台湾长期护理

Determinants of Long-Term Care Services among the Elderly:A Population-Based Study in TaiwanChen-Yi Wu1,2,Hsiao-Yun Hu1,3,Nicole Huang3,4,Yi-Ting Fang5,6,Yiing-Jeng Chou1*,Chung-Pin Li7,8*1Institute of Public Health,National Yang-Ming University,Taipei,Taiwan,2Department of Dermatology,Taipei City Hospital,Heping Fuyou Branch,Taipei,Taiwan, 3Department of Education and Research,Taipei City Hospital,Taipei,Taiwan,4Institute of Hospital and Health Care Administration,National Yang-Ming University, Taipei,Taiwan,5Institute of Health and Welfare Policy,National Yang-Ming University,Taipei,Taiwan,6Universal Eye Center,Taoyuan Branch,Taiwan,7Division of Gastroenterology,Department of Medicine,Taipei Veterans General Hospital,Taipei,Taiwan,8National Yang-Ming University School of Medicine,Taipei,TaiwanAbstractObjectives:The aim of the study was to investigate determinants of long-term care use and to clarify the differing characteristics of home/community-based and institution-based services users.Design:Cross-sectional,population-based study.Setting:Utilizing data from the2005National Health Interview Survey conducted in Taiwan.Participants:A national sample of2,608people(1,312men,1,296women)aged65and older.Measurements:The utilization of long-term care services(both home/community-and institution-based services)was measured.A x2analysis tested differences in baseline characteristics between home/community-based and institution-based long-term care users.The multiple-logistic model was adopted with a hierarchical approach adding the Andersen model’s predisposing,enabling,and need factors sequentially.Multiple logistic models further stratified data by gender and age.Results:Compared with users of home/community-based care,those using institution-based care had less education (p=0.019),greater likelihood of being single(p=0.001),fewer family members(p=0.002),higher prevalence of stool incontinence(p=0.011)and dementia(P=.025),and greater disability(p=0.016).After adjustment,age(compared with 65–69years;75–79years,odds ratio[OR]=2.08,p=0.044;age$80,OR=3.30,p=0.002),being single(OR=2.16,p=0.006), urban living(OR=1.68,p=0.037),stroke(OR=2.08,p=0.015),dementia(OR=2.32,p=0.007),1–3items of activities of daily living(ADL)disability(OR=5.56,p,0.001),and4–6items of ADL disability(OR=21.57,p,0.001)were significantly associated with long-term care use.Conclusion:Age,single marital status,stroke,dementia,and ADL disability are predictive factors for long-term care use.The utilization was directly proportional to the level of disability.Citation:Wu C-Y,Hu H-Y,Huang N,Fang Y-T,Chou Y-J,et al.(2014)Determinants of Long-Term Care Services among the Elderly:A Population-Based Study in Taiwan.PLoS ONE9(2):e89213.doi:10.1371/journal.pone.0089213Editor:Gianluigi Forloni,‘‘Mario Negri’’Institute for Pharmacological Research,ItalyReceived September18,2013;Accepted January17,2014;Published February19,2014Copyright:ß2014Wu et al.This is an open-access article distributed under the terms of the Creative Commons Attribution License,which permits unrestricted use,distribution,and reproduction in any medium,provided the original author and source are credited.Funding:This study was supported by the Taiwan Ministry of Education through its‘‘Aim for the Top University Plan,’’and by Taiwan’s National Science Council through Grant98-2314-B-010-015-MY2.The funders had no role in study design,data collection and analysis,decision to publish,or preparation of the manuscript.Competing Interests:The authors have declared that no competing interests exist.