Delaying Decline: The Effect of Long Term Care Services On the Health of American Older Adults in Retirement Communities
There is extremely limited empirical evidence to support the relationship between community based service use and functional health. In examining the effect of community based formal service use, we argue a range of services should be considered together in their use rather than examining an individual effect. Also, other service use including informal support and health service also should be considered together.
Purpose:
First, we looked at the trajectory of functional health of community-dwelling older adults over time. Second, we derived the empirical use pattern of five services including meal service, transportation services, PCS services, and in-home nursing service, chore service. Third, we looked at how the community based formal service use affect their functional health. In doing so, the focus will be on how formal services use affects functional limitation in combination with informal support and health services.
Methods:
First, in order to examine the pattern of different service use combination, we first derived the empirical pattern of service use with clustering analysis. Second, in order to examine the association between the different combination of service uses and the functional health status over time, growth curve modeling was conducted with a longitudinal data from the year 1998 through 2008 in a national sample.
Using data from the Health and Retirement Study (HRS), an analytic sample (N=6210) was drawn from six waves (1998-2008) of data, focusing on non-institutionalized older adults aged 65 and older who reside in senior housing that provided relevant long term care services.
Functional health status was measured by a sum of ADL and IADL limitations. Uses of long term care services, including group meals, chore service, personal care services(PSC), transportation were measured dichotomously. Hospitalization was measured dichotomously whether the respondent had hospitalized in the past 2 years. For informal support, the number of days of help and the number of helpers the respondent receives for ADL and IADL limitations.
Results:
Functional impairment at the mean age of 73 of follow-up was .32 out of a total 10 points and it increased over time (a linear slope of .02 , p<.0001). Second, four groups of service uses were discerned: in cluster 1, most of individuals do not use any of services, while cluster 2 stands out with members using most of the services, followed by cluster 3 and 4 both of which members use four out of five services. Compared to the cluster 1 of least service users, cluster 2 of the most service users showed that informal support is significantly associated with lower functional impairment by .72 (p<.0001) while the other cluster does not show any effect.
Conclusion and Implications:
This study provides important information as to whether and to what extent long-term care services have a beneficial effect on health outcomes when older adults use health services within the community. This finding can serve as meaningful background knowledge in designing a more efficient provision of community based services that aims to help seniors age in place.