What factors influence older people’s intention to enrol in nursing homes? A cross-sectional observational study in Shanghai, China

Objectives Given the increasing need of long-term care and the low occupancy rate of nursing homes in Shanghai, this study attempts to explore what factors influence older people’s intention to enrol in nursing homes. Design A cross-sectional observational study based on the theory of reasoned action was conducted. Survey data were collected from subjects during face-to-face interviews. Structural equation modelling was employed for data analysis. setting This study was conducted in six community health service centres in Shanghai, China. Two service centres were selected in urban, suburban and rural areas, respectively. Participants A total of 641 Shanghai residents aged over 60 were surveyed. results Structural equation modelling analysis showed that the research model fits the data well (χ2/df=2.948, Comparative Fit Index=0.972 and root mean squared error of approximation =0.055). Attitude (β=0.41, p<0.01), subjective norm (β=0.28, p<0.01) and value- added service (β=0.16, p<0.01) were directly associated with enrolment intention, explaining 32% of variance in intention. Attitude was significantly influenced by loneliness (β=−0.08, p<0.05), self-efficacy (β=0.32, p<0.01) and stigma (β=−0.24, p<0.01), while subjective norm was significantly influenced by life satisfaction (β=−0.15, p<0.01) and stigma (β=−0.43, p<0.01). Conclusions This study advances knowledge regarding the influencing factors of older people’s intention to enrol in nursing homes. It suggests that Chinese older persons’ perceived stigma has the strongest indirect effect on their intention to enrol in nursing homes. This is unique to the Chinese context and has practical implications for eldercare in China and other Asian countries with similar sociocultural contexts

Chronic conditions and multimorbidity associated with institutionalization among Finnish community-dwelling older people : an 18-year population-based follow-up study

Key summary pointsAim The aim of the study is to assess the association of chronic conditions and multimorbidity with institutionalization in older people. Findings Having dementia, mood or neurological disorder and/or five or more chronic conditions were associated with a higher risk of institutionalization. Message These risk factors should be recognized in primary care when providing and targeting care and support for home-dwelling older people. Purpose The ageing population is increasingly multimorbid. This challenges health care and elderly services as multimorbidity is associated with institutionalization. Especially dementia increases with age and is the main risk factor for institutionalization. The aim of this study was to assess the association of chronic conditions and multimorbidity with institutionalization in home-dwelling older people, with and without dementia. Methods In this prospective study with 18-year follow-up, the data on participants' chronic conditions were gathered at the baseline examination, and of conditions acquired during the follow-up period from the municipality's electronic patient record system and national registers. Only participants institutionalized or deceased by the end of the follow-up period were included in this study. Different cut-off-points for multimorbidity were analyzed. Cox regression model was used in the analyses. Death was used as a competing factor. Results The mean age of the participants (n = 820) was 74.7 years (64.0-97.0). During the follow-up, 328 (40%) were institutionalized. Dementia, mood disorders, neurological disorders, and multimorbidity defined as five or more chronic conditions were associated with a higher risk of institutionalization in all the participants. In people without dementia, mood disorders and neurological disorders increased the risk of institutionalization. Conclusion Having dementia, mood or neurological disorder and/or five or more chronic conditions were associated with a higher risk of institutionalization. These risk factors should be recognized when providing and targeting care and support for older people still living at home.Peer reviewe

Chronic conditions and multimorbidity associated with institutionalization among Finnish community-dwelling older people: an 18-year population-based follow-up study

