Dataset Information

Social factors influencing utilization of home care in community-dwelling older adults: a scoping review.

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.

SUBMITTER: Mah JC

PROVIDER: S-EPMC7912889 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Social factors influencing utilization of home care in community-dwelling older adults: a scoping review.

Mah Jasmine C JC Stevens Susan J SJ Keefe Janice M JM Rockwood Kenneth K Andrew Melissa K MK

BMC geriatrics 20210227 1

<h4>Background</h4>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 compl ...[more]

PMID: 33639856

Similar Datasets

Project description:ImportanceThe vast majority of older adults desire to age in their communities, and it is not clear what helps them be successful at aging in place.ObjectiveTo investigate the comparative effectiveness of community-designed and community-implemented peer-to-peer (P2P) support programs vs standard community services (SCS) to promote health and wellness in at-risk older adults.Design, setting, and participantsThis comparative effectiveness study involved a longitudinal cohort of adults aged 65 years and older conducted between 2015 and 2017. The setting was 3 communities in which community-based organizations delivered P2P services to older adults in California, Florida, and New York. Participants in the P2P group and in the SCS group were matched at enrollment into the study according to age, sex, and race/ethnicity at each site. Data analysis was performed from October 2018 to May 2020.ExposuresP2P support was provided by trained older adult volunteers in the same community. They provided support targeted at the needs of the older adult they served, including transportation assistance, check-in calls, social activities, help with shopping, and trips to medical appointments.Main outcomes and measuresRates of hospitalization, urgent care (UC) and emergency department (ED) use, and a composite measure of health care utilization were collected over 12 months of follow-up.ResultsA total of 503 participants were screened, 456 participants were enrolled and had baseline data (234 in the SCS group and 222 in the P2P group), and 8 participants had no follow-up data, leaving 448 participants for the main analysis (231 in the SCS group and 217 in the P2P group; 363 women [81%]; mean [SD] age, 80 [9] years). Participants in the P2P group more often lived alone, had lower incomes, and were more physically and mentally frail at baseline compared with the SCS group. After adjusting for propensity scores to account for baseline differences between the 2 groups, there was a statistically significant higher rate of hospitalization in the P2P group than in the SCS group (0.68 hospitalization per year vs 0.44 hospitalization per year; risk ratio, 1.54; 95% CI, 1.14-2.07; P = .005) during the 12 months of observation. There were no significant differences between the 2 groups in the rates of ED or UC visits or composite health care utilization over the 12 months of the study.Conclusions and relevanceP2P support was associated with higher rates of hospitalization but was not associated with other measures of health care utilization. Given that this is not a randomized clinical trial, it is not clear from these findings whether peer support will help older adults age in place, and the topic deserves further study.

Project description:Care of frail and dependent older adults with multiple chronic conditions is a major challenge for health care systems. The study objective was to test the efficacy of providing integrated care at home to reduce unnecessary hospitalizations, emergency room visits, institutionalization, and mortality in community dwelling frail and dependent older adults.A prospective controlled trial was conducted, in real-life clinical practice settings, in a suburban region in Geneva, Switzerland, served by two home visiting nursing service centers. Three hundred and one community-dwelling frail and dependent people over 60 years old were allocated to previously randomized nursing teams into Control (N?=?179) and Intervention (N?=?122) groups: Controls received usual care by their primary care physician and home visiting nursing services, the Intervention group received an additional home evaluation by a community geriatrics unit with access to a call service and coordinated follow-up. Recruitment began in July 2009, goals were obtained in July 2012, and outcomes assessed until December 2012. Length of follow-up ranged from 5 to 41 months (mean 16.3). Primary outcome measure was the number of hospitalizations. Secondary outcomes were reasons for hospitalizations, the number and reason of emergency room visits, institutionalization, death, and place of death.The number of hospitalizations did not differ between groups however, the intervention led to lower cumulative incidence for the first hospitalization after the first year of follow-up (69.8%, CI 59.9 to 79.6 versus 87?·?6%, CI 78?·?2 to 97?·?0; p?=?.01). Secondary outcomes showed that the intervention compared to the control group had less frequent unnecessary hospitalizations (4.1% versus 11.7%, p?=?.03), lower cumulative incidence for the first emergency room visit, 8.3%, CI 2.6 to 13.9 versus 23.2%, CI 13.1 to 33.3; p?=?.01), and death occurred more frequently at home (44.4 versus 14.7%; p?=?.04). No significant differences were found for institutionalization and mortality.Integrated care that included a home visiting multidisciplinary geriatric team significantly reduced unnecessary hospitalizations, emergency room visits and allowed more patients to die at home. It is an effective tool to improve coordination and access to care for frail and dependent older adults.Clinical Trials.gov Identifier: NCT02084108 . Retrospectively registered on March 10th 2014.

