JAMDA xxx (2014) 1e6
JAMDA journal homepage: www.jamda.com
Original Study
Activities of Daily Living in Nursing Home and Home Care Settings: A Retrospective 1-Year Cohort Study Tae Wha Lee RN, PhD a, Eunhee Cho RN, PhD a, *, Eun Shil Yim RN, PhD b, Hye Sun Lee MS c, Yu Kyung Ko RN, PhD d, Bok Nam Kim RN, PhD b, Sinhye Kim RN, MSN a a
Nursing Policy Research Institute, Yonsei University College of Nursing, Seoul, Republic of Korea Department of Nursing, Daegu Health College, Daegu, Republic of Korea Department of Biostatistics, Yonsei University College of Medicine, Seoul, Republic of Korea d Department of Nursing Science, Wonkwang University, Iksan, Jeonbuk, Republic of Korea b c
a b s t r a c t Keywords: Activities of daily living home care services Korea long-term care nursing homes older adults outcomes
Objective: Korea introduced universal long-term care insurance (LTCI) for physically dependent older adults in 2008. Older adults, their family members, and policy makers in Korea want to know patient outcomes in different care modalities because older adults who have a similar functional status and LTC needs can choose either nursing home care or home care. The aim of this study was to compare activities of daily living (ADLs) in nursing home care and home care settings for physically dependent older adults in Korea. Design: A retrospective 1-year cohort study using national LTCI data. Settings: This study used the LTCI dataset from the National Health Insurance Service in Korea. Participants: Participants were identified from among those in the LTCI dataset who enrolled from July 2008 to June 2010. We extracted a sample consisting of 22,557 older adults who consistently received either nursing home care (n ¼ 11,678) or home care (n ¼ 10,879) for 1 year. Measurements: The outcome variable was change in ADLs after 1 year. Covariates were an older adult’s home geographical region, LTC level, age, sex, primary caregiver, Medicaid beneficiary status, bedridden status, medical diagnosis, baseline ADLs, cognitive function, behavioral problems, nursing and special treatment, and rehabilitation needs. Multiple regression analysis of all participants unmatched and a paired t-test with a propensity-score-matched cohort were performed to explain the association of changes in ADLs with the types of LTC. Results: Multiple regression analysis with all participants (n ¼ 22,557) unmatched showed that compared with older adults who received home care, those who received nursing home care had deteriorated further in terms of ADLs after 1 year (b ¼ 0.44108, P < .0001). After propensity-score matching, paired t-test analysis also found that the ADLs of older adults had deteriorated less in the home care group compared with the nursing home group after 1 year (P < .0001). Conclusions: The ADLs of older adults who received home care showed significantly less deterioration than those of the older adults in nursing home care after 1 year. The ADLs of older adults could differ according to the type of LTC they receive, and home care could result in better maintenance of ADLs than nursing home care. Ó 2014 AMDA e The Society for Post-Acute and Long-Term Care Medicine.
Introduction The Organization for Economic Co-operation and Development countries experience a high need for long-term care (LTC) because of the increased proportion of the population over the age of 80 years
* Address correspondence to Eunhee Cho, RN, PhD, Yonsei University College of Nursing, 615 Nursing Education Building, 134 Shinchon-Dong, Seodaemoon-Gu, Seoul 120-752, South Korea. E-mail address: [email protected] (E. Cho). http://dx.doi.org/10.1016/j.jamda.2014.07.013 1525-8610/Ó 2014 AMDA e The Society for Post-Acute and Long-Term Care Medicine.
