Social factors influencing utilization of home care in community-dwelling older adults: a scoping review

Abstract

Background: Older adults want to live at home as long as possible, even in the face of circumstances that limit their autonomy. Home care services reflect this emergent preference, allowing older adults to 'age in place' in familiar settings rather than receiving care for chronic health conditions or ageing needs in an institutionalized setting. Numerous social factors, generally studied in isolation, have been associated with home care utilization. Even so, social circumstances are complex and how these factors collectively influence home care use patterns remains unclear.

Objectives: To provide a broad and comprehensive overview of the social factors influencing home care utilization; and to evaluate the influence of discrete social factors on patterns of home care utilization in community-dwelling older adults in high-income countries.

Methods: A scoping review was conducted of six electronic databases for records published between 2010 and 2020; additional records were obtained from hand searching review articles, reference lists of included studies and documents from international organisations. A narrative synthesis was presented, complemented by vote counting per social factor, harvest plots and an evaluation of aggregated findings to determine consistency across studies.

Results: A total of 2,365 records were identified, of which 66 met inclusion criteria. There were 35 discrete social factors grouped into four levels of influence using a socio-ecological model (individual, relationship, community and societal levels) and grouped according to outcome of interest (home care propensity and intensity). Across all studies, social factors consistently showing any association (positive, negative, or equivocal in pattern) with home care propensity were: age, ethnicity/race, self-assessed health, insurance, housing ownership, housing problems, marital status, household income, children, informal caregiving, social networks and urban/rural area. Age, education, personal finances, living arrangements and housing ownership were associated with home care intensity, also with variable patterns in utilization. Additional community and societal level factors were identified as relevant but lacking consistency across the literature; these included rurality, availability of community services, methods of financing home care systems, and cultural determinants.

Conclusion: This is the first literature review bringing together a wide range of reported social factors that influence home care utilization. It confirms social factors do influence home care utilization in complex interactions, distinguishes level of influences at which these factors affect patterns of use and discusses policy implications for home care reform.

Keywords: Community care; Formal care; Health care utilization; Home health care; Influencing aspects; Social support; Social vulnerability.

Fig. 1

Flowchart of study selection

Fig. 2

A socio-ecological model for social factors influencing utilization of home care in community-dwelling older adults. This model is meant to be dynamic in nature; factors can be added, removed, or moved to different levels of influence to suit the context

Fig. 3

Harvest plot summarizing consistency of evidence for individual level social determinants associated with home care propensity and intensity. Each social determinant is labelled on the left and each box represents one study. The number in the box corresponds to the study number in the references section. The social determinants are arranged in descending order based on counts of studies. The colour of the box indicates the study design (white = cohort, dark grey = secondary data analysis, light grey = secondary econometric analysis, dark blue = experimental, light blue = cross-sectional, pink = quality improvement). Where relevant, the x-axis is labelled with measures used to define the social determinant or to indicate a comparison group (denoted by vs.). The evaluation of aggregated findings is also summarized numerically in the right columns

Fig. 4

Harvest plot summarizing consistency of evidence for relationship level social determinants associatdc with home care propensity and intensity. Each social determinant is labelled on the left and each box represents one study. The number in the box corresponds to the study number in the references section. The social determinants are arranged in descending order based on counts of studies. The colour of the box indicates the study design (white = cohort, dark grey = secondary data analysis, light grey = secondary econometric analysis, dark blue = experimental, light blue = cross-sectional, pink = quality improvement). Where relevant, the x-axis is labelled with measures used to define the social determinant or to indicate a comparison group (denoted by vs.). The evaluation of aggregated findings is also summarized numerically in the right columns. HFSSM = Household food security survey module

Fig. 5

Harvest plot summarizing consistency of evidence for urban versus rural living and its association with home care propensity and intensity. Each box represents one study and the number in the box corresponds to the study number in the references section. The colour of the box indicates the study design (white = cohort, dark grey = secondary data analysis, light grey = secondary econometric analysis, light blue = cross-sectional). The x-axis is labelled with measures used to define the social determinant or to indicate a comparison group (denoted by vs.). The evaluation of aggregated findings is also summarized numerically in the right columns