Home sweet home? Exploring equality in the use of home care services and the potential to prevent adverse health outcomes

Research problem and specific questions: More and more older adults live in their own homes rather than in institutions. To support those in need of care, Sweden has one of the most comprehensive home care systems in the world. Despite this, there is growing concern about unmet care needs, especially in vulnerable population groups.

The proposed project aims to i) describe patterns of social and medical home care utilization among older adults in the total population and in vulnerable groups; ii) identify inequities in care utilization; iii) examine whether inequitable access to care is associated with adverse outcomes; and iv) increase our understanding of how access to care could be improved.Data and method: This mixed-methods project includes four consecutive studies.

Studies I-III are population-wide register studies drawing on unique data of older adults in Stockholm County.

Descriptive statistics, multivariable regression, and quasi-experimental approaches are used to describe the utilization of care, to identify inequities in the population, and to explore the association between care utilization and adverse health outcomes. These outcomes include fall injuries, emergency department visits, and hospitalizations.

Study IV is a qualitative study exploring barriers to care utilization through semi-structured interviews with older adults.Societal relevance and utilization: Population ageing is one of the greatest societal challenges of our time, and older individuals increasingly live longer with multiple chronic diseases.

In order to maintain a high quality of care for every person in need, it is of utmost importance to distribute resources in the best way possible.

A thorough description of which types of elder care are provided, to what extent, and to whom is important knowledge for both policy makers and for research on ageing.

There is potential to prevent negative health outcomes and thus to improve older people’s quality of life, to prevent suffering, and to save resources in the ageing welfare state.Plan for project realization: Building on prior expertise with most registers and methods used in this project, I will analyze quantitative data stored at Karolinska Institutet.

In the Unit of Epidemiology, I am supported by colleagues with thorough knowledge of developing and applying epidemiological methods.

The qualitative study will be conducted together with experienced primary care clinicians working with older adults in Stockholm.