Key summary pointsAim The aim of the study is to assess the association of chronic conditions and multimorbidity with institutionalization in older people.Findings Having dementia, mood or neurological disorder and/or five or more chronic conditions were associated with a higher risk of institutionalization.Message These risk factors should be recognized in primary care when providing and targeting care and support for home-dwelling older people.PurposeThe ageing population is increasingly multimorbid. This challenges health care and elderly services as multimorbidity is associated with institutionalization. Especially dementia increases with age and is the main risk factor for institutionalization. The aim of this study was to assess the association of chronic conditions and multimorbidity with institutionalization in home-dwelling older people, with and without dementia.MethodsIn this prospective study with 18-year follow-up, the data on participants' chronic conditions were gathered at the baseline examination, and of conditions acquired during the follow-up period from the municipality's electronic patient record system and national registers. Only participants institutionalized or deceased by the end of the follow-up period were included in this study. Different cut-off-points for multimorbidity were analyzed. Cox regression model was used in the analyses. Death was used as a competing factor.ResultsThe mean age of the participants (n = 820) was 74.7 years (64.0-97.0). During the follow-up, 328 (40%) were institutionalized. Dementia, mood disorders, neurological disorders, and multimorbidity defined as five or more chronic conditions were associated with a higher risk of institutionalization in all the participants. In people without dementia, mood disorders and neurological disorders increased the risk of institutionalization.ConclusionHaving dementia, mood or neurological disorder and/or five or more chronic conditions were associated with a higher risk of institutionalization. These risk factors should be recognized when providing and targeting care and support for older people still living at home.</p

Development and validation of classifiers and variable subsets for predicting nursing home admission

Abstract Background In previous years a substantial number of studies have identified statistically important predictors of nursing home admission (NHA). However, as far as we know, the analyses have been done at the population-level. No prior research has analysed the prediction accuracy of a NHA model for individuals. Methods This study is an analysis of 3056 longer-term home care customers in the city of Tampere, Finland. Data were collected from the records of social and health service usage and RAI-HC (Resident Assessment Instrument - Home Care) assessment system during January 2011 and September 2015. The aim was to find out the most efficient variable subsets to predict NHA for individuals and validate the accuracy. The variable subsets of predicting NHA were searched by sequential forward selection (SFS) method, a variable ranking metric and the classifiers of logistic regression (LR), support vector machine (SVM) and Gaussian naive Bayes (GNB). The validation of the results was guaranteed using randomly balanced data sets and cross-validation. The primary performance metrics for the classifiers were the prediction accuracy and AUC (average area under the curve). Results The LR and GNB classifiers achieved 78% accuracy for predicting NHA. The most important variables were RAI MAPLE (Method for Assigning Priority Levels), functional impairment (RAI IADL, Activities of Daily Living), cognitive impairment (RAI CPS, Cognitive Performance Scale), memory disorders (diagnoses G30-G32 and F00-F03) and the use of community-based health-service and prior hospital use (emergency visits and periods of care). Conclusion The accuracy of the classifier for individuals was high enough to convince the officials of the city of Tampere to integrate the predictive model based on the findings of this study as a part of home care information system. Further work need to be done to evaluate variables that are modifiable and responsive to interventions

Association of subjective and objective measures of health and functional capacity with institutionalization and mortality – a follow-up study of community-dwelling older people

