Affiliation:
1. Health Economics Resource Center VA Palo Alto Health Care System Menlo Park California USA
2. Department of Health Policy Stanford University School of Medicine Stanford California USA
3. Center for Innovation to Implementation VA Palo Alto Health Care System Menlo Park California USA
4. Division of Primary Care and Population Health Stanford University School of Medicine Stanford California USA
5. Seattle‐Denver Center of Innovation for Veteran‐Centered and Value‐Driven Care VA Puget Sound Health Care System Seattle Washington USA
6. General Medicine Service Veterans Affairs (VA) Puget Sound Health Care System Seattle Washington USA
7. Department of Medicine, School of Medicine University of Washington Seattle Washington USA
8. Center for Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham Veterans Affairs Health Care System Durham North Carolina USA
9. Department of Population Health Sciences Duke University Durham North Carolina USA
10. Division of General Internal Medicine, Department of Medicine Duke University Durham North Carolina USA
11. Duke‐Margolis Center for Health Policy Duke University Durham North Carolina USA
Abstract
AbstractBackgroundMany 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.MethodsA 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.ResultsNot 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%).ConclusionsFindings 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.
Funder
Health Services Research and Development
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