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The aims of this study were to examine health status, utilization of medical and long-term care services, and to explore the important factors in individual factors of predisposing factors, enabling factor, and need factors to affect the utilization of medical and long-term care services in veterans and their family members.
This dataset retrieved from the study program of “Long-term Care Need Assessment “ by National Public Health College in 2002 in Taiwan. Of the 1,344 disabled veterans and their family members who were older than 65 years old, 1,132 of them from the community and 212 from institutions. 69.7% of the sample was male, and mean age was 77.7 years old.,SD was 6.5.45.2% of them were junior high school or higher level of education. 60.1% of them were married and lived with spouses, and 84.5% of them had one or more kids.
The study results indicated that 39.2% of the sample was with cognitive impairment. The mean number of chronic conditions by self-reporting was 2.46. 53.9% of them had hypertension; 33.3% of them had heart disease; and 34.7% of them had arthritis. 9.8% of the sample was at least one tube. 33.5% of them were either cognitive impairement or IADLs(Instrumental Activities of Dialy Living) impairment. 20.1% of them were disabled with 1-2 items ADLs(Activities of Daily Living) impairment; 12.1% of them were disabled with 3-4 items ADLs impairment; 34.4% of them were disabled with 5-6 items ADLs impairment. The results related to the utilization of medical and long-term care service were shown that 76.1% had received out-patient medical services in last one month. 43.4% had received in-patient medical services in last one year. 33.6% had received emergency medical service in last one year. 17.3% had received dentist out-patient medical serviced in last half year. 22.7% had received home aid assistant care in last one year. 19.0% had received long-term institutional care in last one year. 15.9% had received rehabilitation care in last one year.
Multiple logistic regression analyses were used to explore the important factors affecting the utilization of medical care services. The number of type of chronic conditions was the significantly important factor to affect the utilization of out-patient medical services in last one month. Compared to the group with 0-1 type of chronic conditions, the group with 2-3 types (OR=1.99, 95% CI= 1.48 -2.67) and the group with more than 4 types (OR=4.19,95% CI=2.70 -6.52) of chronic conditions had more opportunity (odds ratio) to use out-patient medical services in last one month. Number of chronic conditions, level of dependency, and at least one tube were important factors to affect the utilization of in-patient medical services in last one year. Compared to the group with 0-1 type chronic conditions, and the group with 2-3 types (OR=1.42,95% CI=1.07-1.89), the group with more than 4 types (OR =3.19, 95% CI=2.25-4.53) of chronic conditions had more opportunity (odds ratio) to utilize in-patient medical services. Compared to the groups with cognitive and IADLs impairment only, 1-2 items ADLs impairment (OR=1.71, 95% CI=1.23-2.38), and 3-4 items ADLs impairment (OR=1.62, 95% CI=1.09-2.41), the group with 5-6 items ADLs impairment (OR=2.14, 95% CI=1.53-3.00) had more opportunity (odds ratio) to hospitalize last year. At least one tube (OR= 2.34, 95% CI=1.51-3.61) had more opportunity (odds ratio) than no tube to be hospitalized last year. Care arrangements, number of chronic conditions, level of dependency, and tube insertion were statistically significant factors to affect the utilization of emergent medical services in last year. Compared to the group with institutional care, the group with care by family members (OR= 2.32, 95% CI=1.46-3.69) had more opportunity (odds ratio) to use emergent medical care. Compared to the group with 0-1 type chronic conditions, and the group with 2-3 types of diseases (OR=1.47,95% CI=1.07-2.02), the group with more than 4 types (OR=2.96, 95% CI=2.05-4.26) of chronic conditions had more opportunity (odds ratio) to use emergent medical care. Compared to the group with cognitive and IADLs impairment only and 3-4 items ADLs impairment (OR= 1.68, 95% CI=1.11 -2.56), the group with 5-6 items ADLs impairment (OR=2.06, 95% CI= 1.45 - 2.95) had more opportunity (odds ratio) to use emergent medical care. The subjects with tube insertion (OR=2.00, 95% CI=1.30 -3.08) had more opportunity (odds ratio) than the subjects without tube to use emergent medical care. Age, number of chronic conditions, and level of dependency are statistically significant factors to affect the utilization of dentist out-patient medical services in last half year. Compared to the groups with 65-70 years old, the groups with 75-84 years old (OR=0.68, 95% CI=0.49-0.93) and older than 85 years old (OR= 0.47,95% CI=0.28-0.78) had less opportunity (odds ratio) to use dentist services. Compared to the group with 0-1 type chronic condition, the groups with 2-3 types (OR=1.55,95% CI= 1.06-2.27) and more than 4 types (OR=1.73, 95% CI= 1.01-2.73) of chronic conditions had more opportunity (odds ratio) to use dentist services. Compared to the group with cognitive and IADLs impairment only, the group with 5-6 items ADLs impairment (OR= 0.60, 95% CI=0.39-0.92) had less opportunity (odds ratio) to use dentist services. The subjects with tubes (OR= 0.45, 95% CI=0.21-0.94) had less opportunity (odds ratio) to use dentist services than those without tube.