*E-mail:yjchou@.tw(YJC);cpli@.tw(CPL)IntroductionThe escalating growth of the elderly population in Taiwan and worldwide is of increasing concern.This population,defined as individuals aged65years or older,is projected to increase from 11%of the population in2010to20%by2025,with Taiwan becoming an aged nation according to World Health Organiza-tion(WHO)criteria[1].The elderly,making up6.9%–12.0%of the global population,have a higher incidence of chronic disease, and,as such,the aging population will present a higher prevalence of functional disability,subsequently leading to a greater utilization of long-term care services[2].Such services are often required from onset of the condition for the remaining lifetime,making it of great important to better understand the factors associated with long-term care use to provide appropriate care and alleviate the societal burden caused by population aging.In Taiwan,over97%of health care is covered by the National Health Insurance(NHI);however,this does not include long-term care insurance.Although the NHI reimburses some home-care nursing services,recipients of such care must be severely disabled to qualify[3].Nine per1,000elderly patients in Taiwan reportedly received home-care services in2004,a rate much lower than the proportion of disabled older people in Taiwan[1].For the severely disabled and for low-income families,there are some extended home services provided by the Departments of Health or Social Welfare of local governments.Table1.Characteristics of the study population.Variables Total population Male Female p(N=2,608)(n=1,312;50.3%)(n=1,296;49.7%)%%%Predisposing factorsAge(mean,95%CI)74(73.7–74.3)74.1(73.7–74.5)74(73.6–74.4)0.364 Age(years)65–6932.215.416.80.073 70–7427.313.813.575–7922.612.510.1$8018.18.69.4Education level(years)Illiteracy(0)33.57.426.1,0.001 1–6years43.825.917.9$7years22.717 5.7Smoking27.225.4 1.8,0.001 Alcohol consumption20.216.5 3.7,0.001 BMI a(2,603persons),18.5(underweight) 6.4 2.8 3.60.00318.5–25(normal)55.629.925.8$25(overweight)38.117.620.4Enabling factorsMarital statusSingle35.910.925,0.001 Married/cohabiting64.139.424.7Family membersNo family members9 4.6 4.40.185 1–349.125.623.5$441.920.121.8Household monthly income(NTD),30,00050.925.9250.563 30,000–69,99929.214.814.4$70,00010.8 5.5 5.3Missing data9.1 4.15ResidenceUrban4725.927.10.198 Non-urban5324.422.6Need factorsGeriatric conditionsUrine incontinence23.87.816,0.001 Stool incontinence7.6 3.3 4.30.099 Chronic diseasesHypertension42.42022.40.017 Diabetes17.17.49.70.004 Hyperlipidemia21.99.9120.021 Stroke7.24 3.10.137 Heart disease19.28.910.30.096 Cancer 2.6 1.3 1.30.885 Dementia 4.4 1.6 2.80.008 Hearing problems18.49.58.90.526 Vision problems 5.4 3.1 2.30.117Due to the heterogeneity of chronic diseases and disability, varying types of services are needed in long-term care.Long-term care can be roughly classified into two types:home/community-based and institution-based care.Elderly people’s disability status is reportedly the main factor driving the demand for long-term care services[4].For example,cognitive impairments and reduction in activities of daily living(ADL)are key predictors of institutionalization[5,6].Further,home-visit nursing services utilization is lower when elderly people have no caregivers or are from low income households[7].In Taiwan,old age,cognitive impairment,and functional disabilities are key predictors of the need for formal care,just as observed in Western countries[8]. However,most studies have focused on either home or institu-tional care[7,9–14];few have investigated simultaneous utilization of institutional and home/community care[15,16].Van Campen et ed a multinomial model to analyze the use of long-term care packages in Netherlands[16].But when close substitutes were noted among long-term care services,the independence of irrelevant alternatives assumption of the multinomial model was considered violated[15].Meijer et al.investigated long-term care utilization using an ordered response model that assumed the hierarchical ordering of long-term care services[15].However, with no long-term care insurance and limited publicly financed long-term care in Taiwan,choice of long-term care services depended on individuals’preferences related to both socio-economic and need factors.Because these two factor types are not mutually exclusive,the multinomial and ordered response models were inappropriate analyses.Further