Characteristics and hospitalization of people living with dementia after home healthcare: A nationwide cohort study

The need for home healthcare (HHC) is increasing among people living with dementia (PLWD) to achieve their desire to age. This study aimed to investigate the determinants of hospitalization among PLWD receiving HHC. This retrospective cohort study used data from the National Health Insurance Research Database of Taiwan from 2007 to 2017. The primary outcome was subsequent hospitalization after HHC for PLWD. Using multivariate Poisson regression, baseline and follow-up HHC-related characteristics were examined as covariates and influencing factors. A total of 95,831 PLWD received HHC (mean age: 80.2 years), and 81.7% had at least one subsequent hospitalization during the follow-up period. Regarding baseline characteristics, prior admission was the strongest determinant of subsequent hospitalization, especially being admitted three to six months before HHC use (aRR = 1.47, 95% confidence interval [CI] 1.39-1.56, P < .001), followed by dementia duration from diagnosis to index date more than 3.5 years (aRR = 1.22, 95% CI 1.19-1.24). Among HHC-related characteristics, a higher frequency of HHC visits (more than 2 counts/month) (aRR = 4.81, 95% CI 4.63-5.00) and visits by both physicians and nurses (aRR = 2.03, 95% CI 1.98-2.07) were associated with a higher risk of hospitalization. Our findings suggest that prior admission, longer dementia duration from diagnosis to the index date, and frequency of HHC were positively associated with increased hospitalization. Future interventions and strategies can focus on these factors to decrease hospitalization among PLWD receiving HHC.