Activities of daily living trajectories among institutionalised older adults: A prospective study.

AIMS AND OBJECTIVES: To examine activities of daily living trajectory groups among older residents in Taiwan, and to determine the relative risks of demographic characteristics and health status in explaining the trajectory group of activities of daily living. BACKGROUND: Activity of daily living is a crucial indicator of health status for institutionalised older adults. activities of daily living is a dynamic process and has differences in trajectory groups. DESIGN: This study was a 3-year longitudinal analysis of long-term care facility residents in Taiwan. METHODS: A total of 364 older residents completed the entire research process. We used group-based trajectory modelling and multinomial logistic models for statistical analysis. RESULTS: The result of this study revealed that three activities of daily living trajectory groups among older residents exhibited high dependency with gradually declining function (Group 1, 22.53%), low dependency with gradually declining function (Group 2, 43.13%) and persistent independent function (Group 3, 34.34%). Compared with Group 3, Group 1 was related to the following potential risk factors: older age, female, nonmainland China born and a married status. After considering resident health status in the analysis, three significant factors emerged for Group 1: the number of chronic diseases (odds ratio = 2.45), depressive symptoms (odds ratio = 1.71) and cognitive status (odds ratio = 83.11). Compared with Group 3, Group 2 was related to older age. After adding resident health status to the analysis, two significant factors of Group 2 emerged: the number of chronic diseases (odds ratio = 1.68) and depressive symptoms (odds ratio = 1.74). CONCLUSION: The findings of this study indicated that health factors, including the number of chronic diseases, cognitive status and depressive symptoms, were more likely to contribute to the development of a decline pattern of activities of daily living. RELEVANCE TO CLINICAL PRACTICE: Appropriate exercise programmes and physical activities, according to residents' personal characteristics and activities of daily living status, is crucial for improving physical functioning, alleviating depression and cognitive defects in institutionalised older adults.

Use of a mobile device by nursing home residents for long-term care comprehensive geriatric self-assessment: a feasibility study.

Long-term-care comprehensive geriatric assessments, such as the Minimum Data Set 3.0, are used to evaluate the clinical, psychological, and personal status of residents in long-term-care nursing facilities. Nursing staff conducts assessment interviews, thereby increasing the workload of nurses and the cost of patient care. This study explored the ability of nursing home residents to use two different mobile devices for a geriatric self-assessment. Study participants were residents of long-term-care nursing homes. A modified Minimum Data Set 3.0 was converted to a format for use with a 6-inch mobile pad and a 3.7-inch mobile smartphone. The survey completion rate and the response time were measured. A Technology Assessment Model questionnaire analyzed the participants' experience. All participants were able to use a 6-inch pad, with an average completion rate of 92.9% and an average time for completion of 21 minutes. Only 20% of the participants could complete the assessment with the 3.7-inch smartphone. The participants found the 6-inch pad easier to use than the 3.7-inch smartphone. This exploratory study suggests that nursing home residents are able to use a mobile device to perform a geriatric self-assessment and delineates the importance of the ergonomics of the device.

Surgeon volume for percutaneous nephrolithotomy is associated with medical costs and length of hospital stay: a nationwide population-based study in Taiwan.