descriptive data and investigations of different characteristics of care users may provide better insight into long-term care utilization distributions. Some claims-based data do not include patient-reported factors, such as living environment,geriatric conditions,or functional disability,and therefore may overlook information important for assessing the true state of the elderly.For example,informal care may potentially substitute for formal home care and generally postpones long-term care use[17].Co-residence status is associated with age,and was used as a proxy for informal care availability[18].Among the elderly,geriatric conditions are similar in prevalence to chronic diseases[19].Thus,information about individual situations is very important in investigations of long-term care use.Given improved data availability,we investigated the determinants of long-term care use and sought to clarify differences in the characteristics of home/community-based and institution-based service users.Materials and MethodsData Sources and SamplesThe data for this population-based study were obtained from the National Health Interview Survey(NHIS)conducted in2005 in Taiwan.NHIS participants were selected from the Taiwanese population using a multistage,stratified,systematic sampling design by geographic location and degree of urbanization.All individuals selected were interviewed by well-trained personnel using standardized questionnaires.A proxy participant was interviewed if the participant was unable to answer the questions. The NHIS data are available for public use and can be accessed at .tw.A total of24,726persons completed the survey,of whom2,727individuals were aged65years or older;the overall response rate was80.6%.Some participants were excluded due to missing data,and therefore we analyzed data from2,608 (95.4%)elderly people.The data were weighted to achieve a nationally representative sample.Participants’identification num-bers were encrypted before the data were released for research purposes,ensuring that no participants could be identified.The survey complied with the Declaration of Helsinki,and received the approval of the institutional review board of the National Yang-Ming University(IRB No.101003).Outcome VariableLong-term care services consisted of publicly or privately financed care,and were classified into home/community-based and institution-based services.The former included formal domestic care,personal care,and home nursing care as well as temporary day care or community respite care,while the latter included admissions to residential or nursing homes.Residential homes provide assistance with domestic tasks,whereas nursing homes provide personal and nursing care.Because the survey question was‘‘Did you ever use these long-term care services in the past year?’’we could not differentiate whether the services were publicly or privately financed;further,as anticipated,home/ community-based and institution-based services were not mutually exclusive.Independent VariablesAndersen’s Behavioral Model was used to investigate the associations between individual factors between long-term care services[20].Variables were classified into predisposing,enabling, and need factors.Table2.Characteristics of the study population according to different long-term care use.Variables Non long-term care user Long-term care user(n=179,6.9%)PHome/community-based Institution-based(n=2,429,93.1%)(n=123,4.7%)(n=68,2.6%)n%n%n%Predisposing factorsAge(mean,95%CI)73.673.3–73.879.177.7–80.678.376.4–80.20.252 Age65–69years82133.81512.157.70.264 70–74years67827.92218.11420.475–79years54322.423192131.1$80years38615.96250.82840.8GenderFemale1,19549.27560.93551.50.203 Male1,23450.84839.13348.6Education levelIlliteracy78732.455453551.80.019 1–6years1,08844.83225.82536.7§7years55422.83629.3811.5Smoking67127.62419.21623.30.514 Alcohol consumption51721.37 5.54 6.20.957 BMI*,18.5(underweight)137 5.61411.41421.50.19218.5–25(normal)1,35655.966543147$25(overweight)93238.44334.72131.5Enabling