- Department of Clinical Medicine, Trinity College Dublin (TCD), Dublin, Ireland
| | - Maria O’Sullivan
- Department of Clinical Medicine, Trinity College Dublin (TCD), Dublin, Ireland
| | - Dawn A Skelton
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland
- Later Life Training Ltd, Killin, Scotland
| | | | - Frank Doyle
- Department of Health Psychology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Samira B Jabakhanji
- Healthcare Outcomes Research Centre (HORC), RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Jan Sorensen
- Healthcare Outcomes Research Centre (HORC), RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Lisa Murphy
- North Dublin Home Care (NDHC), Dublin, Ireland
| | - Rose Galvin
- School of Allied Health, Ageing Research Centre, Health Research Institute, University of Limerick (UL), Limerick, Ireland
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Doherty AS, Miller R, Mallett J, Adamson G. Heterogeneity in Longitudinal Healthcare Utilisation by Older Adults: A Latent Transition Analysis of the Irish Longitudinal Study on Ageing. J Aging Health 2022; 34:253-265. [PMID: 34470534 PMCID: PMC8961246 DOI: 10.1177/08982643211041818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Older adults likely exhibit considerable differences in healthcare need and usage. Identifying differences in healthcare utilisation both between and within individuals over time may support future service development. OBJECTIVES To characterise temporal changes in healthcare utilisation among a nationally representative sample of community-dwelling older adults. METHODS A latent transition analysis of the first three waves of The Irish Longitudinal Study on Ageing (TILDA) (N = 6128) was conducted. RESULTS Three latent classes of healthcare utilisation were identified, 'primary care only'; 'primary care and outpatient visits' and 'multiple utilisation'. The classes were invariant across all three waves. Transition probabilities indicated dynamic changes over time, particularly for the 'primary care and outpatient visits' and 'multiple utilisation' statuses. DISCUSSION Older adults exhibit temporal changes in healthcare utilisation which may reflect changes in healthcare need and disease progression. Further research is required to identify the factors which influence movement between healthcare utilisation patterns.
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Affiliation(s)
- Ann S Doherty
- RCSI University of Medicine and
Health Sciences, Dublin, Ireland
| | - Ruth Miller
- Western Health and Social Care
Trust, Londonderry, UK
- School of Pharmacy and Pharmaceutical
Sciences, Ulster University, Coleraine, UK
| | - John Mallett
- RCSI University of Medicine and
Health Sciences, Dublin, Ireland
| | - Gary Adamson
- RCSI University of Medicine and
Health Sciences, Dublin, Ireland
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Swan L, Horgan NF, Cummins V, Burton E, Galvin R, Skelton DA, Townley B, Doyle F, Jabakhanji SB, Sorensen J, Rooney D, Murphy L, Warters A, O’Sullivan M. Embedding Physical Activity Within Community Home Support Services for Older Adults in Ireland – A Qualitative Study of Barriers and Enablers. Clin Interv Aging 2022; 17:223-234. [PMID: 35299723 PMCID: PMC8922314 DOI: 10.2147/cia.s351431] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/11/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction In Ireland, over 55,000 older adults are supported in their community by formal home support, amounting to an estimated 23 million care hours annually. There is a growing need to move beyond care, to more proactive approaches to maintain physical function. In a feasibility study, we delivered the “Care to Move” (CTM) program through existing home support services. This qualitative study aimed to explore the experience and perceptions of Health Care Assistants (HCAs), who were trained in and delivered the CTM program. Methods We conducted semi-structured telephone interviews with 22 HCAs [mean age 49.0 ± 10.7 years and female 21/22] involved in the delivery of the program with older adults [n = 35, mean age 82.8 (7.8) years]. Interview transcripts were coded and analyzed thematically to capture barriers and enablers to program delivery. Results Barriers and enablers were identified under three themes i) the CTM approach ii) the home support setting, iii) older adults and physical activity, with iv) delivering care in a crisis and v) future directions further identified. Overall, there was a positive perception of the program’s focus on “movement prompts and motivators”, the “fit” within home support services, and the training provided. Practical challenges of limited time and the task-orientated nature of home support were reported as recurring barriers for CTM. Many HCAs commented on the value and perceived positive benefits of the program for their clients. Though negative perceptions of older adults’ motivation or ability to engage with physical activity were noted. Risk, such as injury or pain, was identified but was not a dominant theme. Conclusion Our findings suggest that embedding physical activity initiatives within home support services could be feasible. Restructuring of services, engaging HCAs, and moving beyond traditional “task-oriented” care models to more personalised proactive approaches may facilitate this initiative and support aging in place. ![]()
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Affiliation(s)
- Lauren Swan
- Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland
- North Dublin Home Care (NDHC), Dublin, Ireland
| | - N Frances Horgan
- School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Vanda Cummins
- Primary Care Physiotherapy Services CHO9, Health Service Executive (HSE), Dublin, Ireland
| | - Elissa Burton
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Rose Galvin
- School of Allied Health, Ageing Research Centre, University of Limerick (UL), Limerick, Ireland
| | - Dawn A Skelton
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland
- Later Life Training, Killin, UK
| | | | - Frank Doyle
- Department of Health Psychology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Samira B Jabakhanji
- Healthcare Outcomes Research Centre (HORC), RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Jan Sorensen
- Healthcare Outcomes Research Centre (HORC), RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Lisa Murphy
- North Dublin Home Care (NDHC), Dublin, Ireland
| | - Austin Warters
- Older Person Services CHO9, Health Service Executive (HSE), Dublin, Ireland
| | - Maria O’Sullivan
- Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland
- Correspondence: Maria O’Sullivan, Email
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Abstract
The exponential evolution of technology and the growth of the elderly population are two phenomena that will inevitably interact with increasing frequency in the future. This paper analyses scientific literature as a means of furthering progress in sustainable technology for senior living. We carried out a bibliometric analysis of papers published in this area and compiled by the Web of Science (WOS) and Scopus, examining the main participants and advances in the field from 2000 to the first quarter of 2021. The study describes some interesting research projects addressing three different aspects of older adults’ daily lives—health, daily activities and wellbeing—and policies to promote healthy aging and improve the sustainability of the healthcare system. It also looks at lines of research into transversal characteristics of technology. Our analysis showed that publications mentioning sustainability technologies for older adults have been growing progressively since the 2000s, but that the big increase in the number of research works in this area took place during the period 2016–2021. These more recent works show a tendency to study those factors that improve healthy aging, ensure the social inclusion of the elderly through technology and prolong the time in which they can live independent lives thanks to smart environments. Current research gaps in the literature are also discussed.
