Heterogeneity in Longitudinal Healthcare Utilisation by Older Adults: A Latent Transition Analysis of the Irish Longitudinal Study on Ageing

Abstract

Background Older adults likely exhibit considerable differences in healthcare need and usage. Identifying differences in healthcare utilisation both between and within individuals over time may support future service development. Objectives To characterise temporal changes in healthcare utilisation among a nationally representative sample of community-dwelling older adults. Methods A latent transition analysis of the first three waves of The Irish Longitudinal Study on Ageing (TILDA) ( N = 6128) was conducted. Results Three latent classes of healthcare utilisation were identified, ‘primary care only’; ‘primary care and outpatient visits’ and ‘multiple utilisation’. The classes were invariant across all three waves. Transition probabilities indicated dynamic changes over time, particularly for the ‘primary care and outpatient visits’ and ‘multiple utilisation’ statuses. Discussion Older adults exhibit temporal changes in healthcare utilisation which may reflect changes in healthcare need and disease progression. Further research is required to identify the factors which influence movement between healthcare utilisation patterns.

Primary and secondary care service use and costs associated with frailty in an ageing population: longitudinal analysis of an English primary care cohort of adults aged 50 and over, 2006–2017

“…Associations between frailty and increased healthcare service use have previously been described, in general practice (GP) on-site appointments, remote consultations and physiotherapy contacts [ 5 ]; specialist outpatient clinic appointments, day surgery and emergency department visits [ 6 ]; help with meals or household duties, spending at least one night in a hospital or nursing home [ 7 ] and other community health and social care services [ 8 , 9 ]. Longitudinal latent class analysis of a small ageing cohort in Ireland identified different classes of primary and secondary healthcare utilisation for community-dwelling older people which transitioned over time to reflect changes in healthcare need, the drivers of which need further exploration and for which frailty may be a key factor [ 10 ]. Additional healthcare utilisation with increasing frailty severity is in turn associated with higher costs [ 11 , 12 ], mostly attributable to increases in hospital admissions and inpatient bed days.…”