BACKGROUND AND PURPOSE: To investigate the factors associated with outcomes and medical costs for percutaneous nephrolithotomy (PCNL). METHODS: The present study uses a subset of the National Health Insurance Research Database (NHIRD), known as the Longitudinal Health Insurance Database 2005 (LHID 2005), which contains the data of all medical benefit claims from 1997 to 2010 for a subset of 1 million enrollees randomly drawn from the population of 22.72 million persons who were enrolled in 2005. The claims data for all subjects with a diagnosis of urolithiasis who underwent PCNL were analyzed. Hospital and surgeon case volume were classified by quartile. The correlations of all patient, surgeon, and hospital variables with the outcomes and medical costs of PCNL were analyzed by generalized estimating equations. RESULTS: A total of 995 subjects received PCNL. In univariate analysis, PCNL performed by high-volume surgeons (≥12) cost 26% less ($2684 vs $1986) and resulted in a 34.3% shorter hospital stay (6.5 vs 9.9 days) compared with low-volume surgeons (≤3). In multivariate analysis, surgeon volume was a significant predictor for medical cost, length of stay, and intensive care unit transfer but not complications and mortality. CONCLUSIONS: Surgeon volume was associated with lower medical costs and shorter length of stay after PCNL. Surgeon volume, however, was not an independent predictor of complications and mortality. Our findings have important implications for urologists and policymakers with regard to the cost and effectiveness of PCNL.

Factors related to the time to cryptorchidism surgery--a nationwide, population-based study in Taiwan.

BACKGROUND/PURPOSE: Current guidelines recommend that the optimal timing for cryptorchidism surgery is by the age of 12 months. This study investigated the trend of surgical timing and examined the factors associated with time to surgery for cryptorchidism in Taiwan by using a nationwide, population-based database. METHODS: The present study utilized the Longitudinal Health Insurance Database 2005, a subset of the National Health Insurance Research Database, which contains data on all paid medical benefit claims over the period 1997-2007 for a subset of 1 million beneficiaries randomly drawn from 22.72 million individuals enrolled in the National Health Insurance program in 2005. We analyzed the timing of surgery in boys younger than 18 years with diagnosis of cryptorchidism. RESULTS: We identified 547 boys who underwent surgery under 18 years of age. Approximately 79.2% of study participants received surgery after the age of 12 months. A multivariate analysis showed that several factors were significantly associated with time to surgery: age of the physician making the diagnosis, age of the surgeon performing the surgery, age of the patient at the first diagnosis of cryptorchidism, and number of previous clinic visits with the diagnosis of cryptorchidism and urbanization level of the patient's residence. CONCLUSION: A surprisingly high rate (79.2%) of all study participants underwent surgery beyond the optimal timing. Certain doctor and patient factors were associated with time to cryptorchidism surgery. Improving the alertness and education of parents and specialists may lead to earlier surgeries.

Sphincter-preserving surgery for rectal cancer: a population-based study in Taiwan.

BACKGROUND/AIMS: Sphincter-preserving surgery (SPS) has been considered a surrogate for surgical quality for rectal cancer. This study aims to assess its rate for rectal cancer between centers and over time in Taiwan. METHODOLOGY: Data from 1997 to 2006 on patients undergoing sphincter-preserving surgery (anterior resection or AR) and proctectomy with colostomy (abdominoperineal resection or APR) were extracted from a national health insurance database. Hierarchical logistic regression was used to identify independent factors associated with SPS. RESULTS: Data on 19,919 patients were analyzed. Among them, 12,164 (61%) received AR and 7,755 (39%) underwent APR at total of 115 centers. Multifactorial analysis revealed higher SPS rates with female gender (p<0.001) and patients paying higher insurance premiums (p=0.005). Higher APR rates were seen in those receiving surgery at metropolitan hospitals (p=0.001) and hospitals outside higher volume regions (Taipei City and North, p≦0.005). For hospitals with initial low surgical volumes, significant improvement of SPS rate was found (p<0.001) with increasing volume over the study period. CONCLUSIONS: The disparity due to sphincter loss in rectal cancer between hospitals of various regions and levels narrowed in Taiwan. Characteristics of hospital (level, region, volume) and patient (gender, premium level) influenced SPS rate.

Predicting functional decline of older men living in veteran homes by minimum data set: implications for disability prevention programs in long term care settings.