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11
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Mah JC, Stevens SJ, Keefe JM, Rockwood K, Andrew MK. Social factors influencing utilization of home care in community-dwelling older adults: a scoping review. BMC Geriatr 2021; 21:145. [PMID: 33639856 PMCID: PMC7912889 DOI: 10.1186/s12877-021-02069-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/01/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Older adults want to live at home as long as possible, even in the face of circumstances that limit their autonomy. Home care services reflect this emergent preference, allowing older adults to 'age in place' in familiar settings rather than receiving care for chronic health conditions or ageing needs in an institutionalized setting. Numerous social factors, generally studied in isolation, have been associated with home care utilization. Even so, social circumstances are complex and how these factors collectively influence home care use patterns remains unclear. OBJECTIVES To provide a broad and comprehensive overview of the social factors influencing home care utilization; and to evaluate the influence of discrete social factors on patterns of home care utilization in community-dwelling older adults in high-income countries. METHODS A scoping review was conducted of six electronic databases for records published between 2010 and 2020; additional records were obtained from hand searching review articles, reference lists of included studies and documents from international organisations. A narrative synthesis was presented, complemented by vote counting per social factor, harvest plots and an evaluation of aggregated findings to determine consistency across studies. RESULTS A total of 2,365 records were identified, of which 66 met inclusion criteria. There were 35 discrete social factors grouped into four levels of influence using a socio-ecological model (individual, relationship, community and societal levels) and grouped according to outcome of interest (home care propensity and intensity). Across all studies, social factors consistently showing any association (positive, negative, or equivocal in pattern) with home care propensity were: age, ethnicity/race, self-assessed health, insurance, housing ownership, housing problems, marital status, household income, children, informal caregiving, social networks and urban/rural area. Age, education, personal finances, living arrangements and housing ownership were associated with home care intensity, also with variable patterns in utilization. Additional community and societal level factors were identified as relevant but lacking consistency across the literature; these included rurality, availability of community services, methods of financing home care systems, and cultural determinants. CONCLUSION This is the first literature review bringing together a wide range of reported social factors that influence home care utilization. It confirms social factors do influence home care utilization in complex interactions, distinguishes level of influences at which these factors affect patterns of use and discusses policy implications for home care reform.
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Affiliation(s)
- Jasmine C Mah
- Department of Health Policy, London School of Economics and Political Sciences, London, UK.
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
- Department of Medicine, Dalhousie University, Halifax, NS, Canada.
| | - Susan J Stevens
- Faculty of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, NS, Canada
- Continuing Care, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Janice M Keefe
- Faculty of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, NS, Canada
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | - Melissa K Andrew
- Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
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12
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Yu Z, Wang L, Ariyo T. Supply and Demand-Related Decisive Factors in the Utilization of Non-Medical Community Healthcare Services among Elderly Chinese. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:E228. [PMID: 33396806 PMCID: PMC7796362 DOI: 10.3390/ijerph18010228] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/25/2020] [Accepted: 12/27/2020] [Indexed: 11/24/2022]
Abstract
There is little research on the utilization of non-medical community healthcare services among the elderly, compared with that of medical community healthcare services. From the perspective of both supply and demand, based on the survey data from Shaanxi province, this study examined supply-related factors (including service supply, service quality, service charge and service accessibility) and demand-related factors (including service need, individual financial status, family care support and knowledge of service) affecting the utilization of non-medical community healthcare services among the elderly in China by using Poisson regression. The findings show that service supply, service quality, service need and knowledge of service are positively associated with the utilization of non-medical community healthcare services among elderly Chinese, but the other factors identified in previous studies are not significant predictors for the utilization of the services among the elderly in the context of China. To our knowledge, this is the first study to examine both supply-related factors and demand-related factors affecting the utilization of non-medical community healthcare services among elderly Chinese.
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Affiliation(s)
| | - Lijian Wang
- School of Public Policy and Administration, Xi’an Jiaotong University, No 28 Xianning West Road, Xi’an 710049, Shaanxi, China; (Z.Y.); (T.A.)
