Résumé
Background: Older adults want to live at home as long as possible, even in the face of circumstances that limit their autonomy. Home care services reflect this emergent preference, allowing older adults to ‘age in place’ in familiar settings rather than receiving care for chronic health conditions or ageing needs in an institutionalized setting. Numerous social factors, generally studied in isolation, have been associated with home care utilization. Even so, social circumstances are complex and how these factors collectively influence home care use patterns remains unclear. Objectives: To provide a broad and comprehensive overview of the social factors influencing home care utilization; and to evaluate the influence of discrete social factors on patterns of home care utilization in community-dwelling older adults in high-income countries. Methods: A scoping review was conducted of six electronic databases for records published between 2010 and 2020; additional records were obtained from hand searching review articles, reference lists of included studies and documents from international organisations. A narrative synthesis was presented, complemented by vote counting per social factor, harvest plots and an evaluation of aggregated findings to determine consistency across studies. Results: A total of 2,365 records were identified, of which 66 met inclusion criteria. There were 35 discrete social factors grouped into four levels of influence using a socio-ecological model (individual, relationship, community and societal levels) and grouped according to outcome of interest (home care propensity and intensity). Across all studies, social factors consistently showing any association (positive, negative, or equivocal in pattern) with home care propensity were: age, ethnicity/race, self-assessed health, insurance, housing ownership, housing problems, marital status, household income, children, informal caregiving, social networks and urban/rural area. Age, education, personal finances, living arrangements and housing ownership were associated with home care intensity, also with variable patterns in utilization. Additional community and societal level factors were identified as relevant but lacking consistency across the literature; these included rurality, availability of community services, methods of financing home care systems, and cultural determinants. Conclusion: This is the first literature review bringing together a wide range of reported social factors that influence home care utilization. It confirms social factors do influence home care utilization in complex interactions, distinguishes level of influences at which these factors affect patterns of use and discusses policy implications for home care reform.
| Langue d'origine | English |
|---|---|
| Numéro d'article | 145 |
| Journal | BMC Geriatrics |
| Volume | 21 |
| Numéro de publication | 1 |
| DOI | |
| Statut de publication | Published - déc. 2021 |
Note bibliographique
Funding Information:JCM, JMK, MKA and KR are affiliated with the Canadian Consortium on Neurodegeneration in Aging (CCNA). This work was supported in part by CCNA under Team 14 (PI: Melissa K Andrew), which investigates how multi-morbidity and social context modify risk of dementia and patterns of disease expression. The CCNA receives funding from the Canadian Institutes of Health Research (CNA-137794) and partner organizations ( www.ccna-ccnv.ca ). This work is a modified and shortened version of the primary author’s dissertation for her MSc degree. She would like to thank Dr. Juliette Malley (London School of Economics) and Professor Bob Erens (London School of Hygiene and Tropical Medicine) for being her mentors in London.
Funding Information:
The primary author’s graduate studies are supported by scholarships from the Canada Graduate Scholarships-Master’s program (Frederick Banting and Charles Best Scholarship), the Dalhousie Department of Medicine (Killam Postgraduate Medical Scholarship & University Internal Medicine Research Foundation Fellowship), the London Goodenough Association of Canada and Research Nova Scotia (Scotia Scholar’s Award).
Funding Information:
KR is President and Chief Science Officer of DGI Clinical, which in the last five years has contracts with pharma and device manufacturers on individualized outcome measurement. In 2017 he attended an advisory board meeting with Lundbeck. Otherwise any personal fees are for invited guest lectures and academic symposia, received directly from event organizers, chiefly for presentations on frailty. He is Associate Director of the Canadian Consortium on Neurodegeneration in Aging, which is funded by the Canadian Institutes of Health Research, and with additional funding from the Alzheimer Society of Canada and several other charities, as well as, in its first phase (2013–2018), from Pfizer Canada and Sanofi Canada. He receives career support from the Dalhousie Medical Research Foundation as the Kathryn Allen Weldon Professor of Alzheimer Research, and research support from the Canadian Institutes of Health Research, the QEII Health Science Centre Foundation, the Capital Health Research Fund and the Fountain Family Innovation Fund of the QEII Health Science Centre Foundation. MKA reports grant funding and honoraria from Sanofi, GSK, Pfizer and the Canadian Frailty Network for work relating to frailty and vaccine preventable illness. All other authors declare that they have no competing interests.
Publisher Copyright:
© 2021, The Author(s).
ASJC Scopus Subject Areas
- Geriatrics and Gerontology
PubMed: MeSH publication types
- Journal Article
- Research Support, Non-U.S. Gov't
- Review
ODD de l’ONU
Cette action contribue à la réalisation des objectifs de développement durable suivants