old.1 For countries with little formal capacity to supply LTC, this shift in demographics will further push countries to develop formal LTC services. In this context, in 2008, Korea introduced universal LTC insurance (LTCI) for those aged 65 years and over as a type of social insurance system. Korea faces an extremely fast aging population2 and is expected to experience quick decline in the role and responsibility of family members providing care for older adults. LTCI for older adults in Korea provides for services related to supporting physical and cognitive function, as well as housework activities, to older adults who have difficulty taking care of themselves because of
2
T.W. Lee et al. / JAMDA xxx (2014) 1e6
Alzheimer’s disease, stroke, or other geriatric diseases either through nursing home care or home care.3 Services covered by LTCI are provided based on the physical needs and cognitive function of older adults and are universally available regardless of income.3 LTCI beneficiaries are categorized into 3 benefit levels based on their functional assessment scores and special care needs. LTCI provides benefits for older adults at levels 1 and 2 who require help in all or most aspects of their daily lives, with a choice of nursing home care or home care, while those with level 3 benefits are those who require partial assistance with their daily life and only covers home care. Home care includes services provided at the beneficiary’s home or in the community (ie home help, home bathing, visiting nurse service, day and night care center, and welfare equipment supply). Nursing home care provides 24-hour nursing care, social and recreational therapy, rehabilitation, room and board, and other conveniences.3 The delivery of LTC is performed primarily by the private sector. Older adults, their family members, and policy makers in Korea want to know patient outcomes in different care modalities (ie primarily nursing home care or home care), as older adults at levels 1 and 2 choose either nursing home care or home care. Activities of daily living (ADLs) are important outcome measures for LTC given that they are essential factors in planning and providing LTC for older adults. Research comparing ADLs in LTC settings has shown inconsistent findings. Mottram et al4 conducted a systematic review comparing patient outcomes between nursing home care and home care for older adults, and found only 1 randomized controlled trial, which reported no significant difference in the ADLs between nursing home care and foster home care for older adults.5 The systematic review concluded that this single randomized controlled trial was small and of poor methodological quality, and that there was insufficient evidence to compare patient outcomes between nursing home care and home care for older adults.4 There are also few observational studies comparing patient outcomes in different LTC settings, and the results are also inconsistent.6e8 Mitchell8 compared the ADLs of older adults who received home care, community-based nursing home care, or hospital-based nursing home care while controlling for baseline patient characteristics. This study found that the ADLs of older adults who received home care showed the greatest improvement after 3 months.8 More recently, Marek et al7 compared clinical outcomes of older adults in home care with those in nursing home care by matching older adults receiving home care with those receiving nursing home care. They found that ADLs, cognition, depression, and incontinence stabilized or improved in home care recipients but deteriorated in nursing home care recipients.7 On the other hand, Braun et al6 found no difference in the ADLs or mobility after 6 months in nursing home care or home care when controlling for baseline patient characteristics. There are only a few studies that have compared the effects of nursing home care and home care for functionally dependent older adults in terms of ADLs, and the majority of the literature is outdated. A literature review showed that the results are inconclusive, but the outcomes of home care are at least as equally good compared with nursing home care. Furthermore, no study has addressed ADLs associated with the different types of LTC in Korea. Thus, the purpose of this study is to compare ADLs in nursing home care and home care for physically dependent older adults in Korea. Methods Study Population Participants were identified from the LTCI dataset, which included 163,562 LTC beneficiaries who were enrolled from July 2008 to June
2010. We extracted a sample consisting of 22,557 people who met the inclusion criteria as follows: (1) 65 years or older, (2) living in their homes when applied for LTC benefits, (3) older adults who belonged to LTC level 1 or 2 consistently for 1 year, and (4) received either nursing home care (n ¼ 11,678) or home care (n ¼ 10,879) consistently for 1 year. Older adults who alternated between both types of services were excluded. Sources of Data This study used LTCI dataset from the National Health Insurance Service. The LTCI dataset is a national level data source that includes all applicants’ assessment data for LTC benefit eligibility: (1) personal information (geographical region of home, age, sex, primary caregiver, Medicaid beneficiary, etc.), (2) general health status (medical diagnosis, bedridden status, etc.), (3) a 52-item functional assessment score, and (4) final LTC levels (rating 1, 2, 3). The 52-item functional assessment is referred to as the Long-term Care Approval Checklist, which is a standardized