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13
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Walsh B, Lyons S, Smith S, Wren MA, Eighan J, Morgenroth E. Does formal home care reduce inpatient length of stay? HEALTH ECONOMICS 2020; 29:1620-1636. [PMID: 32924255 DOI: 10.1002/hec.4158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 07/03/2020] [Accepted: 08/18/2020] [Indexed: 06/11/2023]
Abstract
Formal home care is an appropriate substitute for acute hospital care for many older people. However, limited empirical evidence exists on the extent of substitution between the supply of home care and hospital use. This study examines whether patients from areas with a better supply of home care have lower inpatient length of stay (LOS). We link administrative data on over 300,000 public hospital inpatient admissions in Ireland between 2012 and 2015 to region-year panel data on public home care supply. In addition to modeling average LOS, we estimate unconditional quantile regressions to examine whether home care supply has a disproportionately strong impact on long LOS. We find that inpatients from areas with higher per capita home care supply have lower average LOS; a 10% increase in home care is associated with a 1.2%-2.1% reduction in LOS. This result is driven by the subset of patients with the longest LOS, likely delayed discharges. Stronger results were found for stroke and hip fracture patients, who might be expected to have higher than average propensity to use home care services, and for patients from a region that experienced an unusually large increase in home care supply.
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Affiliation(s)
- Brendan Walsh
- Economic and Social Research Institute, Dublin, Ireland
- Department of Economics, Trinity College Dublin, Dublin, Ireland
| | - Seán Lyons
- Economic and Social Research Institute, Dublin, Ireland
- Department of Economics, Trinity College Dublin, Dublin, Ireland
| | - Samantha Smith
- Centre for Health Policy & Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Maev-Ann Wren
- Economic and Social Research Institute, Dublin, Ireland
- Department of Economics, Trinity College Dublin, Dublin, Ireland
| | - James Eighan
- Economic and Social Research Institute, Dublin, Ireland
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Roe L, Galvin M. Providing inclusive, person-centred care for LGBT+ older adults: A discussion on health and social care design and delivery. J Nurs Manag 2020; 29:104-108. [PMID: 33051942 PMCID: PMC7839502 DOI: 10.1111/jonm.13178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/24/2020] [Accepted: 10/04/2020] [Indexed: 11/30/2022]
Abstract
Aim To examine how health system design and delivery can fail to support the needs of LGBT+ older adults. Background LGBT+ older adults face barriers in access to care, impacting their ability to receive person‐centred care in old age, which is central to the prevention and management of frailty, disability and disease. Evaluation Using a conceptual framework of access to care, this commentary illustrates issues LGBT+ older adults may face in accessing health and social care services in Ireland, and provides examples of how access may be improved from the published international literature. Key issue(s) Health policies, service design and delivery all impact on the ability of the health system to meet the needs of LGBT+ older adults across all levels and types of care. Conclusion Heteronormativity and discrimination must be addressed across the whole health system to achieve the health policy goal of supporting all older adults to enjoy health and well‐being. Implications for nursing management We suggest nursing professionals use a systems perspective to address the multilevel issues relating to care for LGBT+ older adults. Researchers in gerontological nursing should include the experiences and outcomes of service utilization for LGBT+ older adults in their research agenda.
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Affiliation(s)
- Lorna Roe
- Global Brain Health Institute, Trinity College Dublin, the University of Dublin, Ireland.,Centre for Health Policy and Management, Trinity College Dublin, the University of Dublin, Ireland.,The Irish Longitudinal Study on Ageing, Trinity College Dublin, the University of Dublin, Ireland
| | - Miriam Galvin
- Global Brain Health Institute, Trinity College Dublin, the University of Dublin, Ireland.,Academic Unit of Neurology, School of Medicine, Trinity College Dublin, the University of Dublin, Ireland
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Higginbotham O, O'Neill A, Barry L, Leahy A, Robinson K, O'Connor M, Galvin R. The diagnostic and predictive accuracy of the PRISMA-7 screening tool for frailty in older adults: A systematic review protocol. HRB Open Res 2020; 3:26. [PMID: 34195542 PMCID: PMC8201424 DOI: 10.12688/hrbopenres.13042.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2020] [Indexed: 12/20/2022] Open
Abstract
Background: Older adults are at risk of adverse outcomes due to frailty. A number of frailty screening instruments have been developed to identify older adults at increased risk of frailty. This systematic review and meta-analysis will look to examine the diagnostic accuracy of the Program of Research to Integrate the Services for the Maintenance of Autonomy 7 (PRISMA-7). Methods and analysis: A systematic literature search will be conducted from 2008-February 2020 in PubMed, EMBASE, CINAHL, EBSCO and the Cochrane Library to identify validation studies of the PRISMA-7 tool. A pre-specified PRISMA-7 score of ≥3 (maximum score 7 points) will be used to identify frailty in older adults. Prospective or retrospective cohort studies, cross-sectional studies and the control arm of randomised controlled trials will be included that attempt to validate the diagnostic accuracy of the PRISMA-7 screening tool in older adults across all healthcare settings when compared to a reference standard. The predictive accuracy of the PRISMA-7 tool will also be explored. Study quality will be assessed by the QUADAS-2 tool. A bivariate random effects model will be used to generate pooled estimates of sensitivity and specificity. Statistical heterogeneity will be explored using validated methods. Ethics and dissemination: Formal ethical approval is not required as primary data will not be collected. The results will be disseminated through a peer-reviewed publication, conference presentation and the popular press. Protocol registration: Awaiting registration with the International Prospective Register for Systematic Reviews (PROSPERO).
