Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-26T00:25:03.752Z Has data issue: false hasContentIssue false
  • English
  • Français

Care trajectories through community and residential aged care services: disease effects

Published online by Cambridge University Press:  16 January 2012

ROSEMARY KARMEL ,
DIANE GIBSON ,
PHIL ANDERSON ,
YVONNE WELLS  and
STEPHEN DUCKETT
ROSEMARY KARMEL
Affiliation:
Australian Institute of Health and Welfare, Canberra, Australia.
DIANE GIBSON
Affiliation:
University of Canberra, Canberra, Australia.
PHIL ANDERSON
Affiliation:
Australian Institute of Health and Welfare, Canberra, Australia.
YVONNE WELLS
Affiliation:
School of Public Health, La Trobe University, Melbourne, Australia.
STEPHEN DUCKETT*
Affiliation:
School of Public Health, La Trobe University, Melbourne, Australia.
*
Address for correspondence: Professor Stephen Duckett, School of Public Health, LaTrobe University, Melbourne, Victoria 3086, Australia. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

As in other ageing populations, dementia, musculoskeletal conditions and cardiovascular disease affect a high proportion of Australians aged over 65 years, and the prevalence of these conditions increases significantly with age. People with these conditions may need to access a range of care services over time to enable them to remain living in their homes. Many eventually need to move into a nursing home.

In contrast to the considerable recent literature on the funding of long-term care systems for population ageing, studies on the care pathways followed by individuals are much less common. This paper explores the effect of disease on use of community care services and nursing homes over time, focusing on people with dementia, cardiovascular disease and musculoskeletal conditions. Care-use transitions are identified using linked administrative client data for a cohort of 33,300 community-living Australians who had an aged care assessment in 2003-04 and who had not previously used aged care services.

The different symptoms and courses of diseases meant that the patterns of aged care service use, both in terms of care services accessed and the timing of this access, varied considerably for people with different health conditions. These differences persisted across a range of client characteristics. In particular, people with dementia or cerebrovascular disease as their main health condition were more likely to enter nursing home care than those with heart disease or musculoskeletal conditions.

The variation in use of aged care services according to disease group need to be taken into account in any projections of demand for aged care. Such projections must allow for predictions of disease prevalence, or else they will yield inaccurate predictions of demand for both community and residential care.

Keywords

Australiaarthritiscardiovascular diseasecare trajectoriesdementiahealth conditionslong-term carerecord linkage
Type
Articles
Information
Ageing & Society , Volume 32 , Issue 8 , November 2012 , pp. 1428 - 1445
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

