LONG-TERM CARE INSTITUTIONALIZATION: AN ANALYSIS OF FACTORS INFLUENCING SELECTION BY ELDERLY PERSONS AND THEIR FAMILIES

摘要

This study was designed to answer the following questions: (1) are there statistically significant differences in demographic, social, economic, health and functional characteristics of older persons utilizing three levels of long-term care, (2) are there statistically significant associations between pairs of selected variables relating to persons in three levels of care, (3) does ethnicity make a difference (Japanese and Caucasian), (4) which variables predict institutionalization, (5) are there statistically significant differences in disability of older persons in free-standing and hospital-based ICFs, or for-profit and not-for-profit ICFs?;Data from two surveys using the comprehensive OARS instrument, were used for the comparisons. There were three comparison groups: (1) elderly persons about to enter ICFs, n = 91, (2) those using home care services, n = 129, and (3) those not using home care services, n = 376. The dependent variable was level of care with the above three outcomes. Independent variables were more than 200 factors relating to subjects regarding their social and economic resources, physical and mental health, and functional abilities.;Bivariate analysis revealed many statistically significant differences in each of the categories of variables among persons at the three levels of care. Using multivariate procedures, seven variables emerged as statistically significant predictors of level of care: age, having a caregiver as long as needed, eyesight, self-rate of health, incontinence, interviewers' Activity of Daily Living Score, and the interviewers' Cumulative Impairment Score. Application of the knowledge of risk factors may lead to appropriate use of a variety of interventions which could perhaps prevent or delay institutionalization.;The study illustrated the importance of research on ways to prevent or alleviate the problems of incontinence. Research on falls and fractures among the elderly is also desperately needed. Other important variables which need researching are those relating to the total long-term care system, such as: the economic resources of the elderly and payment for services, availability and accessibility of services, and how governmental policies regarding long-term care services affect the well-being of the elderly.