Social vulnerability and frailty associations with home care hours among community dwelling older adults followed for ten years in Nova Scotia, Canada

Abstract Background Home care (HC) services enable older adults to maintain independence and delay institutionalization. In addition to frailty, a key element to aging in place is a person’s social circumstances. Our research aimed to understand how social vulnerability (SV) influences formal HC use among older adults aged 65 years+ from the province of Nova Scotia, Canada who received publicly funded HC from 2005 to 2018. Methods This cohort study measured frailty and SV using indices. Multilevel growth models examined HC hours over time in relation to baseline frailty, baseline SV and changes in SV, accounting for age, sex, dementia, receipt of nursing services, and year of HC initiation. Sex-separated analyses were also conducted. Results Among 5,170 older adults with 13,552 home care assessments over ten years, the mean age was 80.5 (SD 7.5) and 67.6% were female. Greater changes in SV were associated with lower number of HC hours such that each 0.1 increase in SV per year was associated with a decrease in annual log hours of 3.3%. For males, and individuals assessed within 5 years of death, high baseline SV was also statistically significantly negatively correlated with HC hours. In all models, baseline frailty had the greatest positive and significant effect on hours. Discussion As social vulnerability increased, the number of HC hours decreased. This study contributes to the literature by exploring the dynamic interplay between social vulnerability, frailty and HC usage, with implications for how HC services can better serve older adults aging in the community.