Associations between diabetes and risk of short-term and long-term nursing home stays among older people receiving home care services: A nationwide registry study.

BACKGROUND

Older people with diabetes who live at home and receive home care services (HCS) are vulnerable, which may result in a need for more care than the HCS can provide. In this study we aimed to explore associations between pharmacologically treated diabetes and the risk of short-term and long-term nursing home stays (NHS) among older people receiving HCS.

METHODS

This nationwide registry study included older people ≥ 65 years receiving HCS, as registered in the Norwegian Information System for the Nursing and Care Sector (IPLOS) (2010-2014). Data from IPLOS were merged with data from the Norwegian Prescription Database and the Norwegian Patient Registry. Pharmacologically treated diabetes (hereafter referred to as diabetes) was defined based on prescriptions of glucose-lowering drugs (GLD) (≥ 1 prescription in the current or previous year). Persons not prescribed GLD were defined as not having diabetes. Based on Anatomical Therapeutic Chemical (ATC) codes we identified the following subgroups: persons without diabetes, persons using "non-insulin GLD only", "insulin and non-insulin GLD" and "insulin only". An NHS was defined as at least one stay during a given calendar year, where a short-term NHS is temporary, and a long-term NHS is permanent. Log-binomial regression was used to test for differences in NHS and results are reported as risk ratios (RR) with 95% CIs.

RESULTS

Both insulin-treated subgroups had a higher risk of a short-term NHS ("insulin only" users RR 1.06 (CI 1.03-1.09) and "insulin and non-insulin GLD" users RR 1.04 (CI 1.02-1.06)) compared to those without diabetes. In general, persons with diabetes had a lower risk of a long-term NHS than those without diabetes (RR 0.92 (CI 0.89-0.94)). The subgroup using "insulin and non-insulin GLD" had the lowest risk of a long-term NHS (RR 0.86 (CI 0.81-0.91)).

CONCLUSION

Despite a lower risk of a long-term NHS among older people with diabetes, we found an increased risk of a short-term NHS among persons with insulin-treated diabetes who live at home and receive HCS. This calls for attention when planning health care, in order to provide coordinated and individualized care to prevent short-term NHS's.