Determinants of long-term care services among the elderly: A population-based study in Taiwan

Objectives: The aim of the study was to investigate determinants of long-term care use and to clarify the differing characteristics of home/community-based and institution-based services users. Design: Cross-sectional, population-based study. Setting: Utilizing data from the 2005 National Health Interview Survey conducted in Taiwan. Participants: A national sample of 2,608 people (1,312 men, 1,296 women) aged 65 and older. Measurements: The utilization of long-term care services (both home/community- and institution-based services) was measured. A χ² analysis tested differences in baseline characteristics between home/community-based and institution-based long-term care users. The multiple-logistic model was adopted with a hierarchical approach adding the Andersen model's predisposing, enabling, and need factors sequentially. Multiple logistic models further stratified data by gender and age. Results: Compared with users of home/community-based care, those using institution-based care had less education (p = 0.019), greater likelihood of being single (p = 0.001), fewer family members (p = 0.002), higher prevalence of stool incontinence (p = 0.011) and dementia (P = .025), and greater disability (p = 0.016). After adjustment, age (compared with 65-69 years; 75-79 years, odds ratio [OR] = 2.08, p = 0.044; age ≥80, OR = 3.30, p = 0.002), being single (OR = 2.16, p = 0.006), urban living (OR = 1.68, p = 0.037), stroke (OR = 2.08, p = 0.015), dementia (OR = 2.32, p = 0.007), 1-3 items of activities of daily living (ADL) disability (OR = 5.56, p<0.001), and 4-6 items of ADL disability (OR = 21.57, p<0.001) were significantly associated with long-term care use. Conclusion: Age, single marital status, stroke, dementia, and ADL disability are predictive factors for long-term care use. The utilization was directly proportional to the level of disability.