The proportion of persons receiving home help care, home services and long-term care has decreased in Sweden in the past decades. Little is known about the dependency of the elderly and the provision of acute care and contacts. There is a need of a systematic assessment and the establishment of a registry that can form the basis for analyzing the relationship between municipal care, for the elderly and their consumption of acute hospital care as well primary health care.
Objective: The aim is to describe the degree of home help care, the degree of dependency and relation to hospital care in five municipalities in southern Sweden.
Design: The present cross-sectional study is part of an ongoing study, The Swedish National Study on Aging and Care (SNAC).
Materials and Methods: The study population included all residents, except for one municipality where only 25% were included, 65 years and older and receiving public service as home help care, home services including medical care at home, or long term care during 2001. The public officer completed a structured questionnaire including type and amount of care services, degree of dependency, Katz ADL index, living conditions, technical aids, cognition and informal care. Information of hospital care, out patient care and diagnosis during 2001 were retrieved from the Skåne County Registry of medical care.
Results: The population comprised 2509 subjects, (39%) with a mean age of 84 years, 72% were women and 47% stayed in sheltered living. The systematic assessment of ADL showed that dependency in all IADL functions were noted in 48% of elderly living in their own homes compared to 91% of subjects in shelterd living. As expected, medical care was higher among elderly with public service than the reference population, all subjects > 65 years in the county, 2.2 vs 1.7 annual primary health care visits and 3.1 vs 2.6 hospital care visits, respectively. However, when the study population was stratified age, the oldest group > 85 years had less medical care, primary health care and hospital care, compared to the age groups, 65 to 74 and 75 to 84 years.
Conclusion: The findings suggest that the most fragile elderly may be marginalized from specialist out-patient care as well as hospital care.
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