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

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+ populationbased 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.

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

“…Most of the studies (44 studies or 66.7%) were secondary data analyses of existing databases, [ 42 , 44 , 45 , 47 , 50 , 51 , 54 , 57 , 59 – 63 , 65 , 66 , 68 , 69 , 71 , 72 , 74 – 76 , 80 , 82 , 83 , 87 , 90 , 93 – 96 , 100 – 102 ]; of which, ten of these studies used econometric analytic techniques [ 41 , 43 , 56 , 64 , 77 , 84 , 86 , 91 , 97 , 98 ]. Other study designs included nine cross-sectional surveys [ 40 , 48 , 55 , 58 , 79 , 81 , 85 , 103 , 105 ], five longitudinal cohort studies [ 46 , 49 , 70 , 78 , 88 ], four retrospective cohort studies [ 73 , 89 , 99 , 104 ], and one each of a case control [ 53 ], quasi experimental [ 52 ], cluster randomized controlled trial [ 92 ] and quality improvement study [ 67 ].…”

“…Older adults open to experiences (described as a tendency to be drawn to novel ideas, feelings, values, actions, and sensations) was positively associated with receipt of home care [ 61 ], as was being afraid to fall and thus choosing to restrict activities [ 57 ]. No association was found for older adults who expressed positive affect, purpose in life or fear of emergency situations [ 55 , 59 ].…”

“…Loneliness [ 49 , 55 ], internet use frequency [ 49 , 66 ], being born outside the country of study [ 57 , 69 , 83 , 94 ] and engaging in certain health behaviours (smoking, drinking alcohol, seatbelt use and/or exercise) [ 44 , 77 , 103 ] did not demonstrate consistent association with home care use. Having good knowledge about home care services [ 57 ] has not associated with use of home care. Retirement [ 79 ], speaking French as a primary language in Canada [ 42 ], and driving as main method of transportation [ 76 ] were negatively correlated with home care propensity but were only examined in a single study precluding synthesis (not shown in Fig.…”

“…Five studies analyzed social networks in relation to home care, and each used a different measure [ 57 , 65 , 72 , 75 , 87 ]. Nonetheless, having a strong social network in which to rely on was associated with a lower likelihood of receiving home care.…”

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

“…The scientific literature distinguishes between these two main providers of care [13], and although there is no overall consensus about the precise definition and meaning of these terms [14], formal care usually refers to services provided by health and social care service organizations, either public or private (both for-profit and non-profit). Apart from residential (or institutional) care, this term usually includes home-based care such as assistance in basic and instrumental Activities of Daily Living (ADLs and IADLs), at-home medical and nursing care, and community-based services such as those provided by day-care centers [15]. Some formal caregivers-mainly medical and nursing home-care staff but also social workers and home helpers-are trained professionals, although in some countries many home-based care providers are represented by persons who are largely untrained in caring for vulnerable older adults and often have a migration background [16,17].…”