Usage of community services and domestic helpers predicted institutionalization of elders having functional or cognitive impairments: A 12-month longitudinal study in Hong Kong

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. Furtherresearch needs to be conducted to investigatethe long term care needs of the elders from the perspectiveof both the elders and their caregivers. © 2012 American Medical Directors Association, Inc.