factorsMarital statusSingle82233.87157.55580.20.001 Married/cohabiting1,60766.25242.51319.8Family membersNo family members2209.13 2.61115.80.002 1–31,20749.75343.22638.3$41,00241.36754.23145.9Household monthly income(NTD)*,30,0001,25151.55141.83247.40.882 30,000–69,999705293931.82029.9$70,00026110.81512811.6Missing data2118.71814.5811.1ResidenceUrban112746.46955.74058.80.671 Non-urban1,30253.65544.42841.3Need factorsGeriatric conditionsUrine incontinence51621.26754.34566.80.116 Stool incontinence128 5.34234.33652.40.011 Chronic diseasesHypertension1,00941.66754.83551.70.691 Diabetes39316.23427.62130.50.636 Hyperlipidemia53121.93125.41015.30.091 Stroke126 5.23730.22841.80.121Predisposing factors.The predisposing factors we included were age,gender,education level,smoking(yes/no),current alcohol consumption(yes/no),and body mass index(BMI).Age was categorized as65–69,70–74,75–79,and$80years; education level as illiteracy,1–6years education,and$7years education;and BMI(based on WHO criteria)as,18.5kg/m2 (underweight),18.5–24.9kg/m2(normal),and$25kg/m2(over-weight).Enabling factors.The enabling factors were marital status, co-residence with family members,household monthly income, and residence.Marital status was categorized as single or married/ cohabiting;co-residence with family members as0,1–3,and$4 family members;household monthly income as,30,000,30,000–69,999,and$70,000NTD(1USD=30NTD);and residence as either urban or non-urban.Need factors.The need factors were self-reported geriatric conditions,chronic diseases,visiting a hospital emergency room in the past year,hospitalization in the past year,and disability status. Geriatric conditions included urine or stool incontinence.Chronic diseases were physician-diagnosed diseases including hypertension, diabetes,hyperlipidemia,stroke,heart disease,cancer,dementia, hearing problems,and vision problems.A history of visiting the emergency room or hospitalization in the past year was used as proxies of disease severity.ADL measured the difficulty in performance on six activities:eating,bathing,dressing,using the toilet,getting in or out of bed,and walking indoors[21].The Instrumental Activities of Daily Living(IADL)measured the difficulty in performance on eight activities:cooking,buying groceries,operating a telephone,taking medications,household chores,laundering,cleaning the house,and managing personal finances[22].According to the measured items in difficulty of performing each activity of ADL or IADL,disability status was then categorized as no disability,IADL disability only,1–3items of ADL disability,and4–6items of ADL disability.Statistical AnalysisUsing a x2analysis,we examined differences in baseline characteristics between home/community-based and institution-based long-term care users.Andersen model was incorporated in the multiple logistic models,with hierarchical approach by added predisposing,enabling,and need factors sequentially.The outcome of the multiple logistic regression models was utilization of long-term care(home/community-based and institution-based). Multiple logistic models were further stratified by gender and age. All analyses were conducted using SAS9.1(SAS Institute Inc., Cary,NC)and STATA10.0(StataCorp LP,College Station,TX) and incorporated the weighted procedures used in the NHIS sampling design.ResultsParticipant CharacteristicsParticipants’characteristics(n=2,608;age$65years; Male=50.3%,Female=49.7%)are shown in Table1.There were significant gender differences in education level(p,0.001), smoking(p,0.001),alcohol consumption(p,0.001),BMI (p=0.003),marital status(p,0.001),existence of urine inconti-nence(p,0.001),hypertension(p=0.017),diabetes(p=0.004), hyperlipidemia(p=0.021),dementia(p=0.008),and disability level(p,0.001).Characteristics by Long-term Care Service TypeTable2presents participant characteristics grouped by non-long-term care users,and long-term care user(including both home/community-and institution-based care).During the year preceding assessment,123individuals(4.7%)used home/commu-nity-based services(home care,n=22;paid caregiver,n=98,[82 non-Taiwanese caregivers and16Taiwanese caregivers];nursing care,n=13;day care,n=2;respite care,n=3),and68persons (2.6%)used institution-based pared with users ofTable2.Cont.Variables Non long-term care user Long-term care user(n=179,6.9%)PHome/community-based Institution-based(n=2,429,93.1%)(n=123,4.7%)(n=68,2.6%)n%n%n% Heart diseases46819.325209130.22 Cancer62 2.57 5.600Dementia58 2.43326.72942.70.025 Hearing problems41817.24234.11927.90.378 Visions problems131 5.47 5.579.80.243 Visiting ER in the past year44718.46452.32739.60.102 Hospitalized in the past year39716.35645.63247.60.839 DisabilityNo disability1,506621512.6913.10.016 IADL disability only69828.71814.74 6.11–3items of ADL disability133 5.52217.74 6.14–6items of ADL disability93 3.868555174.7?*Missing4BMI data in non long-term care user;Missing2BMI data in institution user.BMI:Body mass index;NTD:New Taiwan dollar;ER:emergency room;IADL:instrumental activities of daily living;ADL:activities of daily living.doi:10.1371/journal.pone.0089213.t002home/community-based care,those who used institution-based care had significantly lower education level (p =0.019),being single (p =0.001),fewer family members (p =0.002),and greater prevalence of stool incontinence (p =0.011),dementia (p =0.025),and disability (p =0.016).Factors Related to Long-term Care UtilizationThe statistics for long-term care service utilization are shown in Table 3.The adjusted Model 1,with predisposing factors entered,showed that older age (compared with age 65–69years:age 70–74,odds ratio [OR]=2.31,p =0.01;age 75–79,OR =3.62,p ,0.001;age $80,OR =8.10,p ,0.001),and BMI ,18.5(OR =2.44,p =0.002,compared with normal BMI 18.5–25)were significantly associated with greater long-term care use.However,education level of 0–6years (OR =0.58,p =0.023,compared with illiteracy),and alcohol consumption (OR =0.32,p =0.003)showed significant associations with reduced long-term care use.Both predisposing and enabling factors were entered into the adjusted Model 2.Results for the predisposing factor were similar to the Model 1findings.Among enabling factors,being single (OR =2.51,p ,0.001,compared with married/cohabiting),and living in urban regions (OR =1.55,p =0.024,compared with living in non-urban regions)were associated with significantly greater long-term care use.In the adjusted Model 3,predisposing,enabling,and need factors were entered simultaneously.Age (compared with age 65–69years:age 75–79,OR =2.08,p =0.044;age $80,OR =3.30,p =0.002),being single (OR =2.16,p =0.006,compared with married/cohabiting),living in urban regions (OR =1.68,p =0.037,compared with living in non-urban region),stroke (OR =2.08,p =0.015),dementia (OR =2.32,p =0.007),1–3items of ADL disability (OR =5.56,p ,0.001),and 4–6items of ADL disability (OR =21.57,p ,0.001)were significantly associ-ated with greater long-term care use.However,heart disease (OR =0.50,p =0.025)was associated with significantly reduced long-term care use.Interactions terms (age 6gender,age 6marital status,gender 6marital status)were added separately into Model 3;none were statistically associated with long-term care use (data not shown).Gender and Long-term Care UtilizationTable 4shows results for utilization of long-term care when stratified by gender.Among men,older age (compared with age 65–69years;age 75–79,OR =3.93,p =0.016;age $80,OR =4.58,p =0.022),being single (OR =2.78,p =0.033,com-pared with married/cohabiting),living in urban regions (OR =2.41,p =0.032,compared with living in non-urban regions),stool incontinence (OR =2.71,p =0.027),dementia (OR =4.73,p =0.009),and 4–6items of ADL disabilityTable 3.Multiple logistic regressions of long-term care use and related factors.Model 1Model 2Model 3VariablesOR pOR pOR pPredisposing factors Age (reference:65–69years)70–74 2.310.0102.310.0111.940.08775–79 3.62,0.001 3.07,0.0012.080.044$808.10,0.001 5.75,0.0013.300.002Gender (Female)Male1.030.8931.500.0881.680.100Education level (Illiteracy)1–6years 0.580.0230.580.0280.650.165$7years 0.780.3820.750.3381.250.590Smoking (No)Yes1.010.9620.950.8521.240.480Alcohol consumption (No)Yes 0.320.0030.320.0020.470.085BMI (18.5–25),18.5 2.440.002 2.410.0030.890.751$251.000.9911.000.9920.890.658Enabling factorsMarital status (married/cohabiting)Single2.51,0.0012.160.006Family members (no family members)1–3 1.590.231 1.000.992$41.990.0781.490.320Household monthly income (,30,000NTD)30,000–69,999 1.110.6360.810.414$70,000 1.100.7720.690.306Missing data 1.710.0822.210.063Residence (non-urban)Urban 1.550.0241.680.037Need factors Geriatric conditions Urine incontinence 1.670.061Stool incontinence 1.360.294Chronic diseases Hypertension 1.600.069Diabetes 1.230.414Hyperlipidemia 1.130.659Stroke 2.080.015Heart disease 0.500.025Cancer 1.040.958Dementia 2.320.007Hearing problems 0.890.669Vision problems 0.940.904Visited ER in the past year 1.230.510Hospitalized in the past year 1.560.195Disability (no disability)Table 3.Cont.Model 1Model 2Model 3VariablesOR pOR pOR p IADL disability only 1.200.6351–3items of ADL disability 5.56,0.0014–6items of ADL disability21.57,0.001OR =odds ratio;BMI =body mass index;NTD =New Taiwan dollar;ER =emergency room;IADL =Instrumental Activities of Daily Living;ADL =Activities of Daily Living.doi:10.1371/journal.pone.0089213.t003(OR =15.14,p ,0.001)were all significantly associated with greater long-term care use;education level of 0–6years (OR =0.30,p =0.015,compared with illiteracy)and alcohol consumption (OR =0.24,p =0.023)showed significant associa-tions with reduced long-term care use.Among women,older age (compared with age 65–69years;age $80,OR =2.98,p =0.036),education level $7years (OR =3.62,p =0.03,compared with illiteracy),being single (OR =2.24,p =0.023,compared with married/cohabiting),hypertension (OR =2.46,p =0.006),stroke (OR =2.78,p =0.013),dementia (OR =2.70,P =.016),1–3items of ADL disability (OR =16.51,p ,0.001),and 4–6items of ADL disability (OR =42.95,p ,0.001)were all significantly associated with greater long-term care use;heart disease (OR =0.39,p =0.039)showed a significant association with reduced long-term care use.Age and Long-term Care UtilizationTable 5shows the analysis stratified by two age groups:young-old elderly (65–74years)and old-old elderly ($75years).Among young-old elderly,male gender (OR =2.89,p =0.049,compared with female)and 4–6items of ADL disability (OR =28.17,p ,0.001)were significantly associated with greater long-term care use;alcohol consumption (OR =0.12,p =0.011)and low BMI (OR =0.15,p =0.017)showed significant associations with reduced long-term care use.Among old-old elderly,being single (OR =2.68,p =0.012,compared with married/cohabiting),stroke (OR =3.52,p =0.002),dementia (OR =3.50,p =0.001),1–3items of ADL disability (OR =7.18,p =0.001),and 4–6items of ADL disability (OR =29.15,p ,0.001)were significantly associ-ated with greater long-term care use;heart disease (OR =0.37,p =0.015)showed a significant association with reduced long-term care use.DiscussionWe used a nationwide representative sample to investigate the determinants of long-term care utilization among the elderly of Taiwan.Older age,stroke,dementia,ADL disability,and single marital status best predicted long-term care use.Utilization was directly proportional to the level of ADL disability,independent of geriatric conditions or chronic diseases.Furthermore,compared with home/community-based care,users of institution-based care were less educated,had fewer family members,were more disabled,and were more likely to be single,to have dementia,and to experience stool incontinence.In the present study sample,this ratio of home/community-based to institution-based services was 2:1(4.7%vs.2.6%),which is compatible with findings from other studies;however,the usage rates were still much lower than those of countries with insurance-covered long-term care services,such as the Netherlands (15.7%;home care,12.7%;institutional