Determinants of home care utilization among the Swedish old: nationwide register-based study

AbstractSince the 1990s, Sweden has implemented aging-in-place policies increasing the share of older adults dependent on home care instead of residing in care homes. At the same time previous research has highlighted that individuals receive home care at a higher age than before. Consequently, services are provided for a shorter time before death, increasing reliance on family and kin as caregivers. Previous studies addressing how homecare is distributed rely primarily on small surveys and are often limited to specific regions. This study aims to ascertain how home care services are distributed regarding individual-level factors such as health status, living arrangements, availability of family, education, and socioeconomic position. To provide estimates that can be generalized to Sweden as a whole, we use register data for the entire Swedish population aged 65 + in 2016. The study's main findings are that home care recipients and the amount of care received are among the oldest old with severe co morbidities. Receiving home care is slightly more common among women, but only in the highest age groups. Childlessness and socioeconomic factors play a small role in who receives home care or not. Instead, the primary home care recipients are those older adults living alone who lack direct support from family members residing in the same household.

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Challenges associated with the recognition and treatment of depression in older recipients of home care services

International Psychogeriatrics ◽

10.1017/s1041610209991797 ◽

2010 ◽

Vol 22 (4) ◽

pp. 514-522 ◽

Cited By ~ 12

Author(s):

Liat Ayalon ◽

Daniela Fialová ◽

Patricia A. Areán ◽

Graziano Onder

Keyword(s):

Older Adults ◽

Home Care ◽

Home Environment ◽

Home Care Services ◽

Caregiver Distress ◽

Care Services ◽

Psychotherapeutic Interventions ◽

Care Recipients ◽

Treatment Of Depression ◽

Older Recipients

ABSTRACTBackground: Home care for older adults is a common phenomenon worldwide because it allows older adults to remain in their home environment. Research has shown that depression is frequently found in older recipients of home care services. Nonetheless, it is often poorly recognized and treated. Untreated or poorly treated depression in older home care recipients has been associated with a variety of negative outcomes, including increased morbidity and mortality, greater likelihood of nursing home institutionalization and higher caregiver distress.Methods: The present review outlines some of the challenges associated with appropriate recognition and treatment of depression in older home care recipients.Results: Our review demonstrates that more aggressive management of depressive symptoms and the employment of an interdiciplinary team can result in beneficial outcomes.Conclusions: Further research is needed, especially in the area of psychotherapeutic interventions as these should be flexible enough to meet the unique and evolving needs of this frail population of older adults.

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Formal home care use by older adults: trajectories and determinants in the Lc65+ cohort

BMC Health Services Research ◽

10.1186/s12913-019-4867-6 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Julien Dupraz ◽

Yves Henchoz ◽

Brigitte Santos-Eggimann

Keyword(s):

Older Adults ◽

Home Care ◽

Home Care Services ◽

Community Dwelling ◽

Care Utilization ◽

Financial Situation ◽

Care Services ◽

Major Interest ◽

Professional Home ◽

Professional Home Care

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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Retirement, Home Care and the Importance of Gender

Historical Life Course Studies ◽

10.51964/hlcs9589 ◽

2021 ◽

Vol 10 ◽

pp. 172-179

Author(s):

Anders Brändström ◽

Glenn Sandström

Keyword(s):

Health Status ◽

Home Care ◽

Living Arrangements ◽

Elderly Care ◽

Institutional Care ◽

The Elderly ◽

Home Care Services ◽

Minor Role ◽

Retirement Home ◽

Swedish Population

In recent decades elderly care policies in Sweden have been characterized by a marked shift from institutional care to home care. Previous research has highlighted how this has resulted in the elderly receiving care at a higher age and increased reliance on family and kin for providing care. Using register data for the entire Swedish population aged 65+ in 2016, we analyze how home care services in contemporary Sweden distribute regarding individual-level factors such as gender, health status, living arrangements, and closeness to kin. By far, the most critical determinants of receiving home care are age, health status, and whether the elderly are living alone or not. Although our results do not discard that access to kin have become more important, our results show that childlessness and geographical proximity to adult children play a minor role for differentials in the reception of home care. The main conduit for informal care instead takes the form of spousal support. Gender plays a role in how living arrangements influence the probability of receiving home care, where cohabiting women are significantly more likely to receive care than cohabiting men. We interpret this as a result of women, on average, being younger than their male partners and more easily adopting caregivers' roles. This gendered pattern is potentially explained by the persistence of more traditional gender roles prevailing in older cohorts.

