Background
Methods
Study design and population
Variables
Predisposing factors
Enabling factors
Need factors
Statistical analysis
Attrition and sensitivity analysis
Results
Study population
2004 sample (N = 995) | 2009 sample (N = 1160) | Both (N = 2155) | N | ||
---|---|---|---|---|---|
Formal home care use trajectory between 2012 and 2018a, n (%) | 2155 | # | |||
Non-users | 790 (79.4) | 995 (85.8) | 1785 (82.8) | ||
New users | 125 (12.6) | 116 (10.0) | 241 (11.2) | ||
Former users | 36 (3.6) | 23 (2.0) | 59 (2.7) | ||
Continuing users | 44 (4.4) | 26 (2.2) | 70 (3.3) | ||
Predisposing factors | |||||
Demographic | |||||
Age in 2012, mean (SD) | 76.0 (1.4) | 70.8 (1.4) | 73.2 (2.9) | 2155 | # |
Female sex, n (%) | 600 (60.3) | 704 (60.7) | 1304 (60.5) | 2155 | |
Social | |||||
Born abroad (vs born in Switzerland), n (%) | 239 (24.0) | 313 (27.1) | 552 (25.7) | 2152 | |
Highest level of educational attainment, n (%) | 2152 | # | |||
Compulsory education | 219 (22.1) | 197 (17.0) | 416 (19.3) | ||
Apprenticeship | 402 (40.5) | 461 (39.7) | 863 (40.1) | ||
High school, university or equivalent | 371 (37.4) | 502 (43.3) | 873 (40.6) | ||
Beliefs, knowledge and attitudes | |||||
Knows very well or rather well what a home care organization is and what it can offer (vs rather no or not at all), n (%) | 691 (80.8) | 828 (78.5) | 1519 (79.5) | 1910 | |
Would not hesitate at all to seek help from a home care organization in case of need (vs a little, a lot or would not seek help), n (%) | 489 (58.3) | 595 (57.1) | 1084 (57.6) | 1881 | |
Among respondents that would hesitate to seek help from a home care organization (N = 797), n (%) afraid of | |||||
- Losing their ability to decide for the organization of everyday life | 297 (88.9) | 385 (91.2) | 682 (90.2) | 756 | |
- Losing their privacy | 266 (80.1) | 348 (82.9) | 614 (81.7) | 752 | |
- Losing their ability to choose who comes home | 270 (82.1) | 325 (77.9) | 595 (79.8) | 746 | |
- Seeing their household “invaded” by several people | 274 (82.5) | 319 (76.9) | 593 (79.4) | 747 | |
- The heaviness of administrative procedures | 261 (79.6) | 321 (77.0) | 582 (78.1) | 745 | |
- The waiting time before receiving help and care | 253 (76.7) | 307 (73.8) | 560 (75.1) | 746 | |
- Looking fragile, impaired | 244 (74.9) | 304 (72.9) | 548 (73.8) | 743 | |
- Home care fees | 230 (69.9) | 297 (70.9) | 527 (70.5) | 748 | |
Enabling factors | |||||
Social support | |||||
Without children, n (%) | 214 (21.6) | 242 (21.0) | 456 (21.3) | 2143 | |
Lubben Social Network Scale (LSNS-6) score of less than 12 (vs 12 or more), n (%) | 247 (26.0) | 231 (22.6) | 478 (24.2) | 1974 | |
Lives alone, n (%) | 409 (41.4) | 485 (42.0) | 894 (41.7) | 2145 | |
Available income and wealth | |||||
Difficult financial situation, n (%) | 210 (24.8) | 250 (24.4) | 460 (24.6) | 1872 | |
Organization and accessibility | |||||
Number of years with the current attending physician, n (%) | 1868 | # | |||
2 years or less | 96 (11.3) | 138 (13.5) | 234 (12.5) | ||
3 to 10 years | 204 (24.1) | 293 (28.7) | 497 (26.6) | ||
More than 10 years | 548 (64.6) | 589 (57.8) | 1137 (60.9) | ||
