Morbidity and hospitalisations among older adults with home care – a nationwide register study

Abstract

Abstract Background: Older adults with home care have potentially complex disease patterns and extensive use of health care. Increased understanding is necessary to tailor their social and medical care. To our knowledge, this is the first study to describe patterns of morbidity and hospitalisations among community-dwelling older home care clients nation-wide and in subgroups defined by age, sex, and amount of home care. Methods: Nationwide register-based cohort study in community-dwelling adults aged 70 and older receiving publicly funded home care in Sweden on January 1st 2019 as well as an age-and-sex matched comparison group. Using register data from inpatient and specialized outpatient care, we assessed the prevalence of sixty chronic diseases, frailty, and multimorbidity. We further calculated incidence rates and explored reasons for hospital admissions during two years of follow-up. Results: We identified 138,113 persons with home care (mean age 85, 66% women, 57% ≥5 chronic diseases). The most common diseases were cardiovascular and eye conditions. Compared to their same-aged peers, home care recipients had a higher prevalence of almost all conditions, with an overrepresentation of neurological including dementia and psychiatric disease. Home care clients were hospitalized twice as often as their peers and one third of hospitalisations were due to injuries, infections, and heart failure. Hospitalisations for chronic obstructive pulmonary disease, confusion, infections, and breathing difficulties were disproportionally more common among home care recipients. Conclusion: Neurological diseases including dementia, and psychiatric diseases are overrepresented among home care clients, and they are hospitalized twice as often as their same-aged peers. Severe infections, falls and decompensated heart failure are the most common reasons for hospitalization, all of which are be potentially preventable by a well-functioning primary care. Potential strategies to improve care for older HC recipients include close collaboration between primary care, neurologists, and rehabilitative medicine; and the prevention of functional decline through fall prevention or prescription of anticoagulation to people with atrial fibrillation.