OBJECTIVE: To evaluate the risk and protective factors for functional decline of veteran home residents in Taiwan to develop disability prevention programs in long term care settings. DESIGN: A prospective cohort study. SETTING: Two veteran homes in Taiwan. PARTICIPANTS: A total of 1045 residents of veteran homes. INTERVENTION: None. MEASUREMENTS: Minimum data set (MDS), resident assessment protocols (RAP), MDS-COGS, Resource Utilization Group-III Activities of Daily Living scale, MDS Social engagement scale, MDS Pain scale. RESULTS: A total of 1045 (83.0 ± 5.1 years, all men) residents completed the study, and 11.3% of them developed significant functional decline during the study period. Participants with long-term institutionalization history (odds ratio [OR] 2.966, confidence interval [CI] 1.270-6.927), underlying cerebrovascular disease (OR 4.432, CI 1.994-9.852) and dementia (OR 2.150, CI 1.029-4.504), and higher sum of RAP triggers (OR 1.366, CI 1.230-1.517) were more likely to develop functional decline, whereas those who had better social engagement were significantly protective from functional decline (OR 0.528, CI 0.399-0.697). CONCLUSIONS: Cerebrovascular disease, dementia, higher sum of RAP triggers, and long-term institutionalization were independent risk factors for functional decline, whereas better social engagement had a protective effect on functional dependence. Further study is needed to develop an integrated disability prevention program based on the discoveries of this study.

Factors associated with delayed pediatric hypospadias surgery in Taiwan: a population-based, nationwide analysis.

BACKGROUND/PURPOSE: Current guidelines recommend that hypospadias repair should be performed before age 18 months. This study aims to investigate the trends of surgical timing and to determine what factors are associated with age at surgery. METHODS: The present study utilized a subset of the National Health Insurance Research Database, known as Longitudinal Health Insurance Database 2005, which contains the data of all paid medical benefit claims over the period from 1997 to 2007 for a subset of one million beneficiaries randomly drawn from the population of 22.72 million individuals in NHI program during any part of calendar year 2005. We analyzed claims data for all subjects with the diagnoses of hypospadias. RESULTS: Among 52,705 live male newborns, 218 were diagnosed with hypospadias and thus were included as subjects in our study. Among them, 89 received repair surgery. Approximately 60.6% of the study subjects received repair after the age of 18 months. Multivariate analysis showed that several factors were significantly associated with age at hypospadias surgery: specialty of clinics where first diagnosis was made; specialty of physician making the first diagnosis, age of physician making the first diagnosis; specialty of surgeon performing the surgery; number of years since surgeon's board certification; urbanization level of subject's residence; modality of surgery; concomitant cryptorchidism; concomitant prematurity and low birth weight; age at diagnosis; and number of well-baby clinic visits. CONCLUSION: This study addresses an important issue of delayed hypospadias surgery in Taiwan, which provides a potential opportunity for improvement in quality of care.

Epidemiology of upper urinary tract stone disease in a Taiwanese population: a nationwide, population based study.

PURPOSE: We investigated the epidemiology of upper urinary tract stone disease in Taiwan using a nationwide, population based database. MATERIALS AND METHODS: This study was based on the National Health Insurance Research Database of Taiwan, which contains data on all medical beneficiary claims from 22.72 million enrollees, accounting for almost 99% of the Taiwanese population. The Longitudinal Health Insurance Database 2005, a subset of the National Health Insurance Research Database, contains data on all medical benefit claims from 1997 through 2010 for a subset of 1 million beneficiaries randomly sampled from the 2005 enrollment file. For epidemiological analysis we selected subjects whose claims records included the diagnosis of upper urinary tract urolithiasis. RESULTS: The age adjusted rate of medical care visits for upper urinary tract urolithiasis decreased by 6.5% from 1,367/100,000 subjects in 1998 to 1,278/100,000 in 2010. There was a significantly decreasing trend during the 13-year period in visits from female and all subjects (r(2) = 0.86, p = 0.001 and r(2) = 0.52, p = 0.005, respectively). In contrast, an increasing trend was noted for male subjects (r(2) = 0.45, p = 0.012). The age adjusted prevalence in 2010 was 9.01%, 5.79% and 7.38% in male, female and all subjects, respectively. The overall recurrence rate at 1 and 5 years was 6.12% and 34.71%, respectively. Male subjects had a higher recurrence rate than female subjects. CONCLUSIONS: Our study provides important information on the epidemiology of upper urinary tract stone disease in Taiwan, helping to quantify the burden of urolithiasis and establish strategies to decrease the risk of urolithiasis.