Knows very well or rather well how to find a home care organization in case of need (vs rather no or not at all), n (%) | 550 (64.0) | 629 (60.4) | 1179 (62.0) | 1902 | |
Need factors | |||||
Perceived | |||||
Self-rated health reported as fair, poor or very poor (vs very good or good), n (%) | 341 (34.3) | 312 (26.9) | 653 (30.3) | 2155 | # |
Suffers since at least 6 months from, n (%) | 2131 | ||||
- Pain in articulations of legs, shoulders, arms or hands, or back pain | 632 (64.2) | 660 (57.6) | 1292 (60.6) | # | |
- Shortness of breath, difficult breathing | 155 (15.7) | 139 (12.1) | 294 (13.8) | # | |
- Memory lapses affecting everyday life, difficulty concentrating, or difficulty taking decisions in everyday life | 155 (15.7) | 155 (13.5) | 310 (14.6) | ||
- Involuntary leakage of urine | 125 (12.7) | 146 (12.7) | 271 (12.7) | ||
Depressed mood, anhedonia or both during the past 4 weeks, n (%) | 259 (26.3) | 258 (22.4) | 517 (24.2) | 2138 | # |
Mobility difficulties, n (%) | 483 (49.0) | 464 (40.4) | 947 (44.4) | 2133 | # |
Falls not associated with sport activity during the past 12 months, n (%) | 2142 | # | |||
No | 763 (77.2) | 947 (82.1) | 1710 (79.8) | ||
Yes, once | 174 (17.6) | 157 (13.6) | 331 (15.5) | ||
Yes, several times | 51 (5.2) | 50 (4.3) | 101 (4.7) | ||
Fear of falling, n (%) | 2113 | # | |||
Not at all | 455 (46.7) | 641 (56.3) | 1096 (51.9) | ||
Yes, without activity restriction | 387 (39.7) | 394 (34.6) | 781 (37.0) | ||
Yes, with restriction from certain activities because of it | 133 (13.6) | 103 (9.1) | 236 (11.2) | ||
Difficulty or need for help in one or more ADL/IADL, n (%) | 2065 | # | |||
No difficulty or need for help in 2018a | 506 (53.2) | 755 (67.8) | 1261 (61.1) | ||
Difficulty or need for help in 2018a, but not in 2012 | 227 (23.9) | 197 (17.7) | 424 (20.5) | ||
Difficulty or need for help in 2012 and 2018a | 218 (22.9) | 162 (14.5) | 380 (18.4) | ||
Evaluated | |||||
Number of diagnosed chronic health conditionsb reported during the past 12 months, n (%) | 2135 | # | |||
0 | 267 (27.2) | 365 (31.7) | 632 (29.6) | ||
1 | 289 (29.4) | 381 (33.1) | 670 (31.4) | ||
More than 1 | 427 (43.4) | 406 (35.2) | 833 (39.0) | ||
Treated for or suffering from the following diagnosed chronic health conditions during the past 12 months, n (%) | 2135 | ||||
- Coronary artery disease, heart failure, heart valve/muscle disease, or cerebrovascular disease | 114 (11.6) | 92 (8.0) | 206 (9.7) | # | |
- Diabetes | 101 (10.3) | 117 (10.2) | 218 (10.2) | ||
- Chronic obstructive pulmonary disease or asthma | 89 (9.1) | 105 (9.1) | 194 (9.1) | ||
- Osteoarthritis or other types of arthritis | 294 (29.9) | 282 (24.5) | 576 (27.0) | # | |
- Cancer, malignancy, lymphoma | 43 (4.4) | 57 (5.0) | 100 (4.7) | ||
Unintentional weight loss during the past 12 months, n (%) | 116 (11.8) | 120 (10.4) | 236 (11.0) | 2140 | |
Frailty phenotype, n (%) | 2098 | # | |||
Robust | 466 (47.9) | 608 (54.0) | 1074 (51.2) | ||
Pre-frail | 409 (42.1) | 460 (40.9) | 869 (41.4) | ||
Frail | 97 (10.0) | 58 (5.2) | 155 (7.4) |
Trajectories of formal home care use: frequencies and bivariable analysis
Non-users | New users | p | N | |
---|---|---|---|---|
(N = 1785) | (N = 241) | |||
Predisposing factors | ||||
Demographic | ||||
