Abstract
BackgroundGiven 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.MethodsWe 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.ResultsOf 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).ConclusionsIn 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.
Highlights
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
Few longitudinal studies addressed the issue of formal home care use and its determinants, and the generalizability of their results is limited by varying designs and definitions [7,8,9,10]
The main objective of the present research was to establish and quantify, during a defined timeframe, the trajectories followed by participants in the Lc65+ cohort regarding professional home care use
Summary
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 secondary objective was to identify factors associated with home care utilization using Andersen’s Behavioural Model of Health Services Use. Fostered by the challenge of population ageing, formal home care services play a growing role in elder care and are of increasing importance in health policies [1, 2]. There is major interest in studying individuals’ characteristics determining their utilization This was performed in previous research using Andersen’s Behavioural Model of Health Services Use, which postulates that individual, societal and health system characteristics all influence service utilization [3, 4]. Few longitudinal studies addressed the issue of formal home care use and its determinants, and the generalizability of their results is limited by varying designs and definitions [7,8,9,10]
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