Abstract
BackgroundLong-term care is often associated with high health care expenditures. In the Netherlands, an ageing population will likely increase the demand for long-term care within the near future. The development of risk profiles will not only be useful for projecting future demand, but also for providing clues that may prevent or delay long-term care utilization. Here, we report our identification of predictors of long-term care utilization in a cohort of hospital patients aged 65+ following their discharge from hospital discharge and who, prior to hospital admission, were living at home.MethodsThe data were obtained from three national databases in the Netherlands: the national hospital discharge register, the long-term care expenses register and the population register. Multinomial logistic regression was applied to determine which variables were the best predictors of long-term care utilization. The model included demographic characteristics and several medical diagnoses. The outcome variables were discharge to home with no formal care (reference category), discharge to home with home care, admission to a nursing home and admission to a home for the elderly.ResultsThe study cohort consisted of 262,439 hospitalized patients. A higher age, longer stay in the hospital and absence of a spouse were found to be associated with a higher risk of all three types of long-term care. Individuals with a child had a lower risk of requiring residential care. Cerebrovascular diseases [relative risk ratio (RRR) = 11.5] were the strongest disease predictor of nursing home admission, and fractures of the ankle or lower leg (RRR = 6.1) were strong determinants of admission to a home for the elderly. Lung cancer (RRR = 4.9) was the strongest determinant of discharge to the home with home care.ConclusionsThese results emphasize the impact of age, absence/presence of a spouse and disease on long-term care utilization. In an era of demographic and epidemiological changes, not only will hospital use change, but also the need for long-term care following hospital discharge. The results of this study can be used by policy-makers for planning health care utilization services and anticipating future health care needs.
Highlights
Long-term care is often associated with high health care expenditures
Data on long-term care use were retrieved from the register of exceptional health care expenses, which was linked by Statistics Netherlands to the population register records using the same primary linkage keys as mentioned above
The five most prevalent diseases among the 23 diagnoses included in the model were diabetes mellitus, cerebrovascular diseases, coxarthrosis, chronic obstructive pulmonary disease (COPD) and heart failure
Summary
In the Netherlands, an ageing population will likely increase the demand for long-term care within the near future. It is expected that the prevalence of chronic diseases will rise, and the number of people in need of long-term care. This global development will have a significant effect on health care services in terms of capacity, planning and costs. In 2005, about 18.5% of the total health care budget in the Netherlands was spent on long-term care provided by nursing homes, homes for the elderly and home care, largely to individuals aged 65+ [5]. Due to the ageing of the post-war 'baby-boomers' and a further predicted increase in life expectancy, a substantial further increase in the proportion of elderly in the general population is anticipated from 2010 onwards
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
