Ten-Year Trends and Predictors of Unplanned Hospitalisation in Community-Dwelling Older People Receiving Home-Based Care

Abstract

Older people prefer to remain living in their own home for as long as possible; however, many require support to do so through health and other care services provided in the home. This study aimed to explore the trends in usage of a home-based care service by older people in metropolitan Melbourne and factors associated with unplanned hospitalisations. This longitudinal study analysed episodes of home-based care for people aged ≥65 years between 2006 and 2015. An episode of care was defined as the period of time during which the home care services were provided to the client. Care episodes culminated in a planned discharge from the service or an unplanned hospitalisation. Descriptive statistics and multivariable logistic regression were utilised to investigate the characteristics associated with unplanned hospitalisations. Utilisation of home-based care services over the 10-year period showed an increasing rate of use by people aged ≥85 years and a reduced usage rate by females aged 70–84 years and males 75–79 years old. Of 170,001 episodes of care, 43,608 (25.7%) resulted in an unplanned hospitalisation. Home-based care delivered to people aged ≥85 years showed an increasing rate of episodes ending in an unplanned transfer to the hospital. Between 2006 and 2015, individuals aged 85–89 years displayed a rate increase of 18.7% in episodes ending in an unplanned hospitalisation; for those aged ≥90 years, the rate rise was 43.6%. Factors associated with an unplanned hospitalisation included advancing age, male gender, living alone, cognitive dysfunction, and the complexity of medical issues. Health policy has focussed on providing services to enable older people to remain in their own home. The increasing rate of unplanned hospitalisations for community-dwellers aged ≥85 years suggests more support is required to enable ageing in place.

Hospitalisations and emergency department presentations by older individuals accessing long-term aged care in Australia

“…Advancing age, being male and increasingly complex health issues and care needs have been identified as potential predictors of unplanned hospitalisations in older people both receiving home care package support and living in residential aged care. 14,24 In people receiving home care package support, cognitive impairment may also be a predictor of unplanned hospitalisations, whereas medicine use, including polypharmacy and high sedative medication load, may also be predictors of unplanned hospitalisations and ED presentations in people living in residential aged care. 25,26 Studies that have examined the implementation of interventions to reduce hospitalisations in residential aged care settings have been mixed.…”

Routine data collection in home care: A national survey of home care providers in England

“…The potential benefits of populating an MDS with routinely collected data in home care have been recognised (e.g. (Dickins, Joe, & Lowthian, 2023; Morandi et al, 2024), and the need for enhanced data in home care is widely acknowledged. However, despite a plan for rapid implementation of digital records in England, our understanding of current practice is limited.…”