The results related to the important factors affecting the utilization of long-term care services by using multiple logistic regression found that level of education, number of kids, marital status, cognitive impairment, level of dependency, tube insertion were statically significant factors to affect the utilization of long-term institutional services in last year. Compared to the group with illiteracy, the group with junior high school or higher level (OR=9.7, 95% CI=5.68-16.57) had more opportunity (odds ratio) to use long-term institutional services. Compared to the group without kid, the groups with 1-2 kids (OR=0.14, 95% CI=0.08-0.25) and more than 3 kids (OR= 0.06, 95% CI=0.03-0.10) had less opportunity (odds ratio) to use long-term institutional services. Compared to the group lived without spouse, the group lived with spouse (OR=0.44, 95% CI=0.29-0.67) had less opportunity (odds ratio) to use long-term institutional services. Compared to the group without cognitive impairment, the group with cognitive impairment (OR=3.20, 95% CI=2.16-4.67) had more opportunity (odds ratio) to use the services. Compared to the group with either cognitive or IADLs impairment only, the subjects with 3-4 items ADLs impairment (OR=2.05, 95% CI=1.04-4.02), and 5-6 items ADLs impairment (OR=4.62, 95% CI=2.68-7.95) had more opportunity (odds ratio) to use it. The subjects with tube insertion (OR=3.05, 95% CI=1.78-5.22) had more opportunity (odds ratio) than the subjects without tube to use it. Age, level of education, and number of chronic diseases were statistically significant factors to affect the utilization of rehabilitation services in last year. Compared to the group with 65-70 years old, the groups with 75-84 years old (OR=0.64, 95% CI=0.45-0.91), and older than 85 years old (OR= 0.34, 95% CI=0.18 -0.65) had less opportunity (odds ratio) to use it. Compared to the group with illiteracy, the group with junior high school or higher (OR=1.64, 95% CI=1.05 -2.57) had more opportunity (odds ratio) to use it. Compared to the group with 0-1 type chronic condition, the group with more than 4 types of chronic conditions (OR=1.65, 95% CI=1.01-2.71) had more opportunity (odds ratio) to use it. Gender, level of education, number of kids, marital status, residential area, cognitive impairment, level of dependency, and tube insertion were important factors to affect the utilization of home aid assistant services in last year. Male (OR= 0.46,95% CI=0.31-0.68) had less opportunity (odds ratio) than female to use it. Compared to the group with illiteracy, the group with junior high school or higher (OR=2.58, 95% CI=1.67-3.99) had more opportunity (odds ratio) to use it. Compared to the group without kid, the group with 1-2 kids (OR=0.43, 95% CI=0.22-0.84) had less opportunity (odds ratio) to use it. Compared to the group lived without spouse, the group lived with spouse (OR=0.35, 95% CI= 0.24 -0.51) had less opportunity (odds ratio) to use it. Compared to the group resident in urban, the group resident in county (OR=1.56,95% CI=1.03-2.37) and the group resident in megalopolitan (OR=2.03,95% CI=1.22-3.39) had more opportunity (odds ratio) to use it. Compared to the group without cognitive impairment, the group with cognitive impairment (OR=0.64, 95% CI=0.45-0.90) had less opportunity (odds ratio) to use it. Compared to the group with either cognitive or IADLs impairment only, the groups with 1-2 items ADLs impairment (OR=2.80, 95% CI=1.67-4.71), 3-4 items ADLs impairment (OR=4.32, 95% CI=2.44-7.65), and 5-6 items ADLs impairment (OR=8.23, 95% CI=5.10 -13.28) had more opportunity (odds ratio) to use it. The subjects with tube insertion (OR=2.25, 95% CI=1.27-3.97) had more opportunity (odds ratio) to use it than the subjects without tube.
In summary, the medical care services utilization was influenced by need factor such as cognitive impairment, number of chronic conditions, and level of dependency. In addition to the needs factor, predisposing characteristic (i.e., gender, and the level of education) and enabling factors (i.e., number of kids, marital status, and residential area) were important factors to affect the utilization of long-term care services. These findings provided important information for the Taiwan Veterans Affairs and related organizations to plan the medical and long-term care policy for veterans and their family members or elderly people in Taiwan.
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