The role of disability in explaining long-term care utilization.
OBJECTIVE
In view of aging populations, it is important to improve our understanding of the determination of long-term care (LTC) service use among the middle-aged and elderly population. We examined the likelihood of using 2 levels of LTC-homecare and institutional care-in the Netherlands and focused on the influence of the measured degree of disability.


METHODS
We pooled 2 cross-sectional surveys-one that excluded institutionalized and one that was targeted at institutionalized individuals aged 50+. Disability is measured by impairment in (instrumental) activities of daily living (iADL, ADL) and mobility. Consistency with official Dutch LTC eligibility criteria resulted in the selection of an ordered response model to analyze utilization. We compared a model with separate disability indicators to one with a disability index.


RESULTS
Age and disability, but not general health, proved to be the main determinants of utilization, with the composite index sufficiently representing the disaggregated components. The presence of at least 1 disability displayed a greater effect on utilization than any additional disabilities. Apart from disability and age, sex, living alone, psychologic problems, and hospitalizations showed a significant influence on LTC use. Some determinants affected the likelihood of homecare or institutional care use differently.


CONCLUSIONS
Even after extensive control for disability, age remains an important driver of LTC use. By contrast, general health status hardly affects LTC use. The model and disability index can be used as a policy tool for simulating LTC needs.
Department of Health Policy and Management and iMTA, Erasmus MC, Rotterdam, Netherlands. c.demeijer@erasmusmc.nl
Claudine A M
CA
de Meijer
Marc A
MA
Koopmanschap
Xander H E
XH
Koolman
Eddy K A
EK
van Doorslaer
D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities; D005260:Female; D015577:Geriatric Assessment; D006699:Home Care Services / Q000706:statistics & numerical data*; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D008134:Long-Term Care / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009735:Nursing Homes / Q000706:statistics & numerical data*; D012737:Sex Factors