BACKGROUND Given the increasing importance of formal home care services in policies dedicated to elder care, there is major interest in studying individuals' characteristics determining their utilization. The main objective of this research was to quantify, during a 6-year timeframe, home care use trajectories followed by community-dwelling participants in a cohort study of older adults. The secondary objective was to identify factors associated with home care utilization using Andersen's Behavioural Model of Health Services Use. METHODS We proceeded to an analysis of data prospectively collected in the setting of the Lc65+ population-based study conducted in Lausanne (Switzerland). Self-reported utilization of professional home care in 2012 and 2018 was used to define trajectories during this timeframe (i.e. non-users, new users, former users and continuing users). Bivariable analyses were performed to compare new users to non-users regarding the three dimensions of Andersen's model (predisposing, enabling and need factors) measured at baseline. Then, binomial logistic regression was used in a series of two hierarchical models to adjust for need factors first, before adding predisposing and enabling factors in a second model. RESULTS Of 2155 participants aged between 69 and 78 in 2012, 82.8% remained non-users in 2018, whereas 11.2% started to use professional home care. There were 3.3% of continuing users and 2.7% of former users. New users exhibited a higher burden of physical and psychological complaints, chronic health conditions and functional limitations at baseline. After adjusting for these need factors, odds of home care utilization were higher only in participants reporting a difficult financial situation (OR 1.65, 95% CI 1.12-2.45). CONCLUSIONS In the setting of a Swiss city, incident utilization of formal home care by older adults appeared to be largely determined by need factors. Modifiable factors like personal beliefs and knowledge about home care services did not play a role. After adjusting for need, odds of becoming home care user remained higher in participants reporting a difficult financial situation, suggesting such vulnerability does not hamper access to professional home care in this specific context.

中文翻译：

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老年人正式使用家庭护理：Lc65 +人群的轨迹和决定因素。

背景技术由于正式的家庭护理服务在致力于老年人护理的政策中的重要性日益增加，因此人们对研究确定其使用率的个人特征非常感兴趣。这项研究的主要目的是在六年的时间范围内量化家庭护理的使用轨迹，然后对老年人进行的队列研究中的社区居民参与者进行量化。次要目标是使用Andersen的“卫生服务使用行为模型”来确定与家庭护理使用相关的因素。方法我们对在洛桑（瑞士）进行的基于Lc65 +人群的研究中预期收集的数据进行了分析。自行报告了2012年和2018年专业家庭护理的使用情况，以定义此时间段内的轨迹（即非用户，新用户，前用户和继续用户）。进行了双变量分析，以比较在基线测量的Andersen模型的三个维度（易感性，促成因素和需求因素）方面的新用户与非用户。然后，在一系列的两个层次模型中使用二项式逻辑回归来首先针对需求因素进行调整，然后在第二个模型中添加易感性和促成因素。结果2012年有2155名年龄在69至78岁之间的参与者，其中2018年仍未使用者占82.8％，而11.2％的人开始使用专业家庭护理。有3.3％的持续用户和2.7％的以前用户。新用户在基线时表现出较高的身体和心理不适负担，慢性健康状况和功能限制。在调整了这些需求因素之后，仅在财务状况困难的参与者中，家庭护理使用的几率更高（OR 1.65，95％CI 1.12-2.45）。结论在瑞士城市的背景下，老年人对正规家庭护理的使用率似乎在很大程度上取决于需求因素。个人信念和有关家庭护理服务的知识等可修改因素并未发挥作用。经过调整需求后，报告家庭经营困难的参与者中成为家庭护理用户的几率仍然较高，这表明这种脆弱性并不妨碍在此特定情况下获得专业家庭护理的机会。个人信念和有关家庭护理服务的知识等可修改因素并未发挥作用。经过调整需求后，报告家庭经营困难的参与者中成为家庭护理用户的几率仍然较高，这表明这种脆弱性不会在这种特定情况下妨碍获得专业家庭护理的机会。个人信念和有关家庭护理服务的知识等可修改因素并未发挥作用。经过调整需求后，报告家庭经营困难的参与者中成为家庭护理用户的几率仍然较高，这表明这种脆弱性并不妨碍在此特定情况下获得专业家庭护理的机会。