ACAP NDR. 2005. Aged Care Assessment Program National Data Repository: Minimum Data Set Report, Annual Report 2003–04. La Trobe University, Melbourne.Google Scholar
Agree, E. M., Freedman, V. A., Cornman, J. C., Wolf, D. A. and Marcotte, J. E. 2005. Reconsidering substitution in long-term care: when does assistive technology take the place of personal care? Journals of Gerontology, 60B, 5, S272–80.Google Scholar
Agüero-Torres, H., vonStrauss, E., Viitanen, M., Winblad, B. and Fratiglioni, L. 2001. Institutionalization in the elderly: the role of chronic diseases and dementia. Cross-sectional and longitudinal data from a population-based study. Journal of Clinical Epidemiology, 54, 8, 795–801.Google Scholar
Australian Institute of Health and Welfare (AIHW) 2002. Aged Care Assessment Program Data Dictionary. Version 1, AIHW, Canberra.Google Scholar
Australian Institute of Health and Welfare (AIHW) 2004. Heart, Stroke and Vascular Diseases, Australian Facts 2004. AIHW, Canberra.Google Scholar
Australian Institute of Health and Welfare (AIHW) 2008. Arthritis and Osteoporosis in Australia 2008. AIHW, Canberra.Google Scholar
Australian Institute of Health and Welfare (AIHW) 2011. Pathways in Aged Care: Program Use After Assessment. AIHW, Canberra.Google Scholar
Begg, S., Vos, T., Barker, B., Stevenson, C., Stanley, L. and Lopez, A. D. 2007. The Burden of Disease and Injury in Australia 2003. Australian Institute of Health and Welfare, Canberra.Google Scholar
Bergman, H., Béland, F., Karunananthan, S., Hummel, S., Hogan, D. and Wolfson, C. 2004. Développement d'un cadre de travail pour comprendre et étudier la fragilité. Gérontologie et Société, 109, 15–29.Google Scholar
Cheek, J., Ballantyne, A., Gillham, D., Mussared, J., Flett, P., Lewin, G., Walker, M., Roder-Allen, G., Quan, J and Vandermeulen, S, et al. 2006. Improving care transitions of older people: challenges for today and tomorrow. Quality in Ageing, 7, 4, 18–26.Google Scholar
Creditor, M. C. 1993. Hazards of hospitalization of the elderly. Annals of Internal Medicine, 118, 3, 219–23.Google Scholar
Dannefer, D. 1988. Differential gerontology and the stratified life course: conceptual and methodological issues. Annual Review of Gerontology and Geriatrics, 8, 1, 3–36.Google Scholar
Day, K., Carreon, D. and Stump, C. 2000. The therapeutic design of environments for people with dementia. The Gerontologist, 40, 4, 397–416.CrossRefGoogle ScholarPubMed
Duckett, S. and Willcox, S. 2011. The Australian Health Care System. Oxford University Press, Melbourne.Google Scholar
Fuller-Iglesias, H., Smith, J. and Antonucci, T. C. 2009. Theories of aging from a life-course and life-span perspective: an overview. Annual Review of Gerontology and Geriatrics, 29, 1, 3–25.CrossRefGoogle Scholar
Gaugler, J. E., Kane, R. L., Kane, R. A., Clay, T. and Newcomer, R. C. 2005 a. The effects of duration of caregiving on institutionalization. The Gerontologist, 45, 1, 78–89.Google Scholar
Gaugler, J. E., Kane, R. L., Kane, R. A. and Newcomer, R. 2005 b. Early community-based service utilization and its effects on institutionalization in dementia caregiving. The Gerontologist, 45, 2, 177–85.Google Scholar
Gibson, D. 1998. Aged Care: Old Policies, New Problems. Cambridge University Press, Cambridge.Google Scholar
Goss, J., Jerga, A., Mann, N., Ho, J. and Stevenson, C. 2005. Health System Expenditure on Disease and Injury in Australia 2000–01. Second edition, Australian Institute of Health and Welfare, Canberra.Google Scholar
Greene, V. L., Lovely, M. E., Miller, M. D. and Ondrich, J. I. 1995. Reducing residential use through community long-term care: an optimization analysis. Journals of Gerontology: Psychological Sciences and Social Sciences, 50B, 4, S259–68.Google Scholar
Grundy, E. and Jitlal, M. 2007. Socio-demographic variations in moves to institutional care 1991–2001: a record linkage study from England and Wales. Age and Ageing, 36, 4, 424–30.Google Scholar
Howe, A. 1997. The aged care reform strategy: a decade of changing momentum and margins for reform. In Borowski, A., Encel, S. and Ozanne, E. (eds), Ageing and Social Policy in Australia. Cambridge University Press, Cambridge.Google Scholar
Howe, A., Doyle, C. and Wells, Y. 2006. Targeting in Community Care: A Review of Recent Literature and Analysis of the Aged Care Assessment Program Minimum Data Set. Department of Health and Ageing, Canberra.Google Scholar
Howell, S., Silberberg, M., Quinn, W. V. and Lucas, J. A. 2007. Determinants of remaining in the community after discharge: results from New Jersey's nursing home transition program. The Gerontologist, 47, 4, 535–48.CrossRefGoogle ScholarPubMed
