Risk of Functional Decline Resulting in Institutionalization and Home Health Care after Acute Hospitalizations of Older Persons in Norway

Background: Population ageing and strained public resources challenge the future provision of health and care services. We assess the uptake of formal health-related care services (FCS), either home health care (HHC) or short- or long-term institutional care (IC), before and after an acute hospital admission in a full-population sample of older persons. Methods: Multinominal logistic population average regression models were applied to Norwegian registry data on older persons (aged 75+) in 2021 (N=68,803) at hospital discharge following admission for select diagnoses (N=94,748) to examine how functional status (for FCS users) and comorbidities (for non-FCS users), acute hospital admissions and sociodemographic characteristics interact to influence HHC and IC within 4 weeks and at 6 months post-discharge. Results: Altogether, 53% of the sample were already recipients of FCS at the time of the acute event, 43% in HHC and 10% in IC. Overall, the shares increased to 33% for IC and decreased to 29% for HHC 4 weeks post-discharge. At 6 months, the respective shares were 14 and 35%. Among HHC recipients at hospital admission, 44% transitioned to IC within 4 weeks. At 6 months, the share had declined to 21%. Multivariate models showed that transitions into and within FCS were associated with older age, female sex, comorbidities/functional status and living alone. Trauma, cerebrovascular and geriatric conditions were substantially associated with subsequent FCS uptake, and especially IC. Short-term IC transitions were more common among HHC-users than non-HHC-users. In terms of moderating factors, larger differences were observed by living situation as opposed to sex and functional status/comorbidity. Conclusions: Irrespective of prior FCS uptake, acute hospital admissions influence subsequent FCS uptake, especially for trauma, cerebrovascular and geriatric conditions. Minor variations across sociodemographic characteristics suggest need-based, equitable service provision. The mode (HHC vs IC) and temporality of FCS uptake warrants further research to identify policy measures that may improve care trajectories to ensure sustainable, safe, and high-quality care and rehabilitation following acute hospitalizations of older individuals. Clinical practice and future research should include hospital frailty measures to improve predictions of future FCS needs, particularly for persons unknown to the FCS system pre-hospitalization.