Use of professional home care in persons with spinal cord injury in Switzerland: a cross-sectional study.

BACKGROUND: Persons with spinal cord injury (SCI) living in the community often require care. The boundaries between professional home care and informal care are blurred, and it is unclear who the typical user of home care is. The objective of this study was to describe the characteristics of persons with SCI using professional home care in Switzerland, determine the frequency of home care visits, and investigate the association of sociodemographic factors, SCI-specific characteristics, secondary health conditions, and functional independence with the use of home care. METHODS: We used cross-sectional data from the 2017 community survey of the Swiss Spinal Cord Injury Cohort Study (SwiSCI). Out of 3,959 eligible individuals 1294 completed the questionnaire and were included in the analysis (response rate 33%). Using descriptive statistics, differences between home care users and non-users as well as the frequency of home care visits were investigated. The association between sociodemographic factors, SCI-specific characteristics, secondary health conditions, functional independence and the use of home care was analyzed using multivariable logistic regression. Multiple imputation was used to account for missing data. RESULTS: Of 1,294 participants, 280 (22%) used professional home care. The median weekly professional home care duration was 6 h (Q1 = 2, Q3 = 12). More home care was used in persons with lower functional independence (Odds ratio (OR) 0.30 per 10 unit decrease in the Spinal Cord Independence Measure, 95%-Confidence interval (CI) 0.24-0.37), fewer secondary health conditions (OR 0.96 per unit Spinal Cord Injury Secondary Conditions Scale, 95%-CI 0.94-0.99), tetraplegia (OR 2.77, 95%-CI 1.92-4.00), women (OR 2.42, 95%-CI 1.70-3.43), higher age (OR 1.22 per 10 years increase, 95%-CI 1.06-1.39), living alone (OR 2.48, 95%-CI 1.53-4.03), and those receiving support from an informal caregiver (OR 1.88, 95%-CI 1.27-2.77). CONCLUSIONS: This is the first study to examine the use of professional home care from the perspective of persons with SCI in Switzerland. Lower functional independence strongly predicts increased home care use. The findings showed that professional home care complements informal care and is more likely to be used by individuals with SCI who live alone, have tetraplegia, and are female.

Comparison of older patient's self-care abilities in acute geriatric and internal medicine departments.

BACKGROUND: There is ongoing controversy whether patients show better functional outcomes when care is provided in acute geriatric (AG) or internal medicine (IM) departments. OBJECTIVE: This study compared the recovery of acutely ill patients concerning activities of daily living (ADL) and instrumental activities of daily living (IADL). MATERIAL AND METHODS: A total of 274 patients (≥70 years old, 67 in AG, 207 in IM) were included consecutively (AG intervention) or data were obtained (IM comparison) in a Swiss hospital with 2 locations. The ADL/IADL data were collected 14 days before admission (t1, retrospectively), on admission (t2), at discharge (t3), and 30 days after admission (t4). This study consisted of a prospective study with a longitudinal quasi-experimental design. RESULTS: The AG patients had a significantly higher probability to gain independence in mobility (between t2/t3, P = 0.008), grooming of the lower body (between t2/t3, P = 0.037) and defecation (between t2/t4, P < 0.001). The IM patients were significantly more independent in IADL at t4 (all P < 0.05) except for meal preparation. The odds for nursing home admission in AG with dependency at t1 were significantly lower in every ADL (all P < 0.05) and with shopping in IADL (P = 0.008). CONCLUSION: This study shows a positive effect of AG compared to IM in self-care with a lower probability for nursing home admission. There is need for further education and research to improve outcomes in older hospitalized patients.

Age at Onset of Spinal Cord Injury is Associated with Increased Inpatient Care Needs, Reduced Independence at Discharge and a Higher Risk of Institutionalization after Primary Inpatient Rehabilitation.

OBJECTIVE: To investigate the influence of age at onset of spinal cord injury on length of stay, inpatient therapy and nursing hours, independence at discharge and risk of institutionalization. DESIGN: Retrospective cohort study. PARTICIPANTS: A total of 250 patients with a newly acquired traumatic or non-traumatic spinal cord injury undergoing primary inpatient rehabilitation in a Swiss spinal cord injury specialized clinic between 2017 and 2019. METHODS: Multiple regression analysis was used to determine if age, in addition to clinical characteristics (co-morbidities, secondary complications and spinal cord injury severity), affects inpatient rehabilitation parameters (length of stay, daily nursing hours and daily therapy hours), independence at discharge (Spinal Cord Independence Measure III) and place of discharge (private residence vs institution). RESULTS: Chronological age correlated with the number of co-morbidities and secondary complications. Older age was associated with increased daily nursing care and reduced independence at discharge. However, both were also influenced by co-morbidities, secondary complications and severity of spinal cord injury. Length of stay and daily therapy hours were age-independent. Odds for institutionalization after discharge increased significantly, by 1.03-fold per year of age. CONCLUSION: Age at onset of spinal cord injury predicted inpatient nursing care, independence at discharge and the risk of institutionalization after primary inpatient rehabilitation. Co-morbidities, secondary complications and severity of spinal cord injury were also important influencing factors.