Age in 2012, mean (SD) | 73.1 (2.9) | 73.7 (2.9) | 0.002 | 2026 |
Female sex, n (%) | 1069 (59.9) | 144 (59.8) | 0.968 | 2026 |
Social | ||||
Born abroad (vs born in Switzerland), n (%) | 448 (25.1) | 71 (29.6) | 0.138 | 2023 |
Highest level of educational attainment, n (%) | 0.227 | 2024 | ||
Compulsory education | 329 (18.4) | 52 (21.7) | ||
Apprenticeship | 711 (39.9) | 101 (42.1) | ||
High school, university or equivalent | 744 (41.7) | 87 (36.3) | ||
Beliefs, knowledge and attitudes | ||||
Knows very well or rather well what a home care organization is and what it can offer (vs rather no or not at all), n (%) | 1273 (79.7) | 153 (74.6) | 0.092 | 1802 |
Would not hesitate at all to seek help from a home care organization in case of need (vs a little, a lot or would not seek help), n (%) | 903 (57.4) | 111 (54.7) | 0.460 | 1776 |
Enabling factors | ||||
Social support | ||||
Without children, n (%) | 368 (20.7) | 54 (22.4) | 0.552 | 2015 |
Lubben Social Network Scale (LSNS-6) score of less than 12 (vs 12 or more), n (%) | 363 (22.0) | 69 (32.9) | < 0.001 | 1859 |
Lives alone, n (%) | 697 (39.3) | 113 (46.9) | 0.024 | 2016 |
Available income and wealth | ||||
Difficult financial situation, n (%) | 329 (21.1) | 83 (39.5) | < 0.001 | 1766 |
Organization and accessibility | ||||
Number of years with the current attending physician, n (%) | 0.936 | 1757 | ||
2 years or less | 189 (12.2) | 24 (11.4) | ||
3 to 10 years | 409 (26.4) | 55 (26.2) | ||
More than 10 years | 949 (61.3) | 131 (62.4) | ||
Knows very well or rather well how to find a home care organization in case of need (vs rather no or not at all), n (%) | 964 (60.7) | 125 (60.1) | 0.857 | 1795 |
Need factors | ||||
Perceived | ||||
Self-rated health reported as fair, poor or very poor (vs very good or good), n (%) | 449 (25.2) | 121 (50.2) | < 0.001 | 2026 |
Suffers since at least 6 months from, n (%) | 2002 | |||
- Pain in articulations of legs, shoulders, arms or hands, or back pain | 1025 (58.1) | 166 (69.8) | 0.001 | |
- Shortness of breath, difficult breathing | 207 (11.7) | 51 (21.4) | < 0.001 | |
- Memory lapses affecting everyday life, difficulty concentrating, or difficulty taking decisions in everyday life | 220 (12.5) | 53 (22.3) | < 0.001 | |
- Involuntary leakage of urine | 204 (11.6) | 42 (17.7) | 0.007 | |
Depressed mood, anhedonia or both during the past 4 weeks, n (%) | 364 (20.5) | 90 (38.0) | < 0.001 | 2010 |
Mobility difficulties, n (%) | 692 (39.2) | 154 (64.4) | < 0.001 | 2005 |
Falls not associated with sport activity during the past 12 months, n (%) | < 0.001 | 2014 | ||
No | 1464 (82.5) | 172 (71.7) | ||
Yes, once | 246 (13.9) | 48 (20.0) | ||
Yes, several times | 64 (3.6) | 20 (8.3) | ||
Fear of falling, n (%) | < 0.001 | 1986 | ||
Not at all | 975 (55.8) | 88 (37.1) | ||
Yes, without activity restriction | 643 (36.8) | 89 (37.6) | ||
Yes, with restriction from certain activities because of it | 131 (7.5) | 60 (25.3) | ||
Difficulty or need for help in one or more ADL/IADL, n (%) | < 0.001 | 1940 | ||
No difficulty or need for help in 2018a | 1179 (69.2) | 53 (22.5) | ||
Difficulty or need for help in 2018a, but not in 2012 | 302 (17.7) | 98 (41.5) | ||
