Trajectories of Long-Term Residential Care Needs Among Older Australian Women: A Cohort Study Using Linked Data

Abstract

ObjectiveOlder women are more likely than men to enter residential aged care (RAC) and generally stay longer. We aimed to identify and examine their trajectories of care needs over time in RAC across 3 fundamental care needs domains, including activities of daily living (ADL), behavior, and complex health care. DesignPopulation-based longitudinal cohort study. SettingRAC facilities in Australia. ParticipantsA total of 3519 participants from the 1921-1926 birth cohort of the Australian Longitudinal Study on Women's Health (ALSWH), who used permanent RAC between 2008 and 2014. MethodsWe used data from the Aged Care Funding Instrument, National Death Index, and linked ALSWH survey. Participants’ care needs in the 3 domains were followed every 6 months up to 60 months from the date of admission to RAC. Trajectories of care needs over time were identified using group-based multitrajectory modeling. ResultsFive distinct trajectory groups were identified, with large variation in the combinations of levels of care needs over time. Approximately 28% of residents belonged to the “high dependent–behavioral and complex need” group, which had high care needs in all 3 domains over time, whereas around one-third of residents (31%) were included in 2 trajectory groups (“less dependent–low need” and “less dependent–increasing need”), which had low or low to medium care needs over time. More than two-fifths of residents (41%) comprised 2 trajectory groups (“high dependent–complex need” and “high dependent–behavioral need”), which had medium to high care needs in 2 domains. Higher age at admission to RAC and multiple morbidities were associated with increased odds of being a member of the high dependent–complex need group than the less dependent–increasing need group. Conclusions and ImplicationsIdentification of the differential trajectories of care needs among older women in RAC will help to better understand the circumstances of their changing care needs over time. This will facilitate appropriate care planning and service delivery for RAC residents, who are mostly older women.