instrument to evaluate core care needs of beneficiaries as a basis for allocating funding. It consists of 5 main areas, including ADLs (13 items), cognitive function (7 items), behavioral problems (14 items), nursing and special treatment (10 items), and rehabilitation needs (8 items). These items are used to determine the benefit coverage levels (1, 2, or 3), with the higher level of benefit being level 1, and the lower dependency and benefit amount being level 3. A mandatory assessment is performed once a year. Our study was approved by the Institutional Review Board of Yonsei University College of Nursing. The requirement for written informed consent from the participant was waived because this is a secondary analysis of an existing dataset and does not disclose any personal information. Measures Sociodemographic and health variables Older adult’s geographical region of home, LTC level, age, sex, primary caregiver, Medicaid beneficiary status, bedridden status, medical diagnosis, ADLs, cognitive function, behavioral problems, nursing and special treatment, and rehabilitation needs in the baseline assessment taken between July 2008 and June 2009 were analyzed. Outcome variable We measured changes in the ADLs after 1 year as the outcome variable for this study. We measured changes in the ADLs of older adults by comparing the first assessment score (baseline) to the score of the second assessment score taken after 1 year. The ADL index is a composite score based on ADL questions from the assessment, with a higher score indicating more dependent function. The ADL index consists of 13 items, which include dressing, face washing, tooth brushing, bathing, eating, position changing, transferring, toileting, bowel incontinence, and bladder incontinence. The level of dependence is divided into independence, needs help, and dependence, by a score of 1 to 3 points, with a maximum total score of 39. Data Analysis Before performing multiple regression analysis and propensityscore matching, we conducted a review of the literature and found potentially available explanatory factors for changes in ADLs with LTC needs. A total of 18 factors were identified that were significantly associated with the outcome variable: geographical region, LTC level, age, sex, primary caregiver, Medicaid beneficiary status, bedridden status, medical diagnosis (dementia, stroke, hypertension, diabetes,
T.W. Lee et al. / JAMDA xxx (2014) 1e6
musculoskeletal disease, or pressure ulcer), baseline ADLs, cognitive function, behavioral problems, nursing and special treatment, and rehabilitation needs. The differences in characteristics between the home care group and the nursing home care group for all participants were analyzed by independent t-test for continuous variables and c2 test for categorical variable. We also created a propensity-score-matched cohort by attempting to match each participant who received home care with one who received nursing home care (a 1:1 match). A nearestneighbor-matching algorithm with a “greedy” heuristic (one that always implements the best immediate, local, or solution) was used to match the participants. In greedy nearest-neighbor matching, a participant receiving home care was randomly selected and matching was attempted with the “nearest” participant receiving nursing home care. After matching, we also evaluated the degree of balance in measured covariates between the home care group and the nursing home care group. The distributions of continuous variables and categorical variables between the 2 groups in the matched cohort were compared with the use of paired t-tests and McNemar’s test, respectively. Multiple regression analysis with all unmatched participants was performed to explain the association of changes in the ADLs with
3
types of LTC as an independent variable after controlling for a set of 18 covariates. In addition, paired t-test with the propensity-scorematched cohort was conducted to compare difference in changes in ADLs between the 2 matched groups. All reported P values are 2 sided, and P values less than .05 were considered to indicate statistical significance. SAS software v 9.2 (SAS Inc., Cary, NC) was used. Results Characteristics of Participants A total of 22,557 participants met the study inclusion criteria. The baseline characteristics of participants who received home care was compared with the nursing home care recipients (Table 1). Overall, 49.2% of the LTC beneficiaries with LTC level 1and 2 in the baseline assessment were receiving home care. The likelihood of receiving home care was significantly greater for those who were younger, male, and had a spouse or children as caregivers, and having no Medicaid benefits, compared with those receiving nursing home care. These participants were also more likely to have a higher percentage of LTC level 1, to be completely bedridden, to have stroke, hypertension, diabetes, and pressure ulcers, but have a lower percentage of
Table 1 Baseline Characteristics of LTC Beneficiaries, According to Type of Care, Before and After Propensity-Score Matching Characteristic
Long-term care level 1 2 Baseline ADLs Cognitive function Behavior problems Nursing and special treatment Rehabilitation needs Region Metropolitan Small city Rural area Age Sex Male Female Primary caregiver None Spouse Children Grandchildren Others Medicaid beneficiary Yes Bedridden status None Partial Complete Medical diagnosis Dementia Yes Stroke Yes Hypertension Yes Diabetes Yes Musculoskeletal disease Yes Pressure ulcers Yes M, mean; SD, standard deviation.