The ageing population poses increasing challenges on health and social services. There is a need for tools to identify older people at higher risk of institutional care and death to better target interventions. The aim of this thesis was to identify tools feasible to use in primary care to identify persons at a higher risk of institutionalization or death. In addition, the aim was to describe the successful agers still living at home after a 20-year follow-up. The study participants were aged 64 years or over and living in the municipality of Lieto at time of the baseline examination in 1998‒1999 (n=1260). The baseline examination included measures of functional capacity, a physical examination and a review of the participants’ medical records. Data on institutionalization were gathered from the electronic patient record system and data on mortality from the official national records during the follow-up periods of 10 and 18 years. The re-examination mirrored the baseline examination after a 20-year follow-up (n=138). The studied variables were frailty (by three frailty tools), self-rated health, self-reported walking ability, comprehensive subjective health, objective health based on chronic conditions, and multimorbidity. Frailty, self-rated health, self-reported walking ability, dementia, neurological disorders, mood disorders and multimorbidity were associated with institutionalization. Frailty, subjective and objective health were associated with mortality. Subjective health had an additive effect on objective health in predicting mortality. Successful agers still living at home without daily care at the age of 84 years or over had a lower biological than chronological age, and were satisfied with their lives both at baseline and at re-examination. Self-rated health, self-reported walking ability, certain chronic conditions and multimorbidity could be used to screen for older people at higher risk of institutionalization. Frailty tools could be used in identifying older adults at higher risk of institutionalization and mortality. Successful agers were satisfied with life despite hardships and had a lower biological than chronological age. Further research is needed to evaluate possible causality.Subjektiivisen ja objektiivisen terveyden ja toimintakyvyn mittareiden yhteys pitkäaikaishoitoon joutumiseen ja kuolemaan – seurantatutkimus kotona-asuvista iäkkäistä Ikääntyvä väestö tulee lisäämään terveydenhuollon ja sosiaalipalveluiden haasteita. Palveluiden kohdentamista varten tarvitaan seulontatyökaluja tunnistamaan ne iäkkäät, jotka ovat suuremmassa riskissä joutua pitkäaikaishoitoon tai kuolla. Väitöskirjatutkimuksen tavoitteena oli löytää perusterveydenhuoltoon soveltuvia työkaluja sellaisten iäkkäiden tunnistamiseen, joilla on suurentunut riski joutua pitkäaikaishoitoon tai kuolla. Lisäksi tavoitteena oli kuvata ne onnistuneesti ikääntyneet tutkittavat, jotka edelleen asuivat kotonaan 20 vuoden seuranta-ajan jälkeen. Tutkimusväestö koostui iältään 64-vuotiaista tai vanhemmista tutkittavista, jotka lähtötilanteessa vuosina 1998‒1999 asuivat Liedon kunnassa (n=1260). Lähtötilanteessa arvioitiin toimintakykyä, tehtiin kliininen tutkimus sekä tarkasteltiin potilasasiakirjoja. Pitkäaikaishoitoon joutuminen selvitettiin potilastietojärjestelmästä ja kuolemat kansallisesta rekisteristä 10 ja 18 vuoden seuranta-ajoilta. Uudelleentutkimus 20 vuoden seuranta-ajan jälkeen vastasi lähtötilanteen tutkimusta (n=138). Tutkitut muuttujat olivat gerastenia (kolme työkalua), itsearvioitu terveys, itsearvioitu kävelykyky, kattava subjektiivinen terveys, pitkäaikaissairauksiin perustuva objektiivinen terveys ja monisairastavuus. Gerastenia, itsearvioitu terveys, itsearvioitu kävelykyky, muistisairaus, neurologiset sairaudet, mielialasairaudet ja monisairastavuus olivat yhteydessä pitkäaikaishoitoon joutumiseen. Gerastenia sekä subjektiivinen ja objektiivinen terveys olivat yhteydessä kuolleisuuteen. Subjektiivisella terveydellä oli lisävaikutus objektiiviseen terveyteen kuolemaa ennustettaessa. Onnistuneesti ikääntyneet, jotka 84 vuoden tai korkeammassa iässä asuivat kotona ilman päivittäistä apua, olivat biologisesti kronologista ikäänsä nuorempia ja tyytyväisiä elämäänsä sekä lähtötilanteessa, että seurantatutkimuksessa. Itsearvioitu terveys, itsearvioitu kävelykyky, tietyt krooniset sairaudet ja monisairastavuus voisivat toimia seulontatyökaluina tunnistettaessa iäkkäitä, joilla on suurempi riski joutua pitkäaikaishoitoon. Gerasteniatyökaluilla voitaisiin tunnistaa iäkkäät, joilla on suurempi riski joutua pitkäaikaishoitoon ja kuolla. Onnistuneesti ikääntyneet olivat tyytyväisiä elämäänsä haasteista huolimatta ja biologiselta iältään kronologista nuorempia. Mahdollinen syy-yhteys vaatii lisätutkimuksia