care,4.5%)or Japan (13.1%)[4,9].Utilization of long-term care services may be significantly underestimated due to under-reporting and lack of universal long-term care service coverage.Considering that 13.8%of the elderly in our sample had at least one item of ADL disability and 7.8%had 4–6items,the long-term care usage rate of 6.9%in Taiwan suggests that informal care is a partial substitute for formal care.Without insurance coverage,accessibility to long-term care may become a concern,and put considerable burden on informal (usually family)caregivers.We observed no significant age difference by gender;however,the women in our study were significantly more disabled,had more geriatric conditions,and greater prevalence of hypertension,diabetes,hyperlipidemia,and dementia than did the men.This isTable 4.Multiple logistic regressions of long-term care use stratified by gender.MaleFemale VariablesORpORpPredisposing factors Age (reference:65–69years)70–74years 2.300.221 1.940.19675–79years 3.930.016 1.280.599$80years4.580.022 2.980.036Education level (Illiteracy)1–6years 0.300.015 1.050.908$7years 0.450.160 3.620.030Smoking (No)Yes1.930.0990.150.054Alcohol consumption (No)Yes 0.240.023 1.030.958BMI (18.5–25),18.50.770.6680.870.759$250.690.457 1.060.876Enabling factorsMarital status (married/cohabiting)Single2.780.033 2.240.023Family members (no family members)1–3 1.860.3800.610.379$41.950.345 1.200.723Household monthly income(,30,000NTD)30,000–69,9990.500.0780.990.979$70,0000.350.206 1.020.968Missing data 1.360.676 2.770.066Residence (non-urban)Urban 2.410.032 1.430.276Need factors Geriatric conditions Urine incontinence 1.970.134 1.240.554Stool incontinence 2.710.0270.870.728Chronic diseases Hypertension 1.000.991 2.460.006Diabetes 1.890.217 1.060.835Hyperlipidemia 1.920.1520.670.313Stroke 1.800.212 2.780.013Heart disease 0.730.5150.390.039Cancer 2.700.2250.750.778Dementia 4.730.009 2.700.016Hearing problems 1.240.6120.800.540Vision problems 1.570.615 1.070.937Visited ER in the past year 1.990.198 1.180.69Hospitalized in the past year 1.270.678 1.950.107Disability (no disability)IADL disability only 0.960.935 1.050.9371–3items of ADL disability 1.360.67716.51,0.0014–6items of ADL disability15.14,0.00142.95,0.001OR =odds ratio;BMI =body mass index;NTD =New Taiwan dollar;ER =emergency room;IADL =Instrumental Activities of Daily Living;ADL =Activities of Daily Living.doi:10.1371/journal.pone.0089213.t004Table5.Multiple logistic regressions of long-term care use stratified by age.Young-old(aged65–74years)Old-old(aged$75years) Variables OR p OR pPredisposing factorsGender(Female)Male 2.890.049 1.590.238Education level(Illiteracy)1–6years0.570.3660.550.146$7years0.310.143 2.200.149Smoking(No)Yes0.970.950 1.760.131Alcohol consumption(No)Yes0.120.0110.460.221BMI(18.5–25),18.50.150.017 1.290.583$250.710.491 1.070.854Enabling factorsMarital status(married/cohabiting)Single 2.290.099 2.680.012Family members(No family members)1–3 3.100.2120.570.259$4 3.790.144 1.170.753Household monthly income(,30,000NTD)30,000–69,999 1.510.3720.670.221$70,000 1.080.8980.850.713Missing data 2.100.304 2.150.139Residence(non-urban)Urban 1.880.186 1.610.119Need factorsGeriatric conditionsUrine incontinence 2.090.250 1.350.340Stool incontinence 1.600.3500.980.967Chronic diseasesHypertension 1.700.283 1.380.346Diabetes 2.030.1350.900.741Hyperlipidemia0.710.53 1.430.335Stroke0.710.582 3.520.002Heart disease0.750.5870.370.015Cancer 1.420.7880.740.736Dementia 1.510.539 3.500.001Hearing problems 1.170.7490.890.732Vision problems 3.880.0750.440.255Visited ER in the past year 1.790.3030.800.589 Hospitalized in the past year 2.700.128 1.440.362Disability(no disability)IADL disability only0.900.858 1.390.5301–3items of ADL disability 5.350.0817.180.0014–6items of ADL disability28.17,0.00129.15,0.001OR=odds ratio;BMI=body mass index;NTD=New Taiwan dollar;ER=emergency room;IADL=Instrumental Activities of Daily Living;ADL=Activities of Daily Living.doi:10.1371/journal.pone.0089213.t005。