Pediatric urolithiasis in Taiwan: a nationwide study, 1997-2006.

OBJECTIVE: To investigate the prevalence, incidence, associated risk factors, and treatment of pediatric urolithiasis in Taiwan. METHODS: The present study used a subset of the National Health Insurance Research Database, known as the Longitudinal Health Insurance Database 2005, which contains the data for all paid medical benefit claims from 1997 to 2006 for a subset of 1 million beneficiaries randomly drawn from the population of 22.72 million individuals during any part of the calendar year 2005. Our analysis included the data of all newly diagnosed pediatric patients with an "International Classification of Disease, 9th revision," diagnosis of urolithiasis from 1997 through 2006. RESULTS: A total of 1679 pediatric subjects who had newly diagnosed urolithiasis without a previous attack were identified from 1997 to 2006 as the study sample. Of the 1679 patients, 808 were boys (48.1%) and 871 were girls (51.9%). The incidence rate of urolithiasis in 2005 was 0.047%. The peak age of pediatric stone occurrence in the study sample was 15-18 years (49.6%). The most common associated disease was urinary tract infection (34.1% of all subjects). The occurrence rate of pediatric urolithiasis correlated significantly with the urbanization level of the residence and geographic area. CONCLUSION: Using a nationwide, population-based study provides important clinical and epidemiologic information regarding pediatric urolithiasis. Additional studies are warranted to determine the effect of geographic area and urbanization level on the occurrence of pediatric stone disease.

How complex documentation with Personal Digital Assistants could be?

The researchers have demonstrated that the PDA could be used for complex documentation and well accepted by users. This study examined whether the researchers could make the PDA system still keep great usability when the contents of information were requested to increase from 262 to 513 questions. Two independent convenience samples from the Veterans Medical Care system in Taiwan and the questionnaire designed based on Technology Acceptance Model were used in this study. Results showed that mobile device such as PDA could still be used for complex documentation with 513 assessment questions, designed with a set of effective screen interface design principles. This is encouraging for the mobile health because its success depends on the use of mobile devices.

Design and development of interface design principles for complex documentation using PDAs.

The screen interface has been believed to be the major barrier for the adoption of PDAs in healthcare. The study objectives were to design a set of screen interface design principles for complex documentation using PDAs and to examine nurses' perception of the ease of use and usefulness of the application. A 21-page Chinese version of the interRAI MDS-HC home-care assessment tool composed of more than 250 assessment questions was used for the application. A WiFi Palm-based PDA was used. A convenience sample of 60 subjects, primarily nurses newly trained to use the MDS-HC assessment tool, were invited to evaluate the PDA system in terms of Davis' Technology Acceptance Model. The final information structure of the PDA application consisted of 18 categories composed of 262 questions over 63 screens. Subjects could move to any assessment question in less than two taps without a memory burden and finish the question in one tap. Respectively, close to 95% and 93% of the subjects agreed that, overall, the system was easy to use and useful for their work. We conclude the screen interface challenge for complex documentation using PDAs can be improved and managed to achieve to a very high usability.

Screening cognitive impairment among institutionalized older Chinese men in Taiwan: a new minimum data set-based dementia screening tool is needed.