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Affiliation(s)
- Owen Higginbotham
- School of Allied Health, University of Limerick, Limerick, Co Limerick, V94 T9PX, Ireland
| | - Aoife O'Neill
- School of Allied Health, University of Limerick, Limerick, Co Limerick, V94 T9PX, Ireland
| | - Louise Barry
- School of Allied Health, University of Limerick, Limerick, Co Limerick, V94 T9PX, Ireland
| | - Aoife Leahy
- School of Allied Health, University of Limerick, Limerick, Co Limerick, V94 T9PX, Ireland
- Department of Geriatric Medicine, University Hospital Limerick, Limerick, Co. Limerick, V94 F858, Ireland
| | - Katie Robinson
- School of Allied Health, University of Limerick, Limerick, Co Limerick, V94 T9PX, Ireland
| | - Margaret O'Connor
- Department of Geriatric Medicine, University Hospital Limerick, Limerick, Co. Limerick, V94 F858, Ireland
| | - Rose Galvin
- School of Allied Health, University of Limerick, Limerick, Co Limerick, V94 T9PX, Ireland
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16
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Horgan NF, Cummins V, Doyle F, O’Sullivan M, Galvin R, Burton E, Sorensen J, Skelton DA, Townley B, Rooney D, Jackson G, Swan L, Warters A. Enhancing existing formal home care to improve and maintain functional status in older adults: Protocol for a feasibility study on the implementation of the Care to Move (CTM) programme in an Irish healthcare setting. J Frailty Sarcopenia Falls 2020; 5:10-16. [PMID: 32300730 PMCID: PMC7155360 DOI: 10.22540/jfsf-05-010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2020] [Indexed: 11/26/2022] Open
Abstract
An increasing ageing population leads to greater demand for care services to help maintain people in their own homes. Physical activity programmes have been shown to improve older adults' functional capacity, enabling the older adult to live independently and maintain functional status. There has been a lack of quality research conducted around physical activity within the landscape of home care services. We describe a feasibility study of implementing the Care to Move (CTM) programme in older adults receiving low-level home care. A Phase 1 mixed-methods feasibility study design will explore the recruitment, attrition, retention, costs to deliver and data loss. It will also explore the acceptability and impact of the CTM programme on older adults and thematic analysis of data collected from older people, home care workers and relevant stakeholders through use of semi-structured interviews and focus groups. We will measure functional status and fall outcomes in older adults receiving low levels of home care, facilitating this population to continue living independently at home and providing data currently not known around this group.
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Affiliation(s)
- N. Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI), Ireland
| | - Vanda Cummins
- School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI), Ireland
- Primary Care Physiotherapy Services CHO9, Health Service Executive (HSE), Royal College of Surgeons in Ireland (RCSI), Ireland
| | - Frank Doyle
- Division of Population Health Sciences (Psychology), Royal College of Surgeons in Ireland (RCSI), Ireland
| | - Maria O’Sullivan
- Department of Clinical Medicine, Trinity College Dublin (TCD), Ireland
| | - Rose Galvin
- School of Allied Health, University of Limerick (UL), Ireland
| | - Elissa Burton
- School of Physiotherapy and Exercise Science, Curtin University, Australia
| | - Jan Sorensen
- Health Outcomes Research Centre (HORC), Royal College of Surgeons in Ireland (RCSI), Ireland
| | - Dawn A. Skelton
- School of Health and Life Sciences, Glasgow Caledonian University, United Kingdom
- Later Life Training, United Kingdom
| | | | | | | | - Lauren Swan
- Department of Clinical Medicine, Trinity College Dublin (TCD), Ireland
| | - Austin Warters
- Older Person Services CHO9, Health Service Executive (HSE), Ireland
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Formal home care use by older adults: trajectories and determinants in the Lc65+ cohort. BMC Health Serv Res 2020; 20:22. [PMID: 31914993 PMCID: PMC6950923 DOI: 10.1186/s12913-019-4867-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 12/23/2019] [Indexed: 12/04/2022] Open
Abstract
Background Given the increasing importance of formal home care services in policies dedicated to elder care, there is major interest in studying individuals’ characteristics determining their utilization. The main objective of this research was to quantify, during a 6-year timeframe, home care use trajectories followed by community-dwelling participants in a cohort study of older adults. The secondary objective was to identify factors associated with home care utilization using Andersen’s Behavioural Model of Health Services Use. Methods We proceeded to an analysis of data prospectively collected in the setting of the Lc65+ population-based study conducted in Lausanne (Switzerland). Self-reported utilization of professional home care in 2012 and 2018 was used to define trajectories during this timeframe (i.e. non-users, new users, former users and continuing users). Bivariable analyses were performed to compare new users to non-users regarding the three dimensions of Andersen’s model (predisposing, enabling and need factors) measured at baseline. Then, binomial logistic regression was used in a series of two hierarchical models to adjust for need factors first, before adding predisposing and enabling factors in a second model. Results Of 2155 participants aged between 69 and 78 in 2012, 82.8% remained non-users in 2018, whereas 11.2% started to use professional home care. There were 3.3% of continuing users and 2.7% of former users. New users exhibited a higher burden of physical and psychological complaints, chronic health conditions and functional limitations at baseline. After adjusting for these need factors, odds of home care utilization were higher only in participants reporting a difficult financial situation (OR 1.65, 95% CI 1.12–2.45). Conclusions In the setting of a Swiss city, incident utilization of formal home care by older adults appeared to be largely determined by need factors. Modifiable factors like personal beliefs and knowledge about home care services did not play a role. After adjusting for need, odds of becoming home care user remained higher in participants reporting a difficult financial situation, suggesting such vulnerability does not hamper access to professional home care in this specific context.