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Comparison of Care Utilization and Institutional Death Rates among Older Adults according to Different Types of Home Care Facilities: a retrospective cohort study in Fukuoka, Japan

10.1101/2020.06.21.20136085 ◽

2020 ◽

Author(s):

Sung-A Kim ◽

Akira Babazono ◽

Aziz Jamal ◽

Yunfei Li ◽

Ning Liu

Keyword(s):

Older Adults ◽

Cohort Study ◽

Home Care ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Home Care Services ◽

Care Utilization ◽

Care Needs ◽

Care Services ◽

Comorbidity Index

AbstractObjectiveWe compared the use of various care services and institutional deaths in older adults among these facility types.DesignThis was a retrospective cohort study.MethodsWe used administrative claim data from April 2014 to March 2017. The study participants comprised Fukuoka Prefecture residents aged 75 and older with certified care needs of level 3 or more in April 2014 and who received home care services during the study period. Participants were divided into 4 groups according to the facility type from which they received home care services: General Clinics, Home Care Support Clinics and hospitals (HCSCs), Enhanced HCSCs with beds and Enhanced HCSCs without beds. The outcomes were utilization of medical and long-term care services and the incidence of institutional deaths. We constructed generalized linear regression models. The evaluated potential risk factors were sex, age, care needs levels, and Charlson comorbidity index (CCI) scores.ResultsThe numbers of inpatient care days were 54.3 days, 70.0 days, 64.7 days, and 75.1 days for users of enhanced HCSCs with beds, enhanced HCSCs without beds, HCSCs, and general clinics, respectively. While the number of home care days were 63.8 days, 50.9 days, 57.8 days, and 29.0 days, respectively. The odds of institutional death in general clinic users were 2.32 times higher (P<0.001) than users of enhanced HCSCs with beds.ConclusionsParticipants who used enhanced HCSCs with beds had reduced inpatient care utilization, increased home care utilization, increased home-based end-of-life care utilization, and fewer institutional deaths. These findings suggest that hospitalizations and institutional deaths could be reduced by further expanding the role of enhanced HCSCs with beds. Our study provides useful information for further investigations of home care for older adults as part of community-based integrated care.Strengths and limitations of this studyThis was a retrospective cohort study including 18,347 participants.We followed up participants for 3 years.We considered the level of care needs and Charlson comorbidity index as confounders. Despite that, the inclusion of these variables did not provide detailed information about living conditions that reflect family structure and characteristics of living.We calculated the number of years that participants lived during the study period, and the annual utilization rates per person-year of observation were estimated.There were no clinical data for individual participants because this study focused on the types of healthcare facilities that provide home care.

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Impact of the Outbreak of the COVID-19 Pandemic on Formal and Informal Care of Community-Dwelling Older Adults: Cross-National Clustering of Empirical Evidence from 23 Countries

Sustainability ◽

10.3390/su13137277 ◽

2021 ◽

Vol 13 (13) ◽

pp. 7277

Author(s):

Aviad Tur-Sinai ◽

Netta Bentur ◽

Paolo Fabbietti ◽

Giovanni Lamura

Keyword(s):

Older Adults ◽

Home Care ◽

Informal Care ◽

Home Care Services ◽

Community Dwelling ◽

European Countries ◽

Care Services ◽

The Impact ◽

Community Dwelling Older Adults ◽

Informal Help

The COVID-19 pandemic has been dramatically affecting the life of older adults with care needs and their family caregivers. This study illustrates how the initial outbreak of the pandemic changed the supply of formal and informal care to older adults in European countries and Israel and assesses the resilience of these countries in providing support to their older populations by means of a mix of both types of care. We subjected data from the Survey of Health, Ageing and Retirement in Europe COVID-19 period (SHARE-COVID-19) across 23 European countries (including Israel) to descriptive and cluster analyses. In the first wave of the outbreak, a significant proportion of older adults in European countries received informal help, with an increase in the frequency of informal help received from children, neighbors, friends, or colleagues and a decrease in that received from other relatives. In most countries, difficulties in receiving home care services from professional providers were reported. Seven clusters were identified, reflecting different combinations of changes in the formal/informal care provision. In most countries, informal care is more resilient than home care services that formal providers deliver. Since they are an essential source for sustainable care, their challenges related to care should be addressed. The impact of the pandemic does not follow the traditional characterization of welfare regimes. A clustering effort may yield more understanding of the priorities that future care policies should exhibit at the national level and may identify potential systems for policymakers to enhance sustainability of care for community-dwelling older adults.