Dementia screening is of great importance in various health settings for older people, long-term care facilities are no exception. The need for an effective dementia screening tool being culture sensitive is important. Minimum data set (MDS) is a population instrument for health care management in the world, which also covers dementia screening. The main purpose of this study was to evaluate the effectiveness of the MDS-based dementia screening tools among older Chinese men in the Veteran Home in Taiwan. Overall, 576 participants (mean age: 80.9±5.3 years, all males, 92.7% physically independent), 18.6% had cognitive impairment according to the mini-mental state examination (MMSE) (mean score: 26.7±3.9). However, the prevalence of cognitive impairment was 5.5% by MDS cognitive performance scale (CPS) and 18.9% by MDS cognition scale (MDS-COGS). The screening results of CPS and MDS-COGS were highly interrelated (γ=0.93, p<0.001), and MMSE scores were also significantly associated with CPS and MDS-COGS status (γ=-0.50, p<0.001 and γ=-0.52, p<0.001, respectively). Although the prevalence of cognitive impairment by MMSE and MDS-COGS are similar, the results are significantly inconsistent (p<0.001). In conclusion, both MDS-COGS and CPS were significantly correlated with MMSE scores, but significant inconsistence was noted between screening results of MMSE, CPS and MDS-COGS. Further study is needed to develop MDS-based dementia screening tools for older Chinese men in Taiwan.

Screening depression among institutionalized older Chinese men by minimum data set: we need a new instrument.

OBJECTIVE: To compare the effectiveness of the Minimum Data Set-based Depression Rating Scale (MDS-DRS) and Geriatric Depression Scale (GDS) in screening depression among older institutionalized Chinese men living in Taiwan. METHOD: MDS Nursing Home 2.1 Chinese version, Mini-Mental State Examination (MMSE), and short form Geriatric Depression Scale (GDS-15) were used among elderly residents in Banciao Veterans Home. Screening results of MDS-DRS and GDS-15, and relationship between 16 MDS Mood and Anxiety symptoms and depression were evaluated. RESULTS: The prevalence of depression defined by MDS-DRS and GDS were 0.2% and 8.7%, respectively. Multiple logistic regression disclosed that E1a (OR: 12.9, 95% CI: 2.8-58.8, p = 0.001), E1k (OR: 15.6, 95% CI: 5.6-43.5, p < 0.001), and E1l (OR: 22.2, 95% CI: 6.1-83.3, p < 0.001) were all independent associative factors for GDS-defined depression but only explained 51.9% of all depressive subjects. CONCLUSIONS: The effectiveness of MDS-DRS is limited, and a new MDS-based depression screening instrument is needed.

Who determines the rehabilitation needs of care home residents? An observational survey.

Determining the rehabilitation needs is of great importance in long-term care setting, but the perception of rehabilitation needs may vary extensively between service provider and recipients. The purpose of this study was to assess the differences between the self-perceived and carer-evaluated rehabilitation needs among care home residents. Data of Longitudinal Older Veterans (LOVE) study were sorted for study. Overall, this study enrolled 581 (mean age=80.9±5.4 years) male participants. Among them, 539 (92.8%) were physically independent, and 463 (79.7%) were cognitively intact. Of these participants, 367 (63.2%) believed they would be physically improved by certain rehabilitation services, but only 57 (9.8%) residents were considered to have rehabilitation potential by their carers. Over half of physically dependent, but only 16.7% of physically independent residents were considered to have positive rehabilitation potential by their carer. Similarly, carers considered that residents with cognitive deficits were more likely to be improved by rehabilitation (24.6% vs. 6.0%, p<0.001) but cognitively intact residents considered themselves more likely to benefit from rehabilitation (67.6% vs. 45.8%, p<0.001). In conclusion, a significant disagreement in rehabilitation potential was noted between residents' self-perception and carer assessment. Residents with physical dependence and intact cognition may be more likely to receive rehabilitation. An intervention study is needed to develop practice guidelines to provide cost-effective rehabilitation for care home residents.

Predicting mortality of older residents in long-term care facilities: comorbidity or care problems?

