Utilization and patterns of community healthcare services for senior residents in long-term care facilities in Taiwan: a nationwide study.

BACKGROUND: Community healthcare is one of the many important services used to care for the disabled elderly in aging societies. The aim of this study was to evaluate the utilization and patterns of community healthcare services used by senior residents in long-term care facilities (LTCFs) in Taiwan. METHODS: Secondary data analyses were conducted of the Taiwan National Health Insurance Research Database for 9338 LTCF senior residents receiving community healthcare services throughout the 2004 calendar year. The community healthcare services used by male and female LTCF senior residents were also compared by Chi-square testing. Descriptive statistics are used to present the patterns of professional visits and services by contracted healthcare facilities. RESULTS: About one-third of those senior residents living in LTCFs in Taiwan in 2004 received community healthcare services. Female residents received a higher percentage of community healthcare services than males in all age groups (p<0.001). Community home nursing care institutions provided 67% of healthcare visits and professional visits. Of those services provided to patients, the majority of the skilled nursing services were attributable to replacement of nasogastric tube (55%) and urinary catheter (38%). CONCLUSION: Whether or not the replacement of nasogastric tubes and urinary catheters among the LTCF senior resident population is an appropriate use of time and targeted medical resources needs further investigation. When addressing concerns about the community healthcare needs of senior residents of LTCFs, policymakers should carefully consider the current shortage of professional healthcare workers as they assess strategies to best meet the needs of the elderly in Taiwan.

Asymptomatic bacteriuria among the elderly residents of long-term care facilities in Taiwan.

BACKGROUND: asymptomatic bacteriuria (ASB) is common among the institutionalised elderly (IE). The cytokine levels and factors associated with ASB are unknown. OBJECTIVE: to analyse cytokines and factors associated with ASB among the IE living in long-term care facilities (LTCFs) in Taiwan. METHODS: this case-control study included residents ≥65 years in two LTCFs. The demographics, functional status, serum and urine levels of cytokines and proteins were compared between IE with ASB and those with sterile urine. Logistic regression was used to determine the factors associated with ASB. RESULTS: the IE with ASB had elevated IL-8 in blood and urine compared with the IE with sterile urine. The Barthel index score, serum creatinine, blood IL-8 and tumour necrosis factor-α levels were significant factors associated with ASB among the IE [odds ratio (OR) 0.957, 95% CI: 0.936-0.979, P < 0.0001; OR: 0.264, 95% CI: 0.076-0.912, P = 0.035 and OR: 1.088, 95% CI: 1.022-1.158, P = 0.009; OR: 0.828, 95% CI: 0.711-0.965, P = 0.016, respectively). CONCLUSION: functional status, renal function and blood cytokine levels were factors significantly associated with ASB among the IE living in Taiwan.

Home healthcare services in Taiwan: a nationwide study among the older population.

BACKGROUND: Home healthcare services are important in aging societies worldwide. The present nationwide study of health insurance data examined the utilization and delivery patterns, including diagnostic indications, for home healthcare services used by seniors in Taiwan. METHODS: Patients ≥65 years of age who received home healthcare services during 2004 under the Taiwanese National Health Insurance Program were identified and reimbursement claims were analyzed. Age, gender, disease diagnoses, distribution of facilities providing home healthcare services, and patterns of professional visits, including physician and skilled nursing visits, were also explored. RESULTS: Among 2,104,978 beneficiaries ≥65 years of age, 19,483 (0.9%) patients received 127,753 home healthcare visits during 2004 with a mean number of 6.0 ± 4.8 visits per person. The highest prevalence of home healthcare services was in the 75-84 year age group in both sexes. Females received more home healthcare services than males in all age groups. Cerebrovascular disease was the most frequent diagnosis in these patients (50.7%). More than half of home healthcare visits and around half of the professional home visits were provided by community home nursing care institutions. The majority of the home skilled nursing services were tube replacements, including nasogastric tubes, Foley catheter, tracheostomy, nephrostomy or cystostomy tubes (95%). CONCLUSIONS: Nine out of 1,000 older patients in Taiwan received home healthcare services during 2004, which was much lower than the rate of disabled older people in Taiwan. Females used home healthcare services more frequently than males and the majority of skilled nursing services were tube replacements. The rate of tube replacement of home healthcare patients in Taiwan deserves to be paid more attention.