Comparison of Healthcare Utilization between Caregivers of Dementia and Nondementia Older Adults

• Main Authors: Su-Yuan Chan, 詹書媛
• Other Authors: Ya-Mei Chen
• Format: Others
• Language: zh-TW
• Published: 2018
• Online Access: http://ndltd.ncl.edu.tw/handle/q2mrk9

碩士 === 國立臺灣大學 === 健康政策與管理研究所 === 106 === Background: Due to population ageing, long-term care, the rise of dementia older adults, and the care burden due to behavior problems, services that support dementia caregivers have become more and more important. Past studies have proved that dementia caregivers have greater care impact, poorer physical and mental health, and it even affects their healthcare utilization. Foreign studies have conducted researches on dementia caregivers&apos;&apos; health care service utilization, but Taiwan hasn’t yet explored the healthcare utilization of dementia caregivers. Therefore, based on research gaps at home and abroad, this study aims to compare the healthcare utilization between the primary caregivers of elderly adults with or without dementia who were in Ten-year Long Term Care Project (TLTCP) of Taiwan. Also, it demonstrates the healthcare utilization effect of long-term care services, and the possible associated variables of healthcare utilization. Methods: Data were extracted from the population-based datasets of the Long-Term Care Service Management System and National Health Insurance of Taiwan. Individuals who acted as the primary caregivers of elderly adults aged 65 or above in the TLTCP from the period of 2008 to 2013 were included in the study (N = 10,771). This study included 5,610 caregivers of elderly adults with dementia and 5,161 caregivers of elderly adults without dementia. Starting from the first long-term care needs assessment, we compared the one-year healthcare utilization of outpatients, emergency department uses and hospitalizations between caregivers of dementia and nondementia older adults. Furthermore, it examined the healthcare utilization impact of long-term care services through stratification based on single or multiple service use. This study applied multiple logistic regression analysis and multiple linear regression analysis. Result: Dementia patients’ caregivers had higher tendency of outpatient visits, lower tendency of outpatient fees, higher tendency of emergency visits and fees, higher tendency of hospitalization visits and fees, but lower tendency of hospitalization days and total fees without significantly difference from nondementia patients’ caregivers. When the care recipients are at the stage of light disability, dementia caregivers had higher emergency fees (β = 2507.83, p < 0.01). When the care recipients are at the stage of severe disability, dementia caregivers had higher hospitalization visits (β = 0.22, p < 0.05). Compared with nondementia caregivers, dementia caregivers had higher emergency visits (β = 0.82, p < 0.05) and higher fees (β = 1590.09, p < 0.05) when they used only single service; but dementia caregivers had lower outpatient fees (β = -3180.14, p < 0.05) and lower per hospitalization fees (β = -9796.04, p < 0.05) when they used multiple services. This result shows that the effects of multiple services on dementia caregivers may be more obvious than nondementia caregivers. We have also found the acute care healthcare utilization of male caregivers is higher, and the reason is needed to be examined in future research. Conclusion: Dementia caregivers, especially caregivers of mild dementia, are more likely to neglect their own health in the caring process, and resulted in more use of acute care health resources eventually. The intervention of multiple services might have greater effect on dementia caregivers than nondementia caregivers. Our study suggests that policymakers should provide additional respite care services to allow caregivers time to seek primary healthcare resources and to improve their self-care. In addition, the findings support future policies that promote the multiple service use pattern among caregivers, particularly among the caregivers of elderly adults with dementia. Future research can focus on the long-term change in healthcare utilization between different types of caregivers, the moderator effect of long-term care services, and the combination of multiple services for the caregivers of elderly adults with dementia.