de Meijer Claudine A M, Koopmanschap Marc A, Koolman Xander H E, van Doorslaer Eddy K A
Department of Health Policy and Management and iMTA, Erasmus MC, Rotterdam, Netherlands.
Med Care. 2009 Nov;47(11):1156-63. doi: 10.1097/MLR.0b013e3181b69fa8.
In view of aging populations, it is important to improve our understanding of the determination of long-term care (LTC) service use among the middle-aged and elderly population. We examined the likelihood of using 2 levels of LTC-homecare and institutional care-in the Netherlands and focused on the influence of the measured degree of disability.
We pooled 2 cross-sectional surveys-one that excluded institutionalized and one that was targeted at institutionalized individuals aged 50+. Disability is measured by impairment in (instrumental) activities of daily living (iADL, ADL) and mobility. Consistency with official Dutch LTC eligibility criteria resulted in the selection of an ordered response model to analyze utilization. We compared a model with separate disability indicators to one with a disability index.
Age and disability, but not general health, proved to be the main determinants of utilization, with the composite index sufficiently representing the disaggregated components. The presence of at least 1 disability displayed a greater effect on utilization than any additional disabilities. Apart from disability and age, sex, living alone, psychologic problems, and hospitalizations showed a significant influence on LTC use. Some determinants affected the likelihood of homecare or institutional care use differently.
Even after extensive control for disability, age remains an important driver of LTC use. By contrast, general health status hardly affects LTC use. The model and disability index can be used as a policy tool for simulating LTC needs.
鉴于人口老龄化，加深我们对中老年人群长期护理（LTC）服务使用决定因素的理解至关重要。我们研究了荷兰使用两种长期护理水平（居家护理和机构护理）的可能性，并重点关注所测量的残疾程度的影响。
我们汇总了两项横断面调查，一项排除了机构化个体，另一项针对50岁以上的机构化个体。残疾通过（工具性）日常生活活动（iADL、ADL）和行动能力受损来衡量。与荷兰官方长期护理资格标准的一致性导致选择有序响应模型来分析利用率。我们将一个带有单独残疾指标的模型与一个带有残疾指数的模型进行了比较。
年龄和残疾，而非总体健康状况，被证明是利用率的主要决定因素，综合指数足以代表分解后的组成部分。至少存在一种残疾对利用率的影响比任何额外的残疾都更大。除了残疾和年龄外，性别、独居、心理问题和住院对长期护理的使用有显著影响。一些决定因素对居家护理或机构护理使用可能性的影响有所不同。
即使在对残疾进行广泛控制之后，年龄仍然是长期护理使用的重要驱动因素。相比之下，总体健康状况几乎不影响长期护理的使用。该模型和残疾指数可作为模拟长期护理需求的政策工具。