Unmatched Participants
Matched Participants
Home Care (n ¼ 10,879)
Nursing Home (n ¼ 11,678)
N (%) or M SD
N (%) or M SD
Home Care (n ¼ 5141)
Nursing Home (n ¼ 5141)
N (%) or M SD
N (%) or M SD
5767 (53.01) 5112 (46.99) 32.32 4.73 5.99 2.98 2.43 3.01 0.35 0.75 17.66 5.06
5863 (50.21) 5815 (49.79) 31.76 5.10 7.11 2.61 3.64 3.45 0.19 0.5 16.76 5.04
2433 (47.33) 2708 (52.67) 31.36 4.93 6.77 2.72 3.35 3.46 0.22 0.53 16.55 4.92
2404 (46.76) 2737 (53.24) 31.33 5.09 6.68 2.68 3.39 3.44 0.22 0.56 16.57 4.95
.5673
4566 (42.01) 4156 (38.23) 2148 (19.76) 77.71 7.77
4044 (34.75) 4707 (40.45) 2887 (24.81) 80.40 7.42
JAMDA journal homepage: www.jamda.com
Original Study
Activities of Daily Living in Nursing Home and Home Care Settings: A Retrospective 1-Year Cohort Study Tae Wha Lee RN, PhD a, Eunhee Cho RN, PhD a, *, Eun Shil Yim RN, PhD b, Hye Sun Lee MS c, Yu Kyung Ko RN, PhD d, Bok Nam Kim RN, PhD b, Sinhye Kim RN, MSN a a
Nursing Policy Research Institute, Yonsei University College of Nursing, Seoul, Republic of Korea Department of Nursing, Daegu Health College, Daegu, Republic of Korea Department of Biostatistics, Yonsei University College of Medicine, Seoul, Republic of Korea d Department of Nursing Science, Wonkwang University, Iksan, Jeonbuk, Republic of Korea b c
a b s t r a c t Keywords: Activities of daily living home care services Korea long-term care nursing homes older adults outcomes
Objective: Korea introduced universal long-term care insurance (LTCI) for physically dependent older adults in 2008. Older adults, their family members, and policy makers in Korea want to know patient outcomes in different care modalities because older adults who have a similar functional status and LTC needs can choose either nursing home care or home care. The aim of this study was to compare activities of daily living (ADLs) in nursing home care and home care settings for physically dependent older adults in Korea. Design: A retrospective 1-year cohort study using national LTCI data. Settings: This study used the LTCI dataset from the National Health Insurance Service in Korea. Participants: Participants were identified from among those in the LTCI dataset who enrolled from July 2008 to June 2010. We extracted a sample consisting of 22,557 older adults who consistently received either nursing home care (n ¼ 11,678) or home care (n ¼ 10,879) for 1 year. Measurements: The outcome variable was change in ADLs after 1 year. Covariates were an older adult’s home geographical region, LTC level, age, sex, primary caregiver, Medicaid beneficiary status, bedridden status, medical diagnosis, baseline ADLs, cognitive function, behavioral problems, nursing and special treatment, and rehabilitation needs. Multiple regression analysis of all participants unmatched and a paired t-test with a propensity-score-matched cohort were performed to explain the association of changes in ADLs with the types of LTC. Results: Multiple regression analysis with all participants (n ¼ 22,557) unmatched showed that compared with older adults who received home care, those who received nursing home care had deteriorated further in terms of ADLs after 1 year (b ¼ 0.44108, P < .0001). After propensity-score matching, paired t-test analysis also found that the ADLs of older adults had deteriorated less in the home care group compared with the nursing home group after 1 year (P < .0001). Conclusions: The ADLs of older adults who received home care showed significantly less deterioration than those of the older adults in nursing home care after 1 year. The ADLs of older adults could differ according to the type of LTC they receive, and home care could result in better maintenance of ADLs than nursing home care. Ó 2014 AMDA e The Society for Post-Acute and Long-Term Care Medicine.
Introduction The Organization for Economic Co-operation and Development countries experience a high need for long-term care (LTC) because of the increased proportion of the population over the age of 80 years
* Address correspondence to Eunhee Cho, RN, PhD, Yonsei University College of Nursing, 615 Nursing Education Building, 134 Shinchon-Dong, Seodaemoon-Gu, Seoul 120-752, South Korea. E-mail address: [email protected] (E. Cho). http://dx.doi.org/10.1016/j.jamda.2014.07.013 1525-8610/Ó 2014 AMDA e The Society for Post-Acute and Long-Term Care Medicine.
