title: Predictors of long-term care utilization by Dutch hospital patients aged 65+.
abstract: BACKGROUND
  Long-term care is often associated with high health care expenditures. In the Netherlands, an ageing population will likely increase the demand for long-term care within the near future. The development of risk profiles will not only be useful for projecting future demand, but also for providing clues that may prevent or delay long-term care utilization. Here, we report our identification of predictors of long-term care utilization in a cohort of hospital patients aged 65+ following their discharge from hospital discharge and who, prior to hospital admission, were living at home.
  
  
  METHODS
  The data were obtained from three national databases in the Netherlands: the national hospital discharge register, the long-term care expenses register and the population register. Multinomial logistic regression was applied to determine which variables were the best predictors of long-term care utilization. The model included demographic characteristics and several medical diagnoses. The outcome variables were discharge to home with no formal care (reference category), discharge to home with home care, admission to a nursing home and admission to a home for the elderly.
  
  
  RESULTS
  The study cohort consisted of 262,439 hospitalized patients. A higher age, longer stay in the hospital and absence of a spouse were found to be associated with a higher risk of all three types of long-term care. Individuals with a child had a lower risk of requiring residential care. Cerebrovascular diseases [relative risk ratio (RRR) = 11.5] were the strongest disease predictor of nursing home admission, and fractures of the ankle or lower leg (RRR = 6.1) were strong determinants of admission to a home for the elderly. Lung cancer (RRR = 4.9) was the strongest determinant of discharge to the home with home care.
  
  
  CONCLUSIONS
  These results emphasize the impact of age, absence/presence of a spouse and disease on long-term care utilization. In an era of demographic and epidemiological changes, not only will hospital use change, but also the need for long-term care following hospital discharge. The results of this study can be used by policy-makers for planning health care utilization services and anticipating future health care needs.
authors.affiliation: Department of Statistics and Mathematical Modeling, Expertise Centre for Methodology and Information Services, National Institute for Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, the Netherlands. albert.wong@rivm.nl
authors.forename: Albert
authors.initials: A
authors.lastname: Wong
authors.forename: Rianne
authors.initials: R
authors.lastname: Elderkamp-de Groot
authors.forename: Johan
authors.initials: J
authors.lastname: Polder
authors.forename: Job
authors.initials: J
authors.lastname: van Exel
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008134:Long-Term Care / Q000706:statistics & numerical data*; D008297:Male; D009426:Netherlands; D010351:Patient Discharge / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018454:Spouses
references.citation: J Gerontol. 1992 Jul;47(4):S173-82
references.pmid: 1624712
references.citation: Health Policy. 2007 Oct;83(2-3):332-42
references.pmid: 17367892
references.citation: Stroke. 2008 Jan;39(1):132-8
references.pmid: 18063828
references.citation: J Clin Psychiatry. 2007 Sep;68(9):1392-8
references.pmid: 17915978
references.citation: J Cross Cult Gerontol. 2000;15(2):99-118
references.pmid: 14618005
references.citation: Stroke. 2003 Aug;34(8):1970-5
references.pmid: 12855818
references.citation: J Gerontol A Biol Sci Med Sci. 2000 May;55(5):M279-87
references.pmid: 10819318
references.citation: J Epidemiol Community Health. 1997 Oct;51(5):531-40
references.pmid: 9425464
references.citation: Age Ageing. 2004 Mar;33(2):110-5
references.pmid: 14960424
references.citation: Soc Work Health Care. 2009;48(2):154-68
references.pmid: 19197772
references.citation: BMC Geriatr. 2007 Jun 19;7:13
references.pmid: 17578574
references.citation: J Am Med Dir Assoc. 2007 Jan;8(1):14-20
references.pmid: 17210498
references.citation: Am J Geriatr Cardiol. 2007 Mar-Apr;16(2):76-83
references.pmid: 17380615
references.citation: Int J Technol Assess Health Care. 1999 Winter;15(1):147-60
references.pmid: 10407602
references.citation: J Health Serv Res Policy. 1999 Oct;4(4):197-203
references.pmid: 10623034
references.citation: Patient. 2008 Jan 1;1(1):55-71
references.pmid: 22272757
references.citation: J Am Geriatr Soc. 2004 Mar;52(3):434-9
references.pmid: 14962161
references.citation: Health Policy. 2005 Sep 28;74(1):85-99
references.pmid: 16098415
references.citation: J Am Geriatr Soc. 2006 Apr;54(4):593-7
references.pmid: 16686868
references.citation: Arch Gerontol Geriatr. 2003 Mar-Apr;36(2):117-26
references.pmid: 12849086
references.citation: Health Econ. 2000 Sep;9(6):513-31
references.pmid: 10983004
references.citation: J Epidemiol Community Health. 1999 Dec;53(12):765-74
references.pmid: 10656085
references.citation: Stroke. 2008 May;39(5):1514-9
references.pmid: 18340094
references.citation: JAMA. 1999 Dec 15;282(23):2215-9
references.pmid: 10605972
references.citation: Med Care Res Rev. 2000 Sep;57(3):259-97
references.pmid: 10981186
references.citation: Tohoku J Exp Med. 2005 Dec;207(4):325-32
references.pmid: 16272803
references.citation: Cerebrovasc Dis. 2005;19(1):11-7
references.pmid: 15528879
references.citation: J Gerontol B Psychol Sci Soc Sci. 1996 Mar;51(2):S61-9
references.pmid: 8785694
references.citation: J Gerontol B Psychol Sci Soc Sci. 2002 Sep;57(5):S285-93
references.pmid: 12198108
references.citation: Stroke. 2005 Feb;36(2):374-86
references.pmid: 15637317
references.citation: J Gerontol. 1990 Nov;45(6):S250-8
references.pmid: 2229951
references.citation: Am J Public Health. 1993 Dec;83(12):1765-7
references.pmid: 8259815
references.citation: Arthritis Rheum. 2004 Dec 15;51(6):1009-17
references.pmid: 15593323
references.citation: Neurology. 2000 Oct 24;55(8):1180-7
references.pmid: 11071497