Project description:AimsLate-life depression has substantial impacts on individuals, families and society. Knowledge gaps remain in estimating the economic impacts associated with late-life depression by symptom severity, which has implications for resource prioritisation and research design (such as in modelling). This study examined the incremental health and social care expenditure of depressive symptoms by severity.MethodsWe analysed data collected from 2707 older adults aged 60 years and over in Hong Kong. The Patient Health Questionnaire-9 (PHQ-9) and the Client Service Receipt Inventory were used, respectively, to measure depressive symptoms and service utilisation as a basis for calculating care expenditure. Two-part models were used to estimate the incremental expenditure associated with symptom severity over 1 year.ResultsThe average PHQ-9 score was 6.3 (standard deviation, s.d. = 4.0). The percentages of respondents with mild, moderate and moderately severe symptoms and non-depressed were 51.8%, 13.5%, 3.7% and 31.0%, respectively. Overall, the moderately severe group generated the largest average incremental expenditure (US$5886; 95% CI 1126-10 647 or a 272% increase), followed by the mild group (US$3849; 95% CI 2520-5177 or a 176% increase) and the moderate group (US$1843; 95% CI 854-2831, or 85% increase). Non-psychiatric healthcare was the main cost component in a mild symptom group, after controlling for other chronic conditions and covariates. The average incremental association between PHQ-9 score and overall care expenditure peaked at PHQ-9 score of 4 (US$691; 95% CI 444-939), then gradually fell to negative between scores of 12 (US$ - 35; 95% CI - 530 to 460) and 19 (US$ -171; 95% CI - 417 to 76) and soared to positive and rebounded at the score of 23 (US$601; 95% CI -1652 to 2854).ConclusionsThe association between depressive symptoms and care expenditure is stronger among older adults with mild and moderately severe symptoms. Older adults with the same symptom severity have different care utilisation and expenditure patterns. Non-psychiatric healthcare is the major cost element. These findings inform ways to optimise policy efforts to improve the financial sustainability of health and long-term care systems, including the involvement of primary care physicians and other geriatric healthcare providers in preventing and treating depression among older adults and related budgeting and accounting issues across services.

Project description:BackgroundHigher maximal- and explosive strength is associated with better physical function among older adults. Although the relationship between isometric maximal strength and physical function has been examined, few studies have included measures of isometric rate of force development (RFD) as a measure of explosive strength. Furthermore, little is known about the oldest old (>80 years), especially individuals who receive home care and use mobility devices. Therefore, the aim of this study was to examine the association between maximal- and explosive muscle strength with physical function in community-dwelling older adults receiving home care.MethodsAn exploratory cross-sectional analysis including 107 (63 females and 43 males) community-dwelling older adults [median age 86 (interquartile range 80-90) years] receiving home care was conducted. Physical function was measured with five times sit-to-stand (5TSTS), timed 8-feet-up-and-go (TUG-8ft), preferred-, and maximal gait speed. Maximal strength was assessed as maximal isometric voluntary contraction (MVC) and explosive strength as RFD of the knee extensors. We used linear regression to examine the associations, with physical function as dependent variables and muscle strength (MVC and RFD) as independent variables.ResultsMVC was significantly associated with 5TSST [standardized regression coefficient β = -0.26 95% CI (-0.45, -0.06)], TUG-8ft [-0.6 (-0.54, -0.17)], preferred gait speed [0.39 (0.22, 0.57)], and maximal gait speed [0.45 (0.27, 0.62)]. RFD was significantly associated with 5TSST [-0.35 (-0.54, -0.17)], TUG-8ft [-0.43 (-0.60, -0.27)], preferred gait speed [0.40 (0.22, 0.57)], and maximal gait speed [0.48 (0.31, 0.66)].ConclusionsHigher maximal- and explosive muscle strength was associated with better physical function in older adults receiving home care. Thus, maintaining and/or improving muscle strength is important for perseverance of physical function into old age and should be a priority.

Dataset Information

Social factors influencing utilization of home care in community-dwelling older adults: a scoping review.

Background

Objectives

Methods

Results

Conclusion

Publications

Social factors influencing utilization of home care in community-dwelling older adults: a scoping review.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets