Incidence of Pressure Ulcers During Home and Institutional Care Among Long-Term Care Insurance Beneficiaries With Dementia Using the Korean Elderly Cohort

Abstract

Objective: To assess whether type of long-term care service is a risk factor of the incidence of pressure ulcers among older adults with dementia who are receiving long-term care insurance (LTCI).

Methods: Data from LTCI beneficiaries (benefit level 1 or 2) with dementia, aged 60 and older (n = 7841), in the Korean Elderly Cohort data set from 2008 to 2013 were used. Type of long-term care service was categorized into home or institutional care using the LTCI Claims Database. The National Health Insurance Claims Database was used to identify the incidence of pressure ulcers as the outcome variable in a survival analysis using the time-dependent Cox proportional hazard model.

Results: Of the 7841 participants, 98 (1.2%) exhibited pressure ulcers. Compared with beneficiaries receiving home care, those receiving institutional care had a higher adjusted hazard ratio for pressure ulcers (hazard ratio 6.48, 95% confidence interval 3.48-10.86). These associations were particularly strong among beneficiaries without pressure ulcers during the mandatory assessment for benefit eligibility and who were partially ambulatory.

Discussion: Beneficiaries receiving institutional care were more likely to have pressure ulcers than were those receiving home care. The government must monitor the quality of institutional long-term care services and encourage service providers to improve such care.

Keywords: Long-term care insurance; home care; institutional care; pressure ulcer; quality of care.