top of page
Search

Determinants of Health and Long Term Care Utilization

  • abissett22
  • Jun 14, 2022
  • 3 min read

Updated: Jun 16, 2022



In the last blog post, we looked at the topic of "What is Health? What Does it Mean in Long Term Care?". Let's delve a little deeper into this topic by looking at factors that influence the health of individuals or populations. These factors are often referred to as Determinants of Health

The following table compares perspectives on determinants of health from the global, national, and provincial levels. There are similarities between the three perspectives (for example, all three include education, employment, and working conditions). There are also differences between the three levels. Housing and food are mentioned at the global and provincial level, but not at the federal level. Interestingly, healthy lifestyle is mentioned at the federal and provincial level, but not at the global level. Health care professionals may also note that all three levels include access to health care, but this is only one of many factors determining overall health. This can be humbling for health care professions, and also highlights the importance of working alongside other public services and government agencies.

Although these lists of determinants of health appear quite extensive, there is still room to consider additional determinants. Holt-Lunstat proposed a more comprehensive view of social connection as a determinant of health, arguing that social connection relates to physical and mental health outcomes, is comparable to other well-known mortality factors, and is relevant across the lifespan. The proposed