Abstract
ObjectiveTo identify factors that predict admission to long‐term care (LTC) and mortality among community‐based, dependent older people in Ireland, who were in receipt of formal home support.MethodsAn audit was conducted of all community‐dwelling older adults receiving government funded home support during 2017 in the Dublin North Central, Health Service Executive administrative area. Data were extracted from the Common Summary Assessment Report (CSAR), a mandatory form used in the provision of home support. Multiple logistic regression analysis was used to examine the factors associated with admission to LTC and mortality, with the results presented as odds ratios (OR) and 95% confidence intervals.ResultsThe audit comprised 1597 community‐dwelling older adults with a mean age of 83.3 (SD: 7.2) years. The prevalence of transition to LTC and mortality was 8% and 9%, respectively, during the 12‐month period. Factors significantly associated with admission to LTC were “cognitive dysfunction” [OR 2.10 (1.41‐3.14), P < .001] and the intensity of home support [OR 1.05 (1.01‐1.06), P < .003], as measured by weekly formal care hours. Physical dependency and advanced age (aged 95 years +) were significantly associated with mortality in this population (P < .001).Conclusion“Cognitive dysfunction” and intensity of formal home support were associated with transition to LTC, while physical dependency and advanced age were associated with mortality. Investment in personalised, cognitive‐specific, services and supports are necessary to keep people with dementia and related cognitive impairments living at home for longer.
Highlights
“Cognitive dysfunction” and intensity of formal home support were significantly associated with admittance to long‐term care in community‐dwelling older people
There is evidence that reduced activities of daily living (ADL) activity is associated with functional deterioration, long‐term care (LTC), and mortality among older people.[20,21]
The data for this this study were extracted from the Common Summary Assessment Report (CSAR), which is a mandatory form completed by a community nurse or other health professional as part of the home support application and review process
Summary
To identify factors that predict admission to long‐term care (LTC) and mortality among community‐based, dependent older people in Ireland, who were in receipt of formal home support. Conclusion: “Cognitive dysfunction” and intensity of formal home support were associated with transition to LTC, while physical dependency and advanced age were associated with mortality. The government in Ireland is spending more than twice as much on residential care than on home care for older people; estimated at €962 million to support 23 334 people in LTC relative to a budget of €408 million for home care services to support approximately 49 000 people annually.[10] Historically, even when public resources were more plentiful, investment in community‐based care has been relatively poor.[11] Similar to UK BoC studies, O'Shea and Monaghan highlighted the potential of enhanced individualised supports for keeping people with dementia living in their own homes for longer in Ireland.[7]. Formal home support is allocated based on a care needs
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