Aging
Determinants of homecare use in old age: A meta-analysis of quantitative studies Afshin Vafaei* Afshin Vafaei Vafaei Vafaei Vafaei Vafaei Vafaei Western University
Background: Homecare services are essential for supporting older adults to age in place. A preceding systematic review revealed physical and social determinants influencing homecare utilization. This meta-analysis aimed to quantify the effect of those determinants, providing quantitative insight into barriers and safeguards pertaining to health service use in later life.
Methods: International data regarding homecare use and influencing determinants from 72 primary quantitative studies were imported onto review-managing software (RevMan). Pooled estimates of each factor and forest plots were generated for formal and informal homecare using DerSimonian-Laird random effect models and inverse-variance weighting in form or relative risks (RR) and corresponding 95% confidence interval (CI). I2 statistics were used to denote heterogeneity between studies.
Results: Effects of 17 identified homecare determinants in the systematic review evaluated in pooled meta-analyses. Overall, physical and social factors both significantly influenced formal homecare use, with physical factors exerting relatively stronger effects. Dementia was the strongest predictor (RR=2.77; 95% CI: 2.18-3.53), followed by older age (RR=1.78; 95% CI: 1.38-2.29), being unmarried (RR=1.78; 95% CI:1.42-2.22), and physical frailty (RR=1.74; 95% CI: 1.02-2.98). Social factors such as female sex and living alone were the only significant predictors of informal homecare.
Discussion: A complex interplay of physical conditions and social determinants of health influences homecare use patterns among older adults. Appreciating the protective or detrimental nature of these determinants is crucial for promoting healthier aging trajectories.