- Title
- Modelling trajectories of aged care use among older Australian women
- Creator
- Rahman, Md Mijanur
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2020
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Background: A substantial growth in the number of older people needing care has raised enormous challenges to the health and social care system in many countries including Australia. The structure and dynamics of the Australian aged care system are not yet able to develop a sustainable system for delivering an appropriate model of care. The current aged care system is complex and older Australians experience multifaceted journeys through the fragmented systems to meet their care needs. Research evidence is limited about how different parts of the system intersect and how an individual transitions from one level of care to another in accordance with changing needs over time. There is also a lack of understanding of how individual and social circumstances and supports might predispose older people to use care, or enable them to use appropriate care when they need it. To fill these knowledge gaps, this study aims to assess patterns and trajectories of different types of aged care use over time and to examine the movements of older women between different levels of aged care use according to their changing needs and circumstances throughout later life. Methods: This study utilised data from the older cohort (born between 1921-26) of the Australian Longitudinal Study on Women’s Health and linked aged care and National Death Index data from 2001 to 2014. The sample consisted of 11,245 women who survived to 2001 and did not opted out of linkage of survey data to aged care information. To address the research objectives, we applied the following statistical methods: 1) k-median cluster analysis to assess patterns of home and community care use; 2) repeated measures latent class analysis to identify latent patterns of aged care use over time; 3) competing risk survival analysis to identify risk factors for the time from first home and community care (HACC) use to residential aged care (RAC) admission; 4) multi-trajectory modelling to assess the trajectories of care need in RAC; and 5) Markov multi-state modelling to estimate the transition rates and probabilities, and length of stay at each level of aged care use. Results: The results reveal a significant diversity in the patterns of HACC use, with a majority of older women living at home independently, requiring only low-level use of a few basic services, while one quarter have complex care needs requiring greater use of multiple services. Women were most likely to enter aged care by first using HACC. Significant variation in the latent patterns of aged care use was also observed, with around two-thirds of women not using any services or using a limited basic community care services until age 85-90. Only a small proportion of women were increasingly dependent on RAC as they age. Having complex use of HACC was associated with delayed admission to RAC, after adjusting for individual characteristics. Substantial variation was observed among residents in RAC in terms of the trajectories of care needs over time across three domains of the Aged Care Funding Instrument including activities of daily living, behaviour, and complex healthcare needs. Multiple morbidities were associated with membership of an increased complex healthcare needs group. Transition to either HACC or RAC was associated with several demographic and health-related factors including living in regional/remote areas, having difficulties in managing income, having low scores in physical functioning, and having falls with injury. Conclusion and Implication: Women spend a substantial period of their later life with care and support from either HACC or RAC. Our findings highlight the importance of providing a range of services to meet the diverse care needs of older women, especially in the community setting. Our findings can facilitate appropriate care planning, service delivery, and future capacity design of the aged care system in Australia.
- Subject
- older women; home and community Care; residential aged care; data linkage; cohort study; modelling; Australia; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1411949
- Identifier
- uon:36406
- Rights
- Copyright 2020 Md Mijanur Rahman
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 6 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 454 KB | Adobe Acrobat PDF | View Details Download |