Predictors of 15-year transitions across living and care settings in a population of Swedish older adults

Abstract

Objective We aimed to investigate the association of sociodemographic, clinical and functional characteristics with the volume of transitions and specific trajectories across living and care settings. Methods Using data from the Swedish National Study on Aging and Care in Kungsholmen study, we identified transitions across home (with or without social care), nursing homes, hospitals and postacute care facilities among 3021 adults aged 60+. Poisson and multistate models were used to investigate the association between sociodemographic, clinical and functional characteristics and both the overall volume and hazard ratios (HRs) of specific transitions. Results Over 15 years, 720 (23.8%) participants experienced between 5 and 10 transitions, and 816 (26.7%) experienced >10 transitions across living and care settings. A higher number of transitions was observed in older participants with multimorbidity and slower walking speed. In contrast, cognitive impairment and disability were associated with a lower number of transitions. After hospital and postacute discharge, each additional year of age (HR range 1.06–1.08) and being a woman compared with being a man (HR range 1.35–4.38) increased the likelihood of discharge to home care. Multimorbidity (HR range 1.14–1.23) and slow gait speed (HR range 1.11–1.50) increased the risk of hospitalisation and home care after hospital discharge. Cognitive impairment raised the hazard of nursing home placement (HR range 1.99–2.15). Disability was associated with a higher hazard of nursing home placement after hospital discharge (HR range 2.57–3.07). Conclusions Accounting for older adults’ whole journey across living and care settings, we identified transition-specific predictors and potential triggers that could be timely leveraged to better tailor care to older adults’ needs.