Abstract
Objective
To investigate the use of home nursing by community-dwelling older women to determine
the nature of services required by those living alone.
Design
A retrospective cohort study using routinely collected data.
Setting and Participants
Women aged 55 years and older living in metropolitan Melbourne who received an episode
of nursing care from a large community home-based nursing service provider between
January 1, 2006 and December 31, 2015.
Methods
Descriptive and inferential statistical analyses were used to examine the relationship
between client- and service-related factors and use of community nursing services.
The primary outcome of interest was the hours of service received in a care episode.
Results
A total of 134,396 episodes of care were analyzed, in which 51,606 (38.4%) episodes
involved a woman who lived alone. The median hours of care per episode to women who
lived alone was almost 70% more than that for women who lived with others. Multivariable
regression identified factors influencing the amount of service use: living alone
status, cognitive health status, and number of required home nursing activities. After
adjusting for confounding and interactions, living alone was associated with at least
13% more hours of care than is provided to those not living alone. Compared with women
who lived with others, women living alone required almost double the amount of assistance
with medication management and were 30% more likely to experience a deterioration
in their condition or be discharged from home nursing care into an acute hospital.
From 2006 to 2015, for all women there was a trend toward fewer hours of nursing service
provided per episode.
Conclusions and Implications
Community-dwelling older women who live alone have greater service needs and higher
rates of discharge to hospital. This knowledge will help guide provision of services
and strategies to prevent clinical deterioration for this population.
Keywords
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References
- Ageing and health.(Available at:)http://www.who.int/news-room/fact-sheets/detail/ageing-and-healthDate: 2018Date accessed: May 7, 2019
- Living alone in later life: A global perspective.Popul Dev Rev. 2018; 44: 427-454
- Aging and multimorbidity: New tasks, priorities, and frontiers for integrated gerontological and clinical research.J Am Med Dir Assoc. 2015; 16: 640-647
- Population attributable risk for functional disability associated with chronic conditions in Canadian older adults.Age Ageing. 2010; 39: 738-745
- Population and fertility by age and sex for 195 countries and territories, 1950-2017: A systematic analysis for the Global Burden of Disease Study 2017.Lancet. 2018; 392: 1995-2051
- Childlessness and support networks in later life: New pressures on familistic welfare states?.J Fam Issues. 2014; 35: 331-357
- Marriage (still) matters: The contribution of demographic change to trends in childlessness in the United States.Demography. 2013; 50: 1641-1661
- Historical trends in childlessness.J Fam Issues. 2007; 28: 1311-1337
- Female labor supply.(Available at:)
- The globalization of migration: Has the world become more migratory?.Int Migr Rev. 2015; 48: 283-323
- Public long-term care financing arrangements in OECD countries.in: Help Wanted? Providing and Paying for Long-Term Care. OECD, Paris2011
- Better Home Care in Canada—A National Action Plan. 2019.The Canadian Home Care Association, Mississauga, ON2016
- Home care in Europe: A systematic literature review.BMC Health Serv Res. 2011; 11: 207-220
- Explaining governmental involvement in home care across Europe: An international comparative study.Health Policy. 2013; 110: 84-93
- Choice, competition and care—Developments in English social care and the impacts on providers and older users of home care services.Soc Policy Admin. 2015; 49: 649-664
- Long-term services and supports (LTSS): A growing challenge for an aging America.Public Policy Aging Rep. 2015; 25: 56-62
- The Desire to Age in Place Among Older Australians.AIHW, Canberra2013
- Home and community preferences of the 45+ population.(Available at:)https://assets.aarp.org/rgcenter/general/home-community-services-10.pdfDate: 2010Date accessed: February 21, 2019
- Health care in Canada, 2011: A focus on seniors and aging. Available at.https://secure.cihi.ca/free_products/HCIC_2011_seniors_report_en.pdfDate: 2011Date accessed: March 21, 2019
- Healthy ageing—Health and social care systems.(Available at:)
- Census of Population and Housing: Reflecting Australia—Stories from the Census, 2016.Australian Bureau of Statistics, Canberra2016
- World Population Ageing 2017—Highlights.(Available at:)https://www.un.org/en/development/desa/population/publications/pdf/ageing/WPA2017_Highlights.pdfDate accessed: April 29, 2019
- Time of Our Lives? Building Opportunity and Capacity for the Economic and Social Participation of Older Australian Women.Lord Mayor's Charitable Foundation, Melbourne2016
- The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) Statement.PLoS Med. 2015; 12: e1001885
- Trajectories of Home Nursing Use for Older Women in Melbourne, Australia: 2006-2015.Australas J Ageing. 2019 Oct 15; ([Epub ahead of print])
Ogrin R, Lowthian JA, Johnstone G, et al. Older women living alone: Co-creating health and social care services (Symposium). Papers presented at: 51st Australian Association of Gerontology Conference; Melbourne, Australia; November 21-23, 2018.
- Episode of care definition.(Available at:)https://meteor.aihw.gov.au/content/index.phtml/itemId/268978Date accessed: March 10, 2019
- Annual report on the funding and financing of the aged care sector—2017.(Available at:)https://www.gen-agedcaredata.gov.au/Resources/2017_acfa_annual_reportDate accessed: May 6, 2019
- International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM).(Available at:)
- ICD-10-AM/ACHI/ACS.(Available at:)
- Introducing ICD-10-AM in Australian hospitals.Med J Aust. 1998; 169: S32-S35
- New ICD-10 version of the Charlson Comorbidity Index predicted in-hospital mortality.J Clin Epidemiol. 2004; 57: 1288-1294
- Evaluation of Charlson’s Comorbidity Index in elderly living in nursing homes.J Clin Epidemiol. 2002; 55: 1144-1147
- Some common misperceptions about P values.Stroke. 2014; 45: e244-e246
- Analyzing interactions of fitted models.(Available at:)https://cran.r-project.org/web/packages/phia/vignettes/phia.pdfDate: 2015Date accessed: September 29, 2019
- Frailty in older women.Maturitas. 2011; 69: 203-207
- Women over the age of 85 years who live alone: A descriptive study.Nurs Prax N Z. 2010; 26: 4-13
- Patterns of home and community care use among older participants in the Australian Longitudinal Study of Women's Health.Eur J Ageing. 2019; 81: 39-47
- Complex interventions to improve physical function and maintain independent living in elderly people: A systematic review and meta-analysis.Lancet. 2008; 371: 725-735
- Risk factors for functional status decline in community-living elderly people: A systematic literature review.Soc Sci Med. 1999; 48: 445-469
- Home care services for older clients with and without cognitive impairment in Sweden.Health Soc Care Community. 2019; 27: 139-150
- Family caregivers of people with dementia.Dialogues Clin Neurosci. 2009; 11: 217-228
- The epidemiology of polypharmacy in older adults: Register-based prospective cohort study.Clin Epidemiol. 2018; 10: 289-298
- Gender differences in social network size and satisfaction in adults in their 70s.J Health Psychol. 2010; 15: 671-679
- How much does it hurt to be lonely? Mental and physical differences between older men and women in the KORA-Age Study.Int J Geriatr Psychiatry. 2014; 29: 245-252
- Partner status and mental and physical health of independently living men aged 70 years and older.Australas J Ageing. 2016; 35: 143-146
- Experiences of older men living alone: A qualitative study.Issues Ment Health Nurs. 2016; 37: 113-120
Article info
Publication history
Published online: December 27, 2019
Footnotes
This work was supported by the Lord Mayor's Charitable Foundation—Eldon & Anne Foote Trust (Innovation Grant 2016).
The authors declare no conflicts of interest.
Identification
Copyright
© 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
