Health Services/Policy
Determinants of Homecare Use in Older Adults: a Systematic Review and Meta-analysis of Quantitative Studies Afshin Vafaei* Afshin Vafaei Marie Y. Savundranayagam Susan Phillips Maria C. Tavares Lauren Bal
Background: Homecare services are essential for supporting older adults to age in place, yet social disparities in their utilization reveal the need for a deeper understanding of the factors that drive homecare needs and use. The aim of this study is to identify health and social determinants of homecare use in older adults.
Methods: Following PRISMA, we conducted a systematic review (Jan 1, 2000 to April 10, 2024) of quantitative peer-reviewed epidemiologic studies among adults older than 65. The main inclusion criteria were incorporation of a form of homecare as an outcome and inclusion of at least one physical or social determinant. Studies focusing on individuals in long-term care or other institutional settings were excluded. Abstract and full-text screenings were performed in duplicate followed by extraction of data on homecare use and quantitative effect estimates of determinants.
Results: After abstract review of 7342 citations and 1177 full-text reviews, 61 articles met our inclusion criteria (figure 1). Physical ability, marital status, gender, and social isolation identified as the main determinants of homecare use. Ethnic minorities, despite greater needs often encountered obstacles in accessing homecare.
Next steps: Extracted quantitative data on effects estimates of determinants of homecare use (in form of RR or OR along with 95% CI) will be pooled by construction of DerSimonian-Laird random-effect models with inverse-variance weighting and heterogeneities between-studies will be quantified by I2 statistic.
Conclusions: Preliminary findings from the systematic review highlight significant social disparities in homecare access across various population groups. By addressing these gaps, this research will provide valuable insights for policymakers and healthcare providers to develop more equitable and effective homecare policies including facilitating aging in place.