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18
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Hu B, Li B, Wang J, Shi C. Home and community care for older people in urban China: Receipt of services and sources of payment. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:225-235. [PMID: 31508864 DOI: 10.1111/hsc.12856] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 07/19/2019] [Accepted: 08/25/2019] [Indexed: 06/10/2023]
Abstract
This study investigates the characteristics of Chinese older people receiving home and community care and the factors associated with the sources of payment for care services. The data come from the Social Survey of Older People in Urban China, which collected information from a random sample of 3,247 older people aged 60 and over in 10 large cities in different regions of China in 2017. Anderson's behavioural model of care utilisation is used to guide the analyses. The study identifies four striking features of the Chinese social care system. First, although disabilities are a significant predictor of receiving home and community care, a large proportion of care recipients do not have disabilities. Second, perceived proximity of care is the most important predictor, which implies high elasticity of demand for care services with regard to perceived distance and the great geographical inequality of care resources in the cities. Third, the government policies support the use of the internet to facilitate care access, but the enabling effect of the internet among older people is limited. Finally, sources of payment for care differ significantly according to people's age, living arrangements, disability and level of education. We argue that the government should consider shifting the focus of financial support from service providers to care recipients in the future.
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Affiliation(s)
- Bo Hu
- Department of Health Policy, Care Policy and Evaluation Centre (CPEC), London School of Economics and Political Science, London, UK
| | - Bingqin Li
- Social Policy Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Jing Wang
- Institute of Sociology, Chinese Academy of Social Sciences, Beijing, China
| | - Cheng Shi
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
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19
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High prevalence of dementia among community dwelling older adults in receipt of state funded home care packages: implications for health care planning. Ir J Psychol Med 2019; 36:139-144. [PMID: 31187722 DOI: 10.1017/ipm.2017.80] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The majority of people living with dementia in Ireland reside in their own homes, some supported by formal or informal home care. This audit aimed to estimate the prevalence of dementia and suspected cognitive impairment (CI) among older adults, 65+ years, in receipt of formal home care (domiciliary care) in a defined health service area in North Dublin. A secondary objective of the audit was to explore factors associated with dementia or CI in this cohort. METHODS A cross-sectional audit was conducted on all clients aged 65+ years actively receiving publicly funded home care packages (HCPs) during May 2016 in Healthcare Service Executive CHO9 Dublin North Central. A total of 935 urban community dwelling older adults were included in the study [mean age 83.7 (s.d. 7.4) years and 65% female]. Basic socio-demographic and health data were extracted from common summary assessment reports. Service users were categorised as having (a) dementia if a diagnosis of dementia or cognitive decline which impacts on independent living, was documented by a health professional or (b) suspected CI where a validated cognitive screening tool was applied and the score was indicative of mild CI. RESULTS Overall, the estimated prevalence of dementia and suspected CI was 37.1% and 8.7%, respectively. Factors significantly associated with dementia and suspected CI were higher dependency and home care hours, communication difficulty and being non-self-caring (p<0.001). Notably, half (51.6%) of those with either dementia or suspected CI group lived alone. CONCLUSIONS Our findings suggest a high prevalence dementia among HCP users, highlighting a need and opportunity for dementia-specific approaches to support older people in their homes.
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20
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Bijnsdorp FM, Pasman HRW, Francke AL, Evans N, Peeters CFW, Broese van Groenou MI. Who provides care in the last year of life? A description of care networks of community-dwelling older adults in the Netherlands. BMC Palliat Care 2019; 18:41. [PMID: 31092227 PMCID: PMC6521417 DOI: 10.1186/s12904-019-0425-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 04/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Home-based care networks differ in size and composition, but little is known about the characteristics of care networks for those nearing the end of their lives. This study aimed to identify different types of home-based care networks of community-dwelling older adults in the Netherlands and to assess the association between care network type and the health status and socio-demographic characteristics of care recipients. METHODS/DESIGN We used data from participants of the Longitudinal Aging Study Amsterdam (2001-2013) with chronic diseases or functional limitations who died within 12 months of their last interview and received home based personal and/or household care (n = 146). Latent Class Analysis was used to model distinct end-of-life care networks among this pooled cross-section of older people whose characteristics imply care needs. The Akaike information criterion was used to determine the optimal model. Associations between network type and care recipient characteristics were explored using conditional inference trees. RESULTS We identified four types of care networks; a partner network (19%) in which care was mainly provided by partners, with little care from private caregivers or professionals, a mixed network (25%) in which care was provided by a combination of children, professionals and/or other family members, a private network (15%) in which only privately paid care was provided, and a professional network (40%) in which care was mainly provided by publicly paid professionals, sometimes with additional care from family or privately paid caregivers. Care networks near the end of life showed similar characteristics to those identified for older people more generally, but care seemed to be more intensive in the last year of life compared to the years preceding it. End-of-life care networks were mostly related to age, educational level and partner status. Formal care substitutes informal care whenever there is no partner or child present and able to provide care. CONCLUSION Our findings indicate that personal and household care can be quite intensive in the last year of life, especially for partner caregivers. To prevent caregiver burden, it is important that professionals make sure partner caregivers receive adequate and timely support to cope with the care situation.