OBJECTIVE: Accurate prediction of life expectancy in long-term care facilities (LTCFs) is important, but previous studies emphasized demographic characteristics, disease diagnosis, or comorbidity. The purpose of this study was to evaluate the roles of geriatric care problems and comorbidity in predicting 12-month mortality in LTCFs. DESIGN: Prospective, observational. SETTING: Veterans Care Home. PARTICIPANTS: Residents of Banciao Veterans Care Home. MEASUREMENTS: A minimum data set (MDS) was implemented, and resident assessment protocol (RAP) triggers were collected as geriatric care problems. Comorbidity of the residents was evaluated using Charlson's comorbidity index (CCI). RESULTS: A total of 559 residents (mean age = 80.9 ± 5.3 years, all males) were successfully followed, and 50 residents (7.9%) died during the study period. Compared with survivors, deceased subjects had a higher sum of RAP triggers (4.9 ± 2.0 versus 4.1 ± 2.0, P = .004) and CCI (1.2 ± 1.2 versus 0.7 ± 0.9, P = .014), and were more likely to be hospitalized (1.6 ± 1.9 versus 0.4 ± 0.9, P < .001) and visit the emergency department (0.9 ± 1.2 versus 0.5 ± 1.2, P = .012). Moreover, deceased subjects were more prone to have cognitive loss, urinary incontinence, and behavioral symptoms than survivors (P all < .05). A Cox proportional hazards model showed that both CCI (HR = 1.44, 95% CI: 1.13-1.82, P = .003) and the sum of RAP triggers (HR = 2.03, 95% CI: 1.08-3.82, P = .028) were significantly associated with 12-month mortality. CONCLUSION: Independent of comorbidity, the sum of geriatric care problems is a significant predictor of 12-month mortality in a veterans care home. Further intervention studies are needed to evaluate whether elimination of these care problems can improve survival in the long-term care setting.

Inpatient rehabilitation utilization for acute stroke under a universal health insurance system.

OBJECTIVE: To explore the population-level utilization and factors associated with the use of inpatient stroke rehabilitation services under a single-payer government-based National Health Insurance (NHI) program in Taiwan. STUDY DESIGN: Retrospective cohort study based on claims data. METHODS: Inpatients with stroke were sampled from a nationally representative cohort of 200,000 NHI program enrollees. Multiple inpatient claims for individuals were merged to create a patient-level file; the first-ever admission was considered the index stroke. Proxy indicators to represent stroke severity, comorbidity, and complications were constructed. Predisposing, need, and enabling characteristics associated with rehabilitation use were explored. RESULTS: Among 2639 identified patients with stroke from January 1, 1997, to December 31, 2002, the overall inpatient rehabilitation utilization was 34.0% (33.0% for physical therapy, 19.6% for occupational therapy, and 5.3% for speech therapy). Stroke type and stroke severity were immediate causes of rehabilitation use. Except in neurology wards, rehabilitation use was unaffected by physician or facility characteristics. Among 898 patients receiving rehabilitation services, the median number of treatment sessions was 8 (interquartile range, 4-19), and the total rehabilitation costs were US $114.00 (interquartile range, $47.80-$258.30), with a mean (SD) length of stay of 22.2 (21.8) days. CONCLUSIONS: In a setting in which ability to pay is neutralized, inpatient stroke rehabilitation service in this universal NHI program was equitable but inadequate relative to use elsewhere or estimated need. Less severe case mix and financial or human resources constraints might partially account for the low utilization. Further studies measuring stroke severity and functional status are needed to clarify the actual utilization, requirements, and cost-effectiveness of inpatient stroke rehabilitation services.

Dementia care costs and the patient's quality of life (QoL) in Taiwan: home versus institutional care services.

