OBJECTIVES To assess the impact of home care on length-of-stay within residential care. DESIGN A retrospective observational data-linkage study. SETTING AND PARTICIPANTS In total there were 3151 participants from the 45 and Up Study in New South Wales, Australia with dementia who entered residential care between 2010 and 2014. METHODS Survey data collected from 2006‒2009 were linked to administrative data for 2006‒2016. The highest level of home care a person accessed prior to residential care was defined as no home care, home support, low-level home care, and high-level home care. Multinomial logistic regression and Cox proportional hazards were used to investigate differences in activities of daily living, behavioral, and complex healthcare scales at entering residential care; and length-of-stay in residential care. RESULTS People with prior high-level home care entered residential care needing higher assistance compared with the no home care group: activities of daily living [odds ratio (OR) 3.41, 95% confidence interval (CI) 2.14‒5.44], behavior (OR 2.61, 95% CI 1.69‒4.03), and complex healthcare (OR 2.02, 95% CI 1.06‒3.84). They had a higher death rate, meaning shorter length-of-stay in residential care (<2 years after entry: hazard ratio 1.12; 95% CI 0.89‒1.42; 2-4 years: hazard ratio 1.49; 95% CI 1.01‒2.21). Those using low-level home care were less likely to enter residential care needing high assistance compared to the no home care group (activities of daily living: OR 0.61, 95% CI 0.45‒0.81; behavioral: OR 0.72, 95% CI 0.54‒0.95; complex healthcare: OR 0.51, 95% CI 0.33‒0.77). There was no difference between the home support and no home care groups. CONCLUSIONS High-level home care prior to residential care may help those with dementia stay at home for longer, but the low-level care group entered residential care at low assistance levels, possibly signaling lack of informal care and barriers in accessing higher-level home care. IMPLICATIONS Better transition options from low-level home care, including more timely availability of high-level care packages, may help people with dementia remain at home longer.

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先前家庭护理对澳大利亚痴呆症患者住院护理时间的影响

目标 评估家庭护理对住宿护理中住院时间的影响。设计 一项回顾性观察数据关联研究。地点和参与者 共有 3151 名来自澳大利亚新南威尔士州 45 岁及以上研究的痴呆症参与者于 2010 年至 2014 年期间进入住院护理。方法 2006-2009 年收集的调查数据与 2006-2016 年的管理数据相关联。一个人在接受住宿护理之前获得的最高水平的家庭护理被定义为无家庭护理、家庭支持、低水平家庭护理和高级家庭护理。多项逻辑回归和 Cox 比例风险用于调查进入院舍护理时日常生活活动、行为和复杂医疗保健量表的差异；和住院护理的逗留时间。结果 与没有家庭护理组相比，先前接受过高级家庭护理的人进入院舍护理时需要更高的帮助：日常生活活动 [比值比 (OR) 3.41，95% 置信区间 (CI) 2.14-5.44]、行为 (OR) 2.61, 95% CI 1.69-4.03) 和复杂的医疗保健 (OR 2.02, 95% CI 1.06-3.84)。他们的死亡率更高，意味着住院时间更短（入院后 <2 年：风险比 1.12；95% CI 0.89-1.42；2-4 年：风险比 1.49；95% CI 1.01-2.21 ）。与无家庭护理组相比，使用低级别家庭护理的人不太可能进入需要高强度援助的住宿护理（日常生活活动：OR 0.61，95% CI 0.45-0.81；行为：OR 0.72，95% CI 0.54- 0.95；复杂的医疗保健：OR 0.51，95% CI 0.33-0.77）。家庭支持组和无家庭护理组之间没有区别。结论 在住宿护理之前进行高级家庭护理可能有助于痴呆症患者在家中呆更长时间，但低级护理组以低援助水平进入住宿护理，这可能表明缺乏非正式护理和进入高级家庭的障碍关心。影响 更好地从低级别家庭护理过渡的选择，包括更及时地提供高级护理套餐，可能有助于痴呆症患者在家里呆得更久。