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Affiliation(s)
- Femmy M. Bijnsdorp
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Expertise Center for Palliative Care, De Boelelaan, 1117 Amsterdam, Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, P.O. Box 7057, 1007 MB Amsterdam, Netherlands
| | - H. Roeline W. Pasman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Expertise Center for Palliative Care, De Boelelaan, 1117 Amsterdam, Netherlands
| | - Anneke L. Francke
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Expertise Center for Palliative Care, De Boelelaan, 1117 Amsterdam, Netherlands
- Nivel, Netherlands Institute for Health Services Research, Otterstraat, 118 Utrecht, The Netherlands
| | - Natalie Evans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Expertise Center for Palliative Care, De Boelelaan, 1117 Amsterdam, Netherlands
| | - Carel F. W. Peeters
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology & Biostatistics, Amsterdam Public Health research institute, De Boelelaan, 1117 Amsterdam, Netherlands
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Hu B, Wang J. Unmet long-term care needs and depression: The double disadvantage of community-dwelling older people in rural China. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:126-138. [PMID: 30052307 DOI: 10.1111/hsc.12630] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 05/24/2018] [Accepted: 07/03/2018] [Indexed: 06/08/2023]
Abstract
This study investigates the relationship between unmet long-term care needs and depressive symptoms among community-dwelling older people in China. The data come from a nationally representative sample of 1,324 disabled older people from the China Health and Retirement Longitudinal Survey (CHARLS) collected between 2013 and 2014. Regression analyses were conducted to examine the factors associated with unmet needs and the impacts of unmet needs on people's depressive symptoms. We found that disabled older people living in rural communities have a higher level of unmet needs than those in urban communities. Unmet needs cause more severe depressive symptoms among rural older people, but they do not have a significant impact among urban older people. Depressive symptoms are also affected by people's health conditions in rural China and by household income in urban China. We argue that older people living in rural communities face a double disadvantage. The first disadvantage relating to unmet needs reinforces the second one relating to mental health. These findings highlight the urgent need for more investment by the Chinese central government in formal social care services and support for carers in rural areas.
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Affiliation(s)
- Bo Hu
- Personal Social Services Research Unit, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Jing Wang
- Institute of Sociology, Chinese Academy of Social Sciences, Beijing, China
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22
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Marangos AM, Waverijn G, de Klerk M, Iedema J, Groenewegen PP. Influence of municipal policy and individual characteristics on the use of informal and formal domestic help in the Netherlands. Health Policy 2018; 122:791-796. [DOI: 10.1016/j.healthpol.2018.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 04/20/2018] [Accepted: 05/16/2018] [Indexed: 10/16/2022]
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Projecting future demand for informal care among older people in China: the road towards a sustainable long-term care system. HEALTH ECONOMICS POLICY AND LAW 2018; 14:61-81. [PMID: 29914586 DOI: 10.1017/s1744133118000221] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The long-term care system in China relies heavily on informal care provided by family members. This study makes projections on the demand for informal care among Chinese older people between 2015 and 2035 and quantifies the level of long-term care resources needed to meet their needs. The data come from longitudinal information in a nationally representative sample, China Health and Retirement Longitudinal Survey 2011 and 2013. The macrosimulation approach (PSSRU model) and the Markov approach are integrated into one Bayesian modelling framework. The Monte Carlo simulation technique is used to capture parameter uncertainty. We project that the demand for informal care will increase from 41.3 million people (95% CI: 39.9-42.7) in 2015 to 82.6 million people (95% CI: 78.3-86.9) in 2035. The long-term care system faces unbalanced pressure of demand for informal care from different groups of older people. The projected demand is sensitive to changes in older people's disability trajectory and the availability of formal care provided by the government, but less sensitive to an increase in singleton households in the future. We discuss possible policy measures to alleviate the mounting pressure on the demand for informal care.
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Clarke M, Moore Z, Patton D, O'Connor T, Nugent L. The impact of an educational intervention on home support workers' ability to detect early pressure ulcer damage. Br J Community Nurs 2017; 22:S6-S19. [PMID: 29189069 DOI: 10.12968/bjcn.2017.22.sup12.s6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the impact of an educational intervention on home support workers' ability to detect early pressure ulcer damage. METHOD A repeated measure design was employed to quantify the effectiveness of an educational intervention, consisting of one pre-test and two post-tests. RESULTS Education was provided to home support workers and this was followed by an assessment of their ability to correctly classify 20 photographs detailing varying stages of skin damage severity. At the baseline (pre-education), 58% of the photographs were classified correctly. At post-test 1, 55% of the photographs were classified correctly. In post-test 2 this increased to 58%, achieving the original baseline scores. There was a moderate negative relationship between pre-training and post-test 2 scores (r=-0.44; n=27; p=0.02). CONCLUSIONS The educational intervention has been shown not to have a statistically significantly positive effect on home support workers' ability to detect early pressure ulcer damage. The moderate negative relationship between pre-training and post-test 2 scores concur with the aforementioned qualitative findings, and similarly indicate behaviour associated with individuals experiencing difficulty comprehending new health terms.