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Quality of Life in European Older Adults of SHARE Wave 7: Comparing the Old and the Oldest-Old

Journal of Clinical Medicine ◽

10.3390/jcm10132850 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2850

Author(s):

Amparo Oliver ◽

Trinidad Sentandreu-Mañó ◽

José M. Tomás ◽

Irene Fernández ◽

Patricia Sancho

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Measurement Invariance ◽

Factor Structure ◽

External Validity ◽

Oldest Old ◽

Age Groups ◽

Depression Scale ◽

Scalar Invariant

CASP-12 (Control, Autonomy, Self-realization, and Pleasure scale) is one of the most common internationally used measures for quality of life in older adults, although its structure is not clearly established. Current research aims to test the factor structure of the CASP-12, so as to provide evidence on reliability and external validity, and to test for measurement invariance across age groups. Data from 61,355 Europeans (≥60 years old) from the Survey of Health, Ageing and Retirement in Europe wave 7 were used. CASP-12, EURO-D (European depression scale), self-perceived health, and life satisfaction measurements were included. Reliability and validity coefficients, competing confirmatory factor models, and standard measurement invariance routine were estimated. A second-order factor model with the original factor structure was retained. The scale showed adequate reliability coefficients except for the autonomy dimension. The correlation coefficients for external validity were all statistically significant. Finally, CASP-12 is scalar invariant across age. We conclude that the best-fitting factor structure retained allows using CASP-12 either by factors, or as an overall score, depending on the research interests. Findings related to CASP-12 measurement invariance encourage its use in the oldest-old too. When comparing the dimensions across age groups, as people age, autonomy slightly increases and the rest of the dimensions decline.

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Examining Fall Recurrence Risk of Homebound Hispanic Older Adults Receiving Home Care Services

Hispanic Health Care International ◽

10.1177/1540415317691490 ◽

2017 ◽

Vol 15 (1) ◽

pp. 20-26

Author(s):

Guillermina R. Solis ◽

Jane Dimmitt Champion

Keyword(s):

Older Adults ◽

Home Care ◽

Home Health Care ◽

Fall Risk ◽

Health Care Services ◽

Home Care Services ◽

Recurrence Risk ◽

The United States ◽

Care Services ◽

Risk Of Fall

Introduction: Unintentional falls and injuries is a major problem among older adults and the fourth cause of death in the United States. A previous fall event doubles the risk of recurrence and lessens the person’s quality of life. Hispanic older adults have higher rates of disability and lower independent functioning due to poor medical health and risk for fall recurrence. Most fall studies focus on fall risk with few studies on fall recurrence in older adults receiving home health care services unrelated to fall incident. Method: A descriptive pilot study of 30 homebound Hispanic older adults receiving home care services who reported a fall within 3 months was conducted by a multidisciplinary team to evaluate risk of fall recurrence. Results: A heightened risk for fall recurrence was identified with high number of chronic illnesses, high intake of medications, vision problems, and prevalence of urinary incontinence. Conclusion: Findings highlight significant number of intrinsic factors for fall risk recurrence and injuries in a Hispanic older adults population that is homebound and receiving home care services. A multidisciplinary evaluation and culturally appropriate interventions to lessen the risk of fall recurrence are recommended.

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Hospital to Home: Supporting the Transition From Hospital to Home for Older Adults

Canadian Journal of Nursing Research ◽

10.1177/08445621211044333 ◽

2021 ◽

pp. 084456212110443

Author(s):

Brittany Barber ◽

Lori Weeks ◽

Lexie Steeves-Dorey ◽

Wendy McVeigh ◽

Susan Stevens ◽

...

Keyword(s):

Older Adults ◽

Home Care ◽

Family Caregivers ◽

Older Adult ◽

Long Term Care ◽

Home Care Services ◽

Term Care ◽

Care Services ◽

Hospital To Home

Background An increasing proportion of older adults experience avoidable hospitalizations, and some are potentially entering long-term care homes earlier and often unnecessarily. Older adults often lack adequate support to transition from hospital to home, without access to appropriate health services when they are needed in the community and resources to live safely at home. Purpose This study collaborated with an existing enhanced home care program called Home Again in Nova Scotia, to identify factors that contribute to older adult patients being assessed as requiring long-term care when they could potentially return home with enhanced supports. Methods Using a case study design, this study examined in-depth experiences of multiple stakeholders, from December 2019 to February 2020, through analysis of nine interviews for three focal patient cases including older adult patients, their family or friend caregivers, and healthcare professionals. Results Findings indicate home care services for older adults are being sought too late, after hospital readmission, or a rapid decline in health status when family caregivers are already experiencing caregiver burnout. Limitations in home care services led to barriers preventing family caregivers from continuing to care for older adults at home. Conclusions This study contributes knowledge about gaps within home care and transitional care services, highlighting the importance of investing in additional home care services for rehabilitation and prevention of rapidly deteriorating health.

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