Organizing optimal care for demented older people is a complex health care issue. Controversies of service models for demented patients should be balanced between cost of care, placement, and quality of life (QoL). The main purpose of this study was to explore the optimal model of dementia care in Taiwan by evaluating the care cost, patients' QoL and healthcare settings. Overall, 140 pairs of demented patients and their primary informal caregivers were enrolled (89 community-living and 51 institute-living). Compared to institute-living subjects, community-living subjects were significantly better in cognition, physical function and QoL. The annual direct cost of institutional care was significantly higher than community care (464,193 New Taiwanese Dollar (NTD) vs. 144,047 (NTD), p<0.001), but indirect cost was significantly higher in home care (287,904 NTD vs. 35,665 NTD, p<0.001). The care cost of home care subjects with low physical dependence was significantly lower than institutional care subjects, but the care cost of home care subjects with high physical dependence was significantly higher than institutional care subjects. Physical dependence was the significant determinant of QoL for demented patients in this study. In conclusion, demented patients with low physical dependence may be cared in the communities with support and those who had high physical dependence may be cared in the institutes in terms of the balance of QoL and the care cost.

Validation of EQ-5D in patients with cervical cancer in Taiwan.

PURPOSE: The survival rate of cervical cancer is increasing due to early diagnosis and timely treatment. As a result, the availability of a valid and reliable general HRQoL is important. The purpose of this study was to evaluate the psychometric properties of the EuroQol questionnaire (EQ-5D) in patients with cervical cancer in Taiwan. METHOD: Outpatients with cervical cancer were recruited from three medical centers across Taiwan. Test-retest reliability and ceiling effect were evaluated. Construct validity including convergent and discriminate validities were examined using the EORTC QLQ C-30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire) and the clinical indicators of the functional performance assessment using the Karnofsky Performance Scale (KPS) and disease status. RESULTS: A total of 530 patients completed the questionnaire. The intraclass correlation coefficient for the EQ-5D index was 0.83, and the Cohen's kappa values for the EQ-5D dimensions ranged from 0.54 to 0.73. The EQ-5D index and VAS scores were higher for patients with a higher KPS score and disease-free status. The EQ-5D index was strongly correlated with all EORTC QLQ-C30 functioning scales. CONCLUSION: The EQ-5D questionnaire is reliable and valid for the assessment of health-related quality of life in patients with cervical cancer in Taiwan.

Pain and health-care utilization among older men in a veterans care home.

Pain is a common health-care issue, and the prevalence increases with advancing age. Although it is often assumed that people with chronic pain are associated with a higher consumption of health care, evidence supporting this assertion is insufficient. Data from the Longitudinal Older VEterans (LOVE) study were stratified to explore the prevalence of pain and its relationship with health-care utilization. In total, data from 574 residents (mean age: 80.9+/-5.4 years, all male) were obtained. Among them, 92.8% were physically independent and 20.2% of them had mild to moderate cognitive impairment. Overall, 153 (26.3%) subjects reported pain; 114 (74.5%) subjects with mild pain and the remaining 39 (25.5%) subjects with moderate pain. The most commonly reported pain was lower back pain (40.5%, 62/153), which was followed by joint pain (29.4%, 45/153). Subjects with pain were more likely to have higher scores on the Geriatric Depression Scale (2.4+/-2.4 vs. 1.8+/-2.2, p = 0.023) and care-complexity problems (4.7+/-2.0 vs. 3.9+/-1.9, p < 0.001), despite being similar in age (81.3+/-5.0 vs. 80.8+/-5.5, p = 0.271), cognitive status and physical independence. Compared with pain-free subjects, subjects with pain were more likely to be hospitalized in the 12-month study period (0.71+/-1.20 vs. 0.46+/-1.00, p = 0.010), but the utilization of emergency department treatment (1.74+/-1.23 vs. 1.88+/-1.63, p = 0.560) was not statistically significant. In conclusion, the prevalence of pain among residents in a Taiwanese veterans care home was 26.3%; subjects with pain having more depressive symptoms, higher clinical-care complexity, and more likely to be hospitalized during the 12-month follow-up.