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Affiliation(s)
- Mairead Clarke
- Community Registered Nurse, Community Health Organisation, 08, Ireland
| | - Zena Moore
- Professor of Nursing & Head of School of Nursing and Midwifery, Royal College of Surgeons, Ireland
| | - Declan Patton
- Senior Lecturer and Director of Nursing & Midwifery Research, Royal College of Surgeons, Ireland
| | - Tom O'Connor
- Senior Lecturer and Director of Academic Affairs, School of Nursing & Midwifery, Royal College of Surgeons, Ireland
| | - Linda Nugent
- Lecturer, School of Nursing & Midwifery, Royal College of Surgeons, Ireland
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Roe L, Normand C, Wren MA, Browne J, O'Halloran AM. The impact of frailty on healthcare utilisation in Ireland: evidence from the Irish longitudinal study on ageing. BMC Geriatr 2017; 17:203. [PMID: 28874140 PMCID: PMC5583758 DOI: 10.1186/s12877-017-0579-0] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 08/04/2017] [Indexed: 11/23/2022] Open
Abstract
Introduction To examine the impact of frailty on medical and social care utilisation among the Irish community-dwelling older population to inform strategies of integrated care for older people with complex needs. Methods Participants aged ≥65 years from the Irish Longitudinal Study on Ageing (TILDA) representative of the Irish community-dwelling older population were analysed (n = 3507). The frailty index was used to examine patterns of utilisation across medical and social care services. Multivariate logistic and negative binomial regression models were employed to examine the impact of frailty on service utilisation outcomes after controlling for other factors. Results The prevalence of frailty and pre-frailty was 24% (95% CI: 23, 26%) and 45% (95% CI: 43, 47%) respectively. Frailty was a significant predictor of utilisation of most social care and medical care services after controlling for the main correlates of frailty and observed individual effects. Conclusions Frailty predicts utilisation of many different types of healthcare services rendering it a useful risk stratification tool for targeting strategies of integrated care. The pattern of care is predominantly medical as few of the frail older population use social care prompting questions about sub-groups of the frail older population with unmet care needs. Electronic supplementary material The online version of this article (doi:10.1186/s12877-017-0579-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lorna Roe
- Centre for Health Policy and Management, Trinity College Dublin, 3-4 Foster Place, College Green, Dublin 2, Ireland.
| | - Charles Normand
- Centre for Health Policy and Management, Trinity College Dublin, 3-4 Foster Place, College Green, Dublin 2, Ireland
| | - Maev-Ann Wren
- The Economic and Social Research Institute, Whitaker Square, Sir John Rogerson's Quay, Dublin 2, Ireland
| | - John Browne
- Epidemiology & Public Health, University College Cork, College Road, Cork, Ireland
| | - Aisling M O'Halloran
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, College Green, Dublin 2, Ireland
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26
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Kelly S, O'Brien I, Smuts K, O'Sullivan M, Warters A. Prevalence of frailty among community dwelling older adults in receipt of low level home support: a cross-sectional analysis of the North Dublin Cohort. BMC Geriatr 2017; 17:121. [PMID: 28592236 PMCID: PMC5463412 DOI: 10.1186/s12877-017-0508-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 05/23/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND There is increasing demand for formal government funded home help services to support community-dwelling older people in Ireland, yet limited information exists on the health profiles of this group, especially regarding frailty. Our aim was to profile a large cohort of adults in receipt of low level home help and to determine the prevalence of frailty. METHODS A total 1312 older adults, (≥ 65 years) in receipt of low level home help (< 5 h per week) were reviewed by community nurses and frailty was assessed using the Clinical Frailty Scale (CFS) in this cross-sectional study. Characteristics of the group were compared between males and females and prevalence of frailty was reported according to gender and principal care. Associations between frailty and a number of variables were explored using bivariate and regression analysis. RESULTS The cohort of low level home-help users was a mean age of 82.1 (SD 7.3) years, predominantly female (70.6%) and over half (69.2%) lived alone. The prevalence of frailty in this population was 41.5%, with subjects primarily considered mildly (23.2%) or moderately frail (14.5%) by the CFS. A further 38.4% were classed as vulnerable. The degree of frailty did not differ significantly across the younger categories aged 65-84 years. However, in the oldest age groups, namely 90-94 and >95 years, moderate frailty was significantly higher relative to the younger groups (21% and 34%, p < 0.05, p < 0.01 respectively). Home help hours significantly correlated with frailty (rs = 0.371, p < 0.001) and functional dependency (rs = 0.609, p < 0.001), but only weakly with age (rs = 0.101, p = 0.034). Based on regression analysis, determinants of frailty included greater dependency (Barthel score), higher home help hours, non-self-caring and communication difficulty, all of which significantly contributed to the model, with a r squared value of 0.508. CONCLUSION A high prevalence of frailty (41.5%) was documented in this population which associated with higher home help utilisation. Frailty was associated with greater functional dependency, but not strongly with chronological age, until after 90 years. These findings highlight opportunities for developing intervention strategies targeted at ageing in place among home help users.
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Affiliation(s)
- Sara Kelly
- North Dublin Home Care Ltd., 2 Malahide Road, Fairview, Dublin 3, Ireland
| | - Irene O'Brien
- North Dublin Home Care Ltd., 2 Malahide Road, Fairview, Dublin 3, Ireland
| | - Karla Smuts
- North Dublin Home Care Ltd., 2 Malahide Road, Fairview, Dublin 3, Ireland.,Clinical Medicine, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland
| | - Maria O'Sullivan
- Clinical Medicine, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland
| | - Austin Warters
- Health Service Executive Healthcare Facility, Ballymun, Dublin 9, Ireland.
