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Classification trees for identifying non-use of community-based long-term care services among older adults

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  • Penkunas, Michael James
  • Eom, Kirsten Yuna
  • Chan, Angelique Wei-Ming

Abstract

Home- and center-based long-term care (LTC) services allow older adults to remain in the community while simultaneously helping caregivers cope with the stresses associated with providing care. Despite these benefits, the uptake of community-based LTC services among older adults remains low. We analyzed data from a longitudinal study in Singapore to identify the characteristics of individuals with referrals to home-based LTC services or day rehabilitation services at the time of hospital discharge. Classification and regression tree analysis was employed to identify combinations of clinical and sociodemographic characteristics of patients and their caregivers for individuals who did not take up their referred services. Patients’ level of limitation in activities of daily living (ADL) and caregivers’ ethnicity and educational level were the most distinguishing characteristics for identifying older adults who failed to take up their referred home-based services. For day rehabilitation services, patients’ level of ADL limitation, home size, age, and possession of a national medical savings account, as well as caregivers’ education level, and gender were significant factors influencing service uptake. Identifying subgroups of patients with high rates of non-use can help clinicians target individuals who are need of community-based LTC services but unlikely to engage in formal treatment.

Suggested Citation

  • Penkunas, Michael James & Eom, Kirsten Yuna & Chan, Angelique Wei-Ming, 2017. "Classification trees for identifying non-use of community-based long-term care services among older adults," Health Policy, Elsevier, vol. 121(10), pages 1093-1099.
    • Handle: RePEc:eee:hepoli:v:121:y:2017:i:10:p:1093-1099
    DOI: 10.1016/j.healthpol.2017.05.008
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    References listed on IDEAS

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    1. Lim, Meng-Kin, 2004. "Shifting the burden of health care finance: a case study of public-private partnership in Singapore," Health Policy, Elsevier, vol. 69(1), pages 83-92, July.
    2. Koike, Soichi & Furui, Yuji, 2013. "Long-term care-service use and increases in care-need level among home-based elderly people in a Japanese urban area," Health Policy, Elsevier, vol. 110(1), pages 94-100.
    3. Truls Østbye & Rahul Malhotra & Chetna Malhotra & Chandima Arambepola & Angelique Chan, 2013. "Does Support From Foreign Domestic Workers Decrease the Negative Impact of Informal Caregiving? Results From Singapore Survey on Informal Caregiving," The Journals of Gerontology: Series B, The Gerontological Society of America, vol. 68(4), pages 609-621.
    4. Teo, Peggy & Chan, Angelique & Straughan, Paulin, 2003. "Providing health care for older persons in Singapore," Health Policy, Elsevier, vol. 64(3), pages 399-413, June.
    5. Martin Pinquart & Silvia Sörensen, 2006. "Gender Differences in Caregiver Stressors, Social Resources, and Health: An Updated Meta-Analysis," The Journals of Gerontology: Series B, The Gerontological Society of America, vol. 61(1), pages 33-45.
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    1. Liangwen Zhang & Yanbing Zeng & Lixia Wang & Ya Fang, 2020. "Urban–Rural Differences in Long-Term Care Service Status and Needs Among Home-Based Elderly People in China," IJERPH, MDPI, vol. 17(5), pages 1-18, March.
    2. Zhenyu Wang & Hanchun Wei & Zhihan Liu, 2022. "Older Adults’ Demand for Community-Based Adult Services (CBAS) Integrated with Medical Care and Its Influencing Factors: A Pilot Qualitative Study in China," IJERPH, MDPI, vol. 19(22), pages 1-17, November.

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