Healthcare utilization, pharmacotherapy prescriptions, and clinical outcomes across a 5-year duration preceding and succeeding the initiation of home health care in a nationwide population-based cohort of 187,547 older adults with disabilities

Shih-Tsung Huang; Fei-Yuan Hsiao; Wei-Ju Lee; Ming-Yueh Chou; Chih-Kuang Liang; Chu-Sheng Lin; Ching-Hui Loh; Liang-Kung Chen

doi:10.1016/j.tjfa.2025.100063

Healthcare utilization, pharmacotherapy prescriptions, and clinical outcomes across a 5-year duration preceding and succeeding the initiation of home health care in a nationwide population-based cohort of 187,547 older adults with disabilities

J Frailty Aging. 2025 Jul 2;14(4):100063. doi: 10.1016/j.tjfa.2025.100063. Online ahead of print.

Authors

Shih-Tsung Huang¹, Fei-Yuan Hsiao², Wei-Ju Lee³, Ming-Yueh Chou⁴, Chih-Kuang Liang⁴, Chu-Sheng Lin⁵, Ching-Hui Loh⁶, Liang-Kung Chen⁷

Affiliations

¹ Department of Pharmacy, National Yang Ming Chiao Tung University, Taipei, Taiwan; Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.
² Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: fyshsiao@ntu.edu.tw.
³ Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, Yi-Lan, Taiwan.
⁴ Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Taiwan.
⁵ Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan.
⁶ Center for Aging and Health, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
⁷ Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Taipei Municipal Gan-Dau Hospital (Managed by Taipei Veterans General Hospital), Taipei, Taiwan. Electronic address: lkchen2@vghtpe.gov.tw.

PMID: 40608512
DOI: 10.1016/j.tjfa.2025.100063

Abstract

Background: Longitudinal trajectories of healthcare utilization, medication prescription, and clinical outcomes among older adults with disabilities receiving home healthcare (HHC) holds significance but remains elusive.

Methods: People aged≥65 years who newly received Taiwan's National Health Insurance funded HHC program from January 2005 to December 2013 were identified. Healthcare utilization, life-sustaining treatment, medication prescriptions (polypharmacy, psychotropics, anticholinergic burden and antibiotics), health status (Charlson's comorbidity index, CCI), and mortality were assessed over a 10-year period spanning 5 years before and after initiating HHC.

Results: Overall, 187,547 patients (80.6 ± 7.7 years, 51.2 % females, CCI 3+: 51.2 %) with a high prevalence of dementia (34.0 %), stroke (38.7 %), and pneumonia (49.5 %), and usage of life-sustaining treatment (urinary catheters: 82.8 % and nasogastric feeding: 78.7 %) were obtained. A sudden peak of admission rate at 1 year (91.7 %) before HHC, followed by the 70 % and 60 % admission rate in the first and second year after receiving HHC were found. Quarterly changes of using life-sustaining treatment showed significant increases from as early as 1 year prior to HHC. Gradual increases of polypharmacy, use of psychotropics, and antibiotic (4.5-fold and 3-fold) after HHC further demonstrated the complex needs (both p < 0.01). The 5-year cumulative mortality rate was 81 % (40 % in the first year with an annual rate of 25 %).

Interpretation: HHC recipients embody a confluence of complex care needs and high mortality risk, whereby various interventions aim to alleviate symptoms and sustain life. Engaging in proactive advanced care planning and end-of-life care should be prioritized when home healthcare is being contemplated.

Keywords: Antibiotic; Healthcare utilization; Home healthcare; Mortality; Polypharmacy.