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van Noort O, Schotanus F, van de Klundert J, Telgen J. Explaining regional variation in home care use by demand and supply variables. Health Policy 2017; 122:140-146. [PMID: 29122376 DOI: 10.1016/j.healthpol.2017.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 04/30/2017] [Accepted: 05/08/2017] [Indexed: 11/15/2022]
Abstract
In the Netherlands, home care services like district nursing and personal assistance are provided by private service provider organizations and covered by private health insurance companies which bear legal responsibility for purchasing these services. To improve value for money, their procurement increasingly replaces fee-for-service payments with population based budgets. Setting appropriate population budgets requires adaptation to the legitimate needs of the population, whereas historical costs are likely to be influenced by supply factors as well, not all of which are necessarily legitimate. Our purpose is to explain home care costs in terms of demand and supply factors. This allows for adjusting historical cost patterns when setting population based budgets. Using expenses claims of 60 Dutch municipalities, we analyze eight demand variables and five supply variables with a multiple regression model to explain variance in the number of clients per inhabitant, costs per client and costs per inhabitant. Our models explain 69% of variation in the number of clients per inhabitant, 28% of costs per client and 56% of costs per inhabitant using demand factors. Moreover, we find that supply factors explain an additional 17-23% of variation. Predictors of higher utilization are home care organizations that are integrated with intramural nursing homes, higher competition levels among home care organizations and the availability of complementary services.
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Affiliation(s)
- Olivier van Noort
- University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands.
| | - Fredo Schotanus
- University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands.
| | | | - Jan Telgen
- University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands.
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Li F, Fang X, Gao J, Ding H, Wang C, Xie C, Yang Y, Jin C. Determinants of formal care use and expenses among in-home elderly in Jing'an district, Shanghai, China. PLoS One 2017; 12:e0176548. [PMID: 28448628 PMCID: PMC5407841 DOI: 10.1371/journal.pone.0176548] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 04/12/2017] [Indexed: 11/23/2022] Open
Abstract
The need for formal care among the elderly population has been increasing due to their greater longevity and the evolution of family structure. We examined the determinants of the use and expenses of formal care among in-home elderly adults in Shanghai. A two-part model based on the data from the Shanghai Long-Term Care Needs Assessment Questionnaire was applied. A total of 8428 participants responded in 2014 and 7100 were followed up in 2015. The determinants of the probability of using formal care were analyzed in the first part of the model and the determinants of formal care expenses were analyzed in the second part. Demographic indicators, living arrangements, physical health status, and care type in 2014 were selected as independent variables. We found that individuals of older age; women; those with higher Activities of Daily Living (ADL) scores; those without spouse; those with higher income; those suffering from stroke, dementia, lower limb fracture, or advanced tumor; and those with previous experience of formal and informal care were more likely to receive formal care in 2015. Furthermore, age, income and formal care fee in 2014 were significant predictors of formal care expenses in 2015. Taken together, the results showed that formal care provision in Shanghai was not determined by ADL scores, but was instead more related to income. This implied an inappropriate distribution of formal care among elderly population in Shanghai. Additionally, it appeared difficult for the elderly to quit the formal care once they begun to use it. These results highlighted the importance of assessing the need for formal care, and suggested that the government offer guidance on formal care use for the elderly.
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Affiliation(s)
- Fen Li
- School of Public Health, Fudan University, Shanghai, P.R.China
- Shanghai Health Development Research Center, Shanghai, P.R.China
- Shanghai Medical Information Center, Shanghai, P.R.China
| | - Xinye Fang
- Shanghai Health Development Research Center, Shanghai, P.R.China
- Shanghai Medical Information Center, Shanghai, P.R.China
| | - Jiechun Gao
- School of Public Health, Fudan University, Shanghai, P.R.China
- * E-mail: (CLJ); (JCG)
| | - Hansheng Ding
- Shanghai Health Development Research Center, Shanghai, P.R.China
- Shanghai Medical Information Center, Shanghai, P.R.China
| | - Changying Wang
- Shanghai Health Development Research Center, Shanghai, P.R.China
- Shanghai Medical Information Center, Shanghai, P.R.China
| | - Chunyan Xie
- Shanghai Health Development Research Center, Shanghai, P.R.China
- Shanghai Medical Information Center, Shanghai, P.R.China
| | - Yitong Yang
- Shanghai University of Finance and Economics, Shanghai, P.R.China
| | - Chunlin Jin
- Shanghai Health Development Research Center, Shanghai, P.R.China
- Shanghai Medical Information Center, Shanghai, P.R.China
- Shanghai Population Development Research Center, Shanghai, P.R.China
- * E-mail: (CLJ); (JCG)
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Abstract
ABSTRACTThis paper examines the factors affecting the receipt of informal care among older people in China. It uses the second wave data of the China Health and Retirement Longitudinal Survey, which collected ageing and health-related information on a nationally representative sample of 8,906 older people aged 60 and over in 2013. Apart from the factors that have been examined in the contexts of developed countries, the paper further investigates two factors specific to Chinese society: rural–urban residence and regular financial assistance from children. Based on binary and multinomial logit regression analyses, the research findings are threefold: the determinants of receiving informal care differ remarkably according to the sources of care; disability and living arrangements are the most important determinants; rural–urban residence plays a vital role in the Chinese context, but regular financial assistance from children makes little difference. It is estimated that 53 million older people are receiving informal care each year, a figure equivalent to the entire population of England. With continuous population ageing, Chinese society will face huge pressure to meet the demand for social care among older people in the future. The Chinese government needs to build a well-rounded welfare system that tackles this challenge from multiple dimensions. The formal care services should aim to complement informal care in the short run and reduce inequality in social care in the long run.
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