Health care profiles of home care users with cognitive impairment - state sequence analysis

Abstract Background In older adults, cognitive impairment can lead to an increased use of services. We examined the service use of older home care recipients with cognitive impairment to a) categorise the service use into profiles, and b) learn how the profiles are associated with individual characteristics. Methods We used national health and social care registers linked with Resident Assessment Instrument (RAI) data of cognitively impaired home care clients (n = 4000) at least 75 years old. The clients’ service use was followed for up to 6 months. State sequence analysis (SSA) was used to group similar care sequences into profiles. Logistic regression and analysis of variance were used to measure the association between the profiles and covariates, such as level of cognition and functioning, existence of an informal carer, and risk of death or transfer to a long-term care facility (LTCF). Results We established 9 profiles: 3 with heavy use of home nursing, 2 with mixed use, 1 with heavy use of remote services, 1 with mostly planned hospitalisations, 1 with heavy use of primary and emergency care, and one with very little use. Use of home nursing was consistent or decreased over time depending on the profile. Heavy use of remote services was associated with dementia. Planned hospitalisations were associated with cancer. Mixed use was often increasing, connected with heavy cognitive and functional impairment, and increased the chance of death or transfer to an LTCF. Heavy use of primary care related to old age and impending death or transfer to an LTCF. An informal carer was usually present when there is heavy cognitive of functional impairment, unless there was also extensive home nursing or primary care use. Conclusions Profile analysis enables a holistic picture of the diversity of service use and its connection with individual characteristics of people with cognitive impairment. It has the potential to advance the effective use of integrated services and improve care outcomes.