A prospective study of incident comprehensive medical home care use among the elderly.

This prospective study directly examines, in a defined community population, the extent to which a wide array of characteristics predict utilization of an important long-term care (LTC) service--medical home care--over a two-year interval among the cohort of 3,706 people aged 65 or older. The overall age-sex adjusted rate of two-year incident home care use was 3.2 per cent. For both men and women, the rates among the aged 85 or older group were approximately 12 times the rates of those aged 65 to 74. The multivariate predictors of incident home care, adjusted for age and sex, were five: receiving help with at least one activity of daily living (ADL), being dependent in Rosow-Breslau functional health areas, being homebound, more errors in mental status items, and no involvement with social groups. The dominance of indicators of frailty in physical function and cognitive function are consistent with the predictors of another group of LTC clients, those who subsequently enter nursing homes. However, in the present study the ratios of medical home care use were similar for those living alone and for those living with others in the multivariate model, suggesting the possibility of differences between home care and institutional LTC clients.