The association between social risks and days at home for older veterans

IF 4.3 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society Pub Date : 2024-07-12 DOI:10.1111/jgs.19064

Josephine C. Jacobs PhD, Liberty Greene MS, MEd, Mayuree Rao MD, MS, Valerie A. Smith DrPH, Courtney H. Van Houtven PhD, Matthew L. Maciejewski PhD, Donna M. Zulman MD, MS

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引用次数: 0

Abstract

Background

Many health systems are trying to support the ability of older adults to remain in their homes for as long as possible. Little is known about the relationship between patient-reported social risks and length of time spent at home. We assessed how social risks were associated with days at home for a cohort of older Veterans at high risk for hospitalization and mortality.

Methods

A prospective cross-sectional study using a 2018 survey of 3479 high-risk Veterans aged ≥65 linked to Veterans Health Administration data. Social risks included measures of social resources (i.e., no partner present, low social support), material resources (i.e., not employed, financial strain, medication insecurity, food insecurity, and transportation barriers), and personal resources (i.e., low medical literacy and less than high school education). We estimated how social risks were associated with days at home, defined as the number of days spent outside inpatient, long-term care, observation, or emergency department settings over a 12-month period, using a negative binomial regression model.

Results

Not having a partner, not being employed, experiencing transportation barriers, and low medical literacy were respectively associated with 2.57, 3.18, 3.39, and 6.14 fewer days at home (i.e., 27% more facility days, 95% confidence interval [CI] 8%–50%; 42% more facility days, 95% CI 7%–89%; 34% more facility days, 95% CI 7%–68%; and 63% more facility days, 95% CI 27%–109%). Experiencing food insecurity was associated with 2.62 more days at home (i.e., 24% fewer facility days, 95% CI 3%–59%).

Conclusions

Findings suggest that screening older Veterans at high risk of community exit for social risks (i.e., social support, material resources, and medical literacy) may help identify patients likely to benefit from home- and community-based health and social services that facilitate remaining in home settings. Future research should focus on understanding the mechanisms by which these associations occur.

查看原文本刊更多论文

老年退伍军人的社会风险与在家天数之间的关联。

背景：许多医疗系统都在努力帮助老年人尽可能长时间地留在家中。人们对患者报告的社会风险与居家时间长短之间的关系知之甚少。我们评估了一组有住院和死亡高风险的老年退伍军人的社会风险与在家天数之间的关系：这是一项前瞻性横断面研究，使用了 2018 年对 3479 名年龄≥65 岁的高风险退伍军人进行的调查，该调查与退伍军人健康管理局的数据相链接。社会风险包括社会资源（即没有伴侣、社会支持度低）、物质资源（即没有工作、经济紧张、用药不安全、食品不安全和交通障碍）和个人资源（即医疗知识水平低和高中以下教育程度）的测量。我们使用负二项回归模型估算了社会风险与在家天数的关系，在家天数是指 12 个月内在住院、长期护理、观察或急诊室之外度过的天数：没有伴侣、没有工作、交通不便和医疗知识水平低分别导致在家天数减少 2.57 天、3.18 天、3.39 天和 6.14 天（即住院天数增加 27%，95% 置信区间 [CI]为 8%-50%；住院天数增加 42%，95% 置信区间为 7%-89%；住院天数增加 34%，95% 置信区间为 7%-68%；住院天数增加 63%，95% 置信区间为 27%-109%）。粮食不安全与在家天数增加 2.62 天有关（即设施天数减少 24%，95% CI 3%-59%）：研究结果表明，对退出社区风险较高的老年退伍军人进行社会风险（即社会支持、物质资源和医疗知识）筛查，可帮助识别出可能受益于以家庭和社区为基础的健康和社会服务的患者，从而帮助他们留在家中。未来的研究应侧重于了解这些关联的发生机制。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Geriatrics Society 医学-老年医学

CiteScore

10.00

自引率

6.30%

发文量

504

审稿时长

3-6 weeks

期刊介绍： Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.