journal articles
HEALTHCARE UTILIZATION, PHARMACOTHERAPY PRESCRIPTIONS, AND CLINICAL OUTCOMES ACROSS A 5-YEAR DURATION PRECEDING AND SUCCEEDING THE INITIATION OF HOME HEALTH CARE IN A NATIONWIDE POPULATION-BASED COHORT OF 187,547 OLDER ADULTS WITH DISABILITIES
Shih-Tsung Huang, Fei-Yuan Hsiao, Wei-Ju Lee, Ming-Yueh Chou, Chih-Kuang Liang, Chu-Sheng Lin, Ching-Hui Loh, Liang-Kung Chen
BACKGROUND: Longitudinal trajectories of healthcare utilization, medication prescription, and clinical outcomes among older adults with disabilities receiving home healthcare (HHC) holds significance but remains elusive.
METHODS: People aged≥65 years who newly received Taiwan’s National Health Insurance funded HHC program from January 2005 to December 2013 were identified. Healthcare utilization, life-sustaining treatment, medication prescriptions (polypharmacy, psychotropics, anticholinergic burden and antibiotics), health status (Charlson’s comorbidity index, CCI), and mortality were assessed over a 10-year period spanning 5 years before and after initiating HHC.
RESULTS: Overall, 187,547 patients (80.6 ± 7.7 years, 51.2 % females, CCI 3+: 51.2 %) with a high prevalence of dementia (34.0 %), stroke (38.7 %), and pneumonia (49.5 %), and usage of life-sustaining treatment (urinary catheters: 82.8 % and nasogastric feeding: 78.7 %) were obtained. A sudden peak of admission rate at 1 year (91.7 %) before HHC, followed by the 70 % and 60 % admission rate in the first and second year after receiving HHC were found. Quarterly changes of using life-sustaining treatment showed significant increases from as early as 1 year prior to HHC. Gradual increases of polypharmacy, use of psychotropics, and antibiotic (4.5-fold and 3-fold) after HHC further demonstrated the complex needs (both p < 0.01). The 5-year cumulative mortality rate was 81 % (40 % in the first year with an annual rate of 25 %).
INTERPRETATION: HHC recipients embody a confluence of complex care needs and high mortality risk, whereby various interventions aim to alleviate symptoms and sustain life. Engaging in proactive advanced care planning and end-of-life care should be prioritized when home healthcare is being contemplated.
CITATION:
Shih-Tsung Huang ; Fei-Yuan Hsiao ; Wei-Ju Lee ; Ming-Yueh Chou ; Chih-Kuang Liang ; Chu-Sheng Lin ; Ching-Hui Loh ; Liang-Kung Chen (2025): Healthcare utilization, pharmacotherapy prescriptions, and clinical outcomes across a 5-year duration preceding and succeeding the initiation of home health care in a nationwide population-based cohort of 187,547 older adults with disabilities. The Journal of Frailty and Aging (JFA). https://doi.org/10.1016/j.tjfa.2025.100063