Jacobzone, S., Cambois, E., Chaplain, E. and Robine, J. 2000. The health of older persons in OECD countries: is it impoving fast enough to compensate for population ageing? OECD Economic Studies, 30, 1, 149–90.Google Scholar
Jorm, L. R., Walter, S. R., Lujic, S., Byles, J. E. and Kendig, H. L. 2010. Home and community care services: a major opportunity for preventive health care. BMC Geriatrics, 10, 26.Google Scholar
Karmel, R., Anderson, P., Gibson, D., Peut, A., Duckett, S. J. and Wells, Y. 2010. Empirical aspects of record linkage across multiple data sets using statistical linkage keys: the experience of the PIAC cohort study. BMC Health Services Research, 10, 41.Google Scholar
Karmel, R., Anderson, P. and Peut, A. 2009. Pathways Through Aged Care Services: A First Look. Australian Institute of Health and Welfare, Canberra.Google Scholar
Karunananthan, S., Wolfson, C., Bergman, H., Beland, F. and Hogan, D. 2009. A multidisciplinary systematic literature review on frailty: overview of the methodology used by the Canadian Initiative on Frailty and Aging. BMC Medical Research Methodology, 9, 68.Google Scholar
Kim, H. and Goggi, J. 2005. System dynamics modeling for long term care policy. Paper presented to Systems Dynamics Society Conference, Boston. Available online at http://www.systemdynamics.org/conferences/2005/proceed/papers/KIM337.pdf [Accessed 3 September 2011].Google Scholar
Klein, B. E. K., Klein, R., Knudtson, M. D. and Lee, K. E. 2005. Frailty, morbidity and survival. Archives of Gerontology and Geriatrics, 41, 2, 141–9.Google Scholar
Magro, I. and Ferry, P. 2005. Discharge from institutional long term care: does it really ever happen? BOLD: Quarterly Journal of the International Institute on Ageing (United Nations – Malta). 15, 4, 29–31.Google Scholar
Manton, K. G. 1988. Planning long-term care for heterogeneous older populations. Annual Review of Gerontology and Geriatrics, 8, 1, 217–55.Google Scholar
Marquardt, G. and Schmieg, P. 2009. Dementia-friendly architecture: environments that facilitate wayfinding in nursing homes. American Journal of Alzheimer's Disease and Other Dementias, 24, 4, 333–40.Google Scholar
Martikainen, P., Nihtilä, E. and Moustgaard, H. 2008. The effects of socioeconomic status and health on transitions in living arrangements and mortality: a longitudinal analysis of elderly Finnish men and women from 1997 to 2002. Journals of Gerontology: Psychological Sciences and Social Sciences, 63B, 2, S99–109.Google Scholar
Mehdizadeh, S. A. 2002. Health and long-term care use trajectories of older disabled women. The Gerontologist, 42, 3, 304–13.Google Scholar
Miller, E. A. and Weissert, W. G. 2000. Predicting elderly people's risk for residential placement, hospitalization, functional impairment, and mortality: a synthesis. Medical Care Research and Review, 57, 3, 259–97.Google Scholar
National Health and Hospitals Reform Commission 2009. A Healthier Future for All Australians – Final Report of the National Health and Hospitals Reform Commission. National Health and Hospitals Reform Commission, Canberra.Google Scholar
Nihtilä, E. K., Martikainen, P. T., Koskinen, S. V. P., Reunanen, A. R., Noro, A. M. an Häkkinen, U. T. 2008. Chronic conditions and the risk of long-term institutionalization among older people. European Journal of Public Health, 18, 1, 77–84.Google Scholar
Peut, A. and Gilham, J. 2009. Ageing and aged care. In Hewitt, M., Verhoeven, A. and Al-Yaman, F. (eds), Australia's Welfare 2009. Australian Institute of Health and Welfare, Canberra, 81–136.Google Scholar
Peut, A., Hogan, R., Goss, J., Mann, N. and Levings, B. 2006. Dementia in Australia: National Data Analysis and Development. Australian Institute of Health and Welfare, Canberra.Google Scholar
Ravaglia, G., Forti, P., Lucicesare, A., Pisacane, N., Rietti, E. and Patterson, C. 2008. Development of an easy prognostic score for frailty outcomes in the aged. Age and Ageing, 37, 2, 161–6.Google Scholar
Runge, C., Gilham, J. and Peut, A. 2009. Transitions in Care of People with Dementia: A Systematic Review. Dementia Collaborative Research Centres UNSW, Sydney.Google Scholar
Taylor, B. J. and Donnelly, M. 2006. Professional perspectives on decision making about the long-term care of older people. British Journal of Social Work, 36, 5, 807–26.Google Scholar
van Hoof, J., Kort, H. S. M., van Waarde, H. and Blom, M. M. 2010. Environmental interventions and the design of homes for older adults with dementia: an overview. American Journal of Alzheimer's Disease and Other Dementias, 25, 3, 202–32.CrossRefGoogle ScholarPubMed
Zhang, Y., Puterman, M., Nelson, M. and Atkins, D. 2010. A Simulation Optimization Approach for Long-term Care Capacity Planning. University of British Columbia, Vancouver.Google Scholar