Attitudes toward and use of subsequent nursing home services among a national sample of older adults

Eligibility for In-Home Respite Care: Ethnic Status and Rural Residence

This research examined whether older adults'ethnicity (African American vs. White) and type of rural residence were associated with nurse case managers' determinations of eligibility for in-home respite care service use, after adjusting for sociodemographic as well as physical and cognitive status characteristics. This study reports the results of a program evaluation of a state Medicaid waiver program for support services. The study sample consisted of 775 older adults residing in the rural counties (63) of Arkansas and enrolled in a Medicaid waiver program for support services. Logistic regression analyses revealed that the combination of being African American and residing in rural counties of smaller population sizes combined with nonadjacency to metropolitan statistical areas were associated with a lower likelihood of being eligible for in-home respite care. The article ends with a discussion on programplanning, policy, and practice initiatives in light of the findings.

Psychosocial Factors Associated With Acceptance of Old Age Home Placement: A Study of Elderly Chinese in Hong Kong

This study examined psychosocial factors associated with the acceptance of long-term placement in old age homes (OAHs) among 185 elderly Chinese in Hong Kong. Participants were recruited from local community centers for elderly people and were individually interviewed on their willingness to enter OAHs, attitudes toward OAHs, perceived mental and physical health status, and beliefs about filial piety and independence. Results showed that only 20% of the participants indicated their willingness to enter OAHs in the coming 6 months. Among depicted services and facilities in OAHs, participants rated the quality of OAH staff as the most important, whereas the choice of food and mealtimes were viewed as the least important. Participants were more willing to enter OAHs if depicted services and facilities were provided at OAHs. Findings of the hierarchical regression analysis revealed that salient correlates of willingness to enter OAHs were positive attitudes toward OAHs, poor perceived physical health, male gender, and a low need for independence. Prior visits to OAHs and filial piety beliefs were unrelated to participants’acceptance of OAH care. Service and policy implications in promoting elderly people’s sense of autonomy and acceptance of OAH care, reducing the cost of placement in OAHs, and ensuring the quality of services and care in OAHs are also discussed.

Risk of continued institutionalization after hospitalization in older adults

BACKGROUND

Little is known about the role of hospitalization as a risk factor for placement into long-term care. We therefore sought to estimate the percentage of long-term care nursing home stays precipitated by a hospitalization and factors associated with risk of nursing home placement after hospitalization.

METHODS

We studied a retrospective cohort of a 5% sample of Medicare enrollees aged ≥ 66 years. The study included 762,243 patients admitted 1,149,568 times in January-April of 1996-2008, with 3,880,292 nonhospitalized controls. We measured residence in a nursing home 6 months after hospitalization.

RESULTS

From 1996 through 2008, 5.55% of hospitalized patients resided in a nursing home 6 months later compared with 0.54% of nonhospitalized control patients. Three quarters of new nursing home placements were precipitated by a hospitalization. Independent risk factors for long-term care placement after hospitalization included advanced age (odds ratio [OR] = 3.56 for age 85-94 vs. 66-74 years), female gender (OR = 1.41), dementia (OR = 6.15), and discharge from the hospital to a skilled nursing facility (SNF; OR = 10.83). Having a primary care physician was associated with reduced odds (OR = 0.75). In the adjusted analyses, risk of institutionalization after hospitalization decreased 4% per year from 1996 to 2008. There were very large geographic variations in rates of long-term care after hospitalization, from < 2% in some hospital referral regions to > 13% in others for patients > 75 years in 2007-2008.

CONCLUSIONS

Most placements in nursing homes are preceded by a hospitalization followed by discharge to a SNF. Discharge to a SNF is associated with a high risk of subsequent long-term care.

Factors affecting the long-term care preferences of the elderly in Taiwan

This study sets out to investigate the preferences of the elderly in northern Taiwan with regard to various types of long-term care services. Taking into consideration sociodemographics, health condition, and access to such medical care services, our study examined both economic and family factors in an attempt to gain an understanding of the knowledge of and attitudes toward, the various types of long-term care among the elderly. An interview survey was carried out by local public health nurses among a sample of 562 elderly Taiwanese residents (people aged 65 years or older) from 7 counties/cities in northern Taiwan, all of whom had been selected by means of multistage sampling. The survey was conducted using a questionnaire based on the Andersen and Newman model of health care utilization, with the intention being to gain a better understanding of the related factors. The results indicate that both ethnic background and the requirement for additional medical care services had significant effects on the long-term care preferences of the elderly in Taiwan, a finding that should help to provide a better understanding of the preferences for and availability of such long-term care services among the elderly. Such improved understanding could result in improving the quality of life for the elderly, particularly if they feel that their preferences have been taken into consideration and their needs have ultimately been met.

Who Wants to Enter a Long-Term Care Facility in a Rapidly Aging Non-Western Society? Attitudes of Older Koreans Toward Long-Term Care Facilities

To estimate future demand for institutional long-term care (LTC) by Koreans, the intention to use LTC facilities was estimated, and the underlying influencing factors were explored. Data from the Korean National Survey of LTC Need in the Elderly compiled in 2001 were used, and 1,850 people aged 65 and older who were classified as the targets for LTC in the survey and for whom complete data were available were sampled. The following influencing variables were selected based on Anderson's service-use model: demographics, social structural factors, family and community resources, and felt and assessed needs. The result shows that, of all the participants, 18.8% intended to use LTC facilities. A stronger intention was related to younger age, Christian religion, fewer children, lower family income, higher chronic comorbidity, and more education. The rapid industrialization of Korea has lead to a transition from the traditional family-centered mode of caregiving to a nontraditional one, but the intention to use LTC facilities is still lower than in Western developed countries. Regarding family resources, the effect of extended families comprising three or more generations is not as significant as expected, but children continue to be regarded as the main resources for LTC. The recent introduction of nontraditional religions to Korea has had a positive effect on intention to use LTC facilities, suggesting that cultural factors influence their use.