Original Study
Usage of Community Services and Domestic Helpers Predicted Institutionalization of Elders Having Functional or Cognitive Impairments: A 12-Month Longitudinal Study in Hong Kong

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Abstract

Objectives

To estimate the 12-month institutionalization rate and to identify the associated predictors among functionally impaired elders with or without cognitive impairment.

Methods

A cohort of Hong Kong community-dwelling elders aged 65 or older with functional and/or cognitive impairments was recruited and interviewed from 2007 to 2008. Twelve months after the baseline interview, the family caregivers or elders were interviewed to update the residence status of the elders. Logistic regressions were used to examine the association between institutionalization and the baseline variables.

Results

Eighty elders (of 749 respondents) had been institutionalized within 12 months from baseline. The institutionalization rates were 6.2% (95% confidence interval (CI): 4.0%–8.5%) for elders with functional impairment only and 17.3% (95% CI: 13.0%–21.6%) for elders with both functional and cognitive impairments. Stepwise multiple logistic regressions found that more usage of community services was the single predictor to institutionalization in 1 year for the elders with functional impairment only. The risk was doubled (odd ratio = 2.166, 95% CI: 1.286–3.647) for usage in 1 more community service. For elders with both functional and cognitive impairments, the institutionalization risk was reduced by about 70% with employment of a domestic helper (odd ratio = 0.268, 95% CI: 0.120–0.598), despite increased risk being associated with advancing age of caregiver, caregiver being male, and deteriorating functional status of the elder.

Conclusion

Among the functionally impaired elders, more usage of community services predicted increased institutionalization, whereas among the functionally and cognitively impaired elders, employment of a domestic helper predicted reduced institutionalization. Innovative services and care models are needed to prevent unnecessary institutionalization and to postpone premature institutionalization. Further research needs to be conducted to investigate the long term care needs of the elders from the perspective of both the elders and their caregivers.

Section snippets

Methods

From June 2007 to March 2008, a cohort of community-dwelling elders aged 65 or older was recruited at public hospitals, social centers, and day care centers for the elderly in Hong Kong. Details of the baseline survey are presented elsewhere.6 In brief, the elders in the cohort were dependent in at least 1 basic activity of daily living, with or without cognitive impairment. At baseline survey, functional impairment of the elders was assessed by the Chinese version of the Multi-dimensional

Results

Figure 1 shows the flow chart of the recruitment and follow-up of the cohort. The cohort was composed of 945 functionally impaired elders, with or without cognitive impairment, recruited in 2007–2008 through interviewing the elders themselves and/or their caregivers. Contact information was available from 642 caregivers. Among the elders whose caregiver contact information was unavailable, contact information was available from 155 elders without cognitive impairment. In the 12-month follow-up

Discussion

Based on a 1-year cohort, this study identified predictors of institutionalization among elders who were more prone to institutionalization. Results showed that community support, in the form of community services or domestic helpers, was associated with institutionalization. Usage of community services increased institutionalization risk of elders with functional impairment only, whereas employment of domestic helpers reduced institutionalization risk of elders with both functional and

Conclusion

A longitudinal study was conducted to show that predictors to institutionalization within 1 year were different in elders with functional impairment only and elders with both functional and cognitive impairments. For elders with functional impairment only, more usage of community services was associated with increased risk; whereas for elders with both functional and cognitive impairments, employment of a domestic helper was associated with reduced risk. Innovative services and care models are

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This study is part of the project entitled “CADENZA: A Jockey Club Initiative for Seniors,” funded by The Hong Kong Jockey Club Charities Trust.

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