old.1 For countries with little formal capacity to supply LTC, this shift in demographics will further push countries to develop formal LTC services. In this context, in 2008, Korea introduced universal LTC insurance (LTCI) for those aged 65 years and over as a type of social insurance system. Korea faces an extremely fast aging population2 and is expected to experience quick decline in the role and responsibility of family members providing care for older adults. LTCI for older adults in Korea provides for services related to supporting physical and cognitive function, as well as housework activities, to older adults who have difficulty taking care of themselves because of
2
T.W. Lee et al. / JAMDA xxx (2014) 1e6
Alzheimer’s disease, stroke, or other geriatric diseases either through nursing home care or home care.3 Services covered by LTCI are provided based on the physical needs and cognitive function of older adults and are universally available regardless of income.3 LTCI beneficiaries are categorized into 3 benefit levels based on their functional assessment scores and special care needs. LTCI provides benefits for older adults at levels 1 and 2 who require help in all or most aspects of their daily lives, with a choice of nursing home care or home care, while those with level 3 benefits are those who require partial assistance with their daily life and only covers home care. Home care includes services provided at the beneficiary’s home or in the community (ie home help, home bathing, visiting nurse service, day and night care center, and welfare equipment supply). Nursing home care provides 24-hour nursing care, social and recreational therapy, rehabilitation, room and board, and other conveniences.3 The delivery of LTC is performed primarily by the private sector. Older adults, their family members, and policy makers in Korea want to know patient outcomes in different care modalities (ie primarily nursing home care or home care), as older adults at levels 1 and 2 choose either nursing home care or home care. Activities of daily living (ADLs) are important outcome measures for LTC given that they are essential factors in planning and providing LTC for older adults. Research comparing ADLs in LTC settings has shown inconsistent findings. Mottram et al4 conducted a systematic review comparing patient outcomes between nursing home care and home care for older adults, and found only 1 randomized controlled trial, which reported no significant difference in the ADLs between nursing home care and foster home care for older adults.5 The systematic review concluded that this single randomized controlled trial was small and of poor methodological quality, and that there was insufficient evidence to compare patient outcomes between nursing home care and home care for older adults.4 There are also few observational studies comparing patient outcomes in different LTC settings, and the results are also inconsistent.6e8 Mitchell8 compared the ADLs of older adults who received home care, community-based nursing home care, or hospital-based nursing home care while controlling for baseline patient characteristics. This study found that the ADLs of older adults who received home care showed the greatest improvement after 3 months.8 More recently, Marek et al7 compared clinical outcomes of older adults in home care with those in nursing home care by matching older adults receiving home care with those receiving nursing home care. They found that ADLs, cognition, depression, and incontinence stabilized or improved in home care recipients but deteriorated in nursing home care recipients.7 On the other hand, Braun et al6 found no difference in the ADLs or mobility after 6 months in nursing home care or home care when controlling for baseline patient characteristics. There are only a few studies that have compared the effects of nursing home care and home care for functionally dependent older adults in terms of ADLs, and the majority of the literature is outdated. A literature review showed that the results are inconclusive, but the outcomes of home care are at least as equally good compared with nursing home care. Furthermore, no study has addressed ADLs associated with the different types of LTC in Korea. Thus, the purpose of this study is to compare ADLs in nursing home care and home care for physically dependent older adults in Korea. Methods Study Population Participants were identified from the LTCI dataset, which included 163,562 LTC beneficiaries who were enrolled from July 2008 to June
2010. We extracted a sample consisting of 22,557 people who met the inclusion criteria as follows: (1) 65 years or older, (2) living in their homes when applied for LTC benefits, (3) older adults who belonged to LTC level 1 or 2 consistently for 1 year, and (4) received either nursing home care (n ¼ 11,678) or home care (n ¼ 10,879) consistently for 1 year. Older adults who alternated between both types of services were excluded. Sources of Data This study used LTCI dataset from the National Health Insurance Service. The LTCI dataset is a national level data source that includes all applicants’ assessment data for LTC benefit eligibility: (1) personal information (geographical region of home, age, sex, primary caregiver, Medicaid beneficiary, etc.), (2) general health status (medical diagnosis, bedridden status, etc.), (3) a 52-item functional assessment score, and (4) final LTC levels (rating 1, 2, 3). The 52-item functional assessment is referred to as the Long-term Care Approval Checklist, which is a standardized instrument to evaluate core care needs of beneficiaries as a basis for allocating funding. It consists of 5 main areas, including ADLs (13 items), cognitive function (7 items), behavioral problems (14 items), nursing and special treatment (10 items), and rehabilitation needs (8 items). These items are