Predictors of self-reliance of older people with a chronic illness receiving home- care: A Prognostic Study

Abstract

Background Most older people wish to remain living at home as long as possible. Being able to perform daily activities and self-reliance are important conditions for older people to achieve this. Evidence regarding predictors of self-reliance in chronically ill older people receiving home-care is lacking. Aims The primary objective is to determine the predictors of self-reliance of patients with a chronic illness receiving home-care at six months follow-up. The secondary objective is to compare characteristics of patients with a chronic illness receiving home-care at six months follow-up, with those who are completely independent and do not receive home-care anymore. Methods A prognostic study with six months follow-up. Patient information regarding demographics, nursing diagnosis, amount of care, nurses and unplanned hospitalization were extracted from electronic patient files, used by a large long- term care organization in the east of the Netherlands. Multiple logistic regression analysis was performed to determine predictors of self-reliance. Results In total, data was collected from 216 patients, of which 127 patients were independent at six months follow-up. Four factors appear to predict self-reliance. Male (Odds Ratio (OR):1,411[95%Confidence Interval (CI):0,78-2,57]), number of actual nursing diagnosis (OR:0,80[95%CI:0,68-0,94]), problems in the psychosocial domain (OR:1,65[95%CI:0,89-3,05]) and problems in the physiological domain (OR:6,95[95%CI:1,54-31,23]) Conclusions The number of nursing diagnosis is the strongest predictor, reducing the chance of self-reliance after six months, followed by problems in the physiological and psychological domain. Being male seems to increase the chance of self-reliance. Recommendations More research is needed to understand which patient-characteristics, -problems and social circumstances influence self-reliance among older people with a chronic illness receiving home-care. Subsequently, interventions can be recommended to stimulate home-care that focusses on improving self-reliance of older people.