Formal home-care utilisation by older adults in Ireland: evidence from the Irish Longitudinal Study on Ageing (TILDA).

The aim of this study was to provide a population-based estimate of the utilisation of publicly financed formal home care by older adults in Ireland and to identify the principal characteristics of those utilising formal home care. Data were collected through computer-aided personal interviews from a representative sample of community living older adults in Ireland. The interviews were conducted between 2009 and 2011 as part of the first wave of the Irish Longitudinal Study on Ageing (TILDA). The study is cross-sectional in design and limited to participants aged 65 years and older (n = 3507). Results reveal that 8.2% (95% CI 7.1%-9.3%) of participants utilised publicly financed formal home care in the form of home help and/or personal care. Key determinants of formal home-care utilisation were Instrumental Activity of Daily Living (IADL) difficulty (Adj OR 3.8, 95% CI 2.7-5.3), older age (Adj OR 3.4, 95% CI 2.4-4.8) and living alone (Adj OR 2.6, 95% CI 1.9-3.8). Almost half of those utilising formal care did not self-report an Activity of Daily Living (ADL) difficulty or an IADL difficulty. Government policy aims to reduce the need for long-term residential care by providing formal home care for older adults with low to moderate levels of dependency. This requires an increasing emphasis on personal care provision in the home. No evidence was found in this study to suggest that a shift in emphasis from formal domestic to personal care is taking place in Ireland. The absence of standardised assessment and eligibility criteria are deemed to be barriers to reorientation of the system. From a health services perspective, the current situation is not sustainable into the future and requires a focused policy response.

Design and methodology of the Irish Longitudinal Study on Ageing.

OBJECTIVES: To provide comprehensive data on older people in Ireland and new insights into the causal processes underlying the aging transformation. DESIGN: The Irish Longitudinal Study on Ageing (TILDA) is a population-representative prospective cohort study with baseline assessment conducted between October 2009 and February 2011 and follow-up waves planned every 2 years. Participants were sampled in geographic clusters, with each member of the Irish population aged 50 and older having an equal probability of being invited to participate in the study. SETTING: Community-living population of the Republic of Ireland aged 50 and older. PARTICIPANTS: Eight thousand one hundred seventy-five participants aged 50 and older at time of interview participated in the study, along with 329 spouses or partners younger than 50. MEASUREMENTS: The Irish Longitudinal Study on Ageing includes detailed assessments of the mental and physical health and social and financial circumstances of participants, which are assessed in a home interview, a self-completion questionnaire, and a detailed health assessment that takes place at a dedicated health center or in the respondent's home. RESULTS: The response rate was 62.0%, with response rate varying according to educational attainment. Data from the first wave of data collection are available for researchers at the Irish Social Sciences Data Archive. CONCLUSION: The Irish Longitudinal Study on Ageing provides an opportunity to study the interactions between the health and social and economic circumstances of the older population in a nationally representative sample.

Comparison of centre and home-based health assessments: early experience from the Irish Longitudinal Study on Ageing (TILDA).

BACKGROUND: some cohort studies of ageing and health supplement questionnaire-based surveys with in-home measurements of biological parameters and others have required respondents to attend assessment centres. Centre-based assessments facilitate detailed measurements and novel technologies, but may differentially influence participation. The aim of this paper is to compare the characteristics of participants who attended a centre with those who chose a home assessment and those who did not have a health assessment. METHODS: trained field workers administered a computer-assisted personal interview (CAPI) to a random sample of community-dwelling people aged 50 and over in the participants' homes. All questionnaire respondents were invited to attend an assessment centre for a comprehensive physical assessment. Participants who refused or were unable to attend a centre were offered a home assessment. RESULTS: of the 291 participants who completed the CAPI, 176 had a health assessment: 138 in an assessment centre and 38 in their own home. The centre, home and no visit respondents differed in demographic characteristics, behavioural factors, physical functioning and health. Lower socio-economic status, physical inactivity and current smoking were the most robust predictors of non-participation in the health assessment. Home respondents had the highest levels of physical disability and were much weaker (grip strength) and slower (walking speed) than centre respondents. CONCLUSION: home and centre physical assessments are required to avoid systematically over-representing healthier and wealthier respondents.