used to determine the benefit coverage levels (1, 2, or 3), with the higher level of benefit being level 1, and the lower dependency and benefit amount being level 3. A mandatory assessment is performed once a year. Our study was approved by the Institutional Review Board of Yonsei University College of Nursing. The requirement for written informed consent from the participant was waived because this is a secondary analysis of an existing dataset and does not disclose any personal information. Measures Sociodemographic and health variables Older adult’s geographical region of home, LTC level, age, sex, primary caregiver, Medicaid beneficiary status, bedridden status, medical diagnosis, ADLs, cognitive function, behavioral problems, nursing and special treatment, and rehabilitation needs in the baseline assessment taken between July 2008 and June 2009 were analyzed. Outcome variable We measured changes in the ADLs after 1 year as the outcome variable for this study. We measured changes in the ADLs of older adults by comparing the first assessment score (baseline) to the score of the second assessment score taken after 1 year. The ADL index is a composite score based on ADL questions from the assessment, with a higher score indicating more dependent function. The ADL index consists of 13 items, which include dressing, face washing, tooth brushing, bathing, eating, position changing, transferring, toileting, bowel incontinence, and bladder incontinence. The level of dependence is divided into independence, needs help, and dependence, by a score of 1 to 3 points, with a maximum total score of 39. Data Analysis Before performing multiple regression analysis and propensityscore matching, we conducted a review of the literature and found potentially available explanatory factors for changes in ADLs with LTC needs. A total of 18 factors were identified that were significantly associated with the outcome variable: geographical region, LTC level, age, sex, primary caregiver, Medicaid beneficiary status, bedridden status, medical diagnosis (dementia, stroke, hypertension, diabetes,
T.W. Lee et al. / JAMDA xxx (2014) 1e6
musculoskeletal disease, or pressure ulcer), baseline ADLs, cognitive function, behavioral problems, nursing and special treatment, and rehabilitation needs. The differences in characteristics between the home care group and the nursing home care group for all participants were analyzed by independent t-test for continuous variables and c2 test for categorical variable. We also created a propensity-score-matched cohort by attempting to match each participant who received home care with one who received nursing home care (a 1:1 match). A nearestneighbor-matching algorithm with a “greedy” heuristic (one that always implements the best immediate, local, or solution) was used to match the participants. In greedy nearest-neighbor matching, a participant receiving home care was randomly selected and matching was attempted with the “nearest” participant receiving nursing home care. After matching, we also evaluated the degree of balance in measured covariates between the home care group and the nursing home care group. The distributions of continuous variables and categorical variables between the 2 groups in the matched cohort were compared with the use of paired t-tests and McNemar’s test, respectively. Multiple regression analysis with all unmatched participants was performed to explain the association of changes in the ADLs with
3
types of LTC as an independent variable after controlling for a set of 18 covariates. In addition, paired t-test with the propensity-scorematched cohort was conducted to compare difference in changes in ADLs between the 2 matched groups. All reported P values are 2 sided, and P values less than .05 were considered to indicate statistical significance. SAS software v 9.2 (SAS Inc., Cary, NC) was used. Results Characteristics of Participants A total of 22,557 participants met the study inclusion criteria. The baseline characteristics of participants who received home care was compared with the nursing home care recipients (Table 1). Overall, 49.2% of the LTC beneficiaries with LTC level 1and 2 in the baseline assessment were receiving home care. The likelihood of receiving home care was significantly greater for those who were younger, male, and had a spouse or children as caregivers, and having no Medicaid benefits, compared with those receiving nursing home care. These participants were also more likely to have a higher percentage of LTC level 1, to be completely bedridden, to have stroke, hypertension, diabetes, and pressure ulcers, but have a lower percentage of
Table 1 Baseline Characteristics of LTC Beneficiaries, According to Type of Care, Before and After Propensity-Score Matching Characteristic
Long-term care level 1 2 Baseline ADLs Cognitive function Behavior problems Nursing and special treatment Rehabilitation needs Region Metropolitan Small city Rural area Age Sex Male Female Primary caregiver None Spouse Children Grandchildren Others Medicaid beneficiary Yes Bedridden status None Partial Complete Medical diagnosis Dementia Yes Stroke Yes Hypertension Yes Diabetes Yes Musculoskeletal disease Yes Pressure ulcers Yes M, mean; SD, standard deviation.
Unmatched Participants
Matched Participants
Home Care (n ¼ 10,879)
Nursing Home (n ¼ 11,678)
N (%) or M SD
N (%) or M SD
Home Care (n ¼ 5141)
Nursing Home (n ¼ 5141)
N (%) or M SD
N (%) or M SD
5767 (53.01) 5112 (46.99) 32.32 4.73 5.99 2.98 2.43 3.01 0.35 0.75 17.66 5.06
5863 (50.21) 5815 (49.79) 31.76 5.10 7.11 2.61 3.64 3.45 0.19 0.5 16.76 5.04
2433 (47.33) 2708 (52.67) 31.36 4.93 6.77 2.72 3.35 3.46 0.22 0.53 16.55 4.92
2404 (46.76) 2737 (53.24) 31.33 5.09 6.68 2.68 3.39 3.44 0.22 0.56 16.57 4.95
.5673
4566 (42.01) 4156 (38.23) 2148 (19.76) 77.71 7.77
4044 (34.75) 4707 (40.45) 2887 (24.81) 80.40 7.42
