Differentiating between home care types to identify older adults at risk of adverse health outcomes in the community

Objectives: Acute hospitalization, recurrent admissions, institutionalization, and death are important adverse health outcomes. Older adults receiving home care are especially at risk of these outcomes, yet it remains unclear if this risk differs between older adults receiving different types of home care and older adults not receiving home care. Design: Retrospective cohort study using national claims data from 2019. Setting and Participants: Community-dwelling Dutch individuals aged ≥ 65 years (N = 3,174,953). Methods: Participants were categorized: no home care, household help, personal care, household help combined with personal care, or nursing home care at home. The primary outcomes were the number of people experiencing acute hospitalization, recurrent admissions, institutionalization, or death. Logistic regression models were applied. Results: In total, 2,758,093 adults were included in the no home care group, 131,260 in the household help group, 154,462 in the personal care group, 96,526 in the household help combined with personal care group, and 34,612 in the nursing home care at home group. The risk of adverse outcomes differed between home care groups, with all showing higher odds compared with the no home care group. Individuals receiving household help combined with personal care had the highest odds for acute hospitalization [odds ratio (OR), 2.60; 95% CI, 2.55–2.64] and recurrent admissions (OR, 2.60; 95% CI, 2.55–2.65), while those receiving nursing home care at home had the highest odds for death (OR, 7.59; 95% CI, 7.35–7.85) and institutionalization (OR, 63.22; 95% CI, 60.94–65.58). Conclusions and Implications: Differentiating between the type of home care older adults receive identifies subpopulations with different risks for adverse health outcomes compared with older adults not receiving home care. Older adults receiving personal care (nurse based) are at high risk for these outcomes and represent a substantial population with prevention potential. Future research should focus on developing effective interventions for this group.

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