Difficulty or need for help in 2012 and 2018a | 223 (13.1) | 85 (36.0) | ||
Evaluated | ||||
Number of diagnosed chronic health conditionsb reported during the past 12 months, n (%) | < 0.001 | 2008 | ||
0 | 568 (32.1) | 46 (19.2) | ||
1 | 569 (32.2) | 68 (28.3) | ||
More than 1 | 631 (35.7) | 126 (52.5) | ||
Treated for or suffering from the following diagnosed chronic health conditions during the past 12 months, n (%) | 2008 | |||
- Coronary artery disease, heart failure, heart valve/muscle disease, or cerebrovascular disease | 141 (8.0) | 40 (16.7) | < 0.001 | |
- Diabetes | 152 (8.6) | 39 (16.3) | < 0.001 | |
- Chronic obstructive pulmonary disease or asthma | 130 (7.4) | 35 (14.6) | < 0.001 | |
- Osteoarthritis or other types of arthritis | 440 (24.9) | 81 (33.8) | 0.003 | |
- Cancer, malignancy, lymphoma | 81 (4.6) | 9 (3.8) | 0.559 | |
Unintentional weight loss during the past 12 months, n (%) | 167 (9.4) | 37 (15.7) | 0.003 | 2012 |
Frailty phenotype, n (%) | < 0.001 | 1971 | ||
Robust | 977 (56.1) | 72 (31.3) | ||
Pre-frail | 687 (39.5) | 121 (52.6) | ||
Frail | 77 (4.4) | 37 (16.1) |
Trajectories of formal home care use: multivariable analysis
Odds ratio | 95% confidence interval | p | |
---|---|---|---|
Model 1: need factors only (N = 1845) | |||
Fear of falling (ref: not at all) | |||
Yes, without activity restriction | 0.97 | (0.68–1.37) | 0.843 |
Yes, with restriction from certain activities because of it | 1.99 | (1.25–3.15) | 0.004 |
Difficulty or need for help in one or more ADL/IADL (ref: none in 2018a) | |||
Difficulty or need for help in 2018a, but not in 2012 | 6.16 | (4.23–8.98) | < 0.001 |
Difficulty or need for help in 2012 and 2018a | 5.03 | (3.28–7.72) | < 0.001 |
Coronary artery disease, heart failure, heart valve/muscle disease, or cerebrovascular disease | 1.75 | (1.13–2.70) | 0.013 |
Frailty phenotype (ref: robust) | |||
Pre-frail | 1.43 | (1.01–2.03) | 0.045 |
Frail | 2.25 | (1.29–3.95) | 0.005 |
Model 2: predisposing, enabling and need factors (N = 1467) | |||
One-year increase in age | 1.04 | (0.98–1.10) | 0.222 |
Born abroad (ref: born in Switzerland) | 1.34 | (0.89–2.01) | 0.166 |
Knows very well or rather well what a home care organization is and what it can offer (ref: rather no or not a at all) | 1.01 | (0.65–1.58) | 0.952 |
Lubben Social Network Scale (LSNS-6) score of less than 12 (ref: 12 or more) | 1.24 | (0.84–1.85) | 0.282 |
Lives alone (ref: living with other people) | 1.16 | (0.80–1.69) | 0.438 |
Difficult financial situation | 1.65 | (1.12–2.45) | 0.012 |
Fear of falling (ref: not at all) | |||
Yes, without activity restriction | 1.19 | (0.79–1.80) | 0.400 |
Yes, with restriction from certain activities because of it | 2.28 | (1.32–3.92) | 0.003 |
Difficulty or need for help in one or more ADL/IADL (ref: none in 2018a) | |||
Difficulty or need for help in 2018a, but not in 2012 | 6.85 | (4.44–10.56) | < 0.001 |
Difficulty or need for help in 2012 and 2018a | 4.54 | (2.69–7.66) | < 0.001 |
Coronary artery disease, heart failure, heart valve/muscle disease, or cerebrovascular disease | 2.06 | (1.27–3.37) | 0.004 |
Frailty phenotype (ref: robust) | |||
Pre-frail | 1.26 | (0.84–1.89) | 0.271 |
Frail | 1.62 | (0.80–3.27) | 0.178 |