Older women’s patterns of home and community care use and transition to residential aged care: An Australian cohort study

Abstract

ObjectiveTo examine whether patterns of home and community care (HACC) use and person-based characteristics were associated with time to enter permanent residential aged care (RAC). Study designA prospective cohort study. The sample consisted of 8062 participants of the Australian Longitudinal Study on Women’s Health who used HACC services between 2001 and 2014. Main outcome measuresTime from first HACC use to enter permanent RAC. The median follow-up time was 63 months. Factors associated with time to enter RAC were identified using competing risk regression models. ResultsOf the 8062 participants, 60% belonged to the ‘basic HACC’ group, who used few services minimally; 16% belonged to the ‘moderate HACC’ group, who predominantly used domestic assistance with moderate use of other services; and 24% belonged to the ‘complex HACC’ group, who used many services frequently. Being a member of the complex HACC group was associated with a lower cumulative incidence of RAC than basic or moderate HACC (chances 15% versus 30% by the median observation period, p < 0.01). Living in a remote/outer region (sub-distributional hazard ratio (sdHR) = 0.83, 95%CI: 0.74 – 0.93) was associated with delayed admission to RAC. Meanwhile, earlier admission was associated with living in an apartment (sdHR = 1.29, 95%CI: 1.20–1.40) or a retirement village (sdHR = 1.54, 95%CI = 1.38–1.72), having a physical functioning score <40 (sdHR = 1.16, 95%CI = 1.05–1.25), and falls with injury (sdHR = 1.15, 95%CI = 1.05–1.25). ConclusionsOur findings highlight the importance of providing more community care services, age-friendly housing, falls prevention and physical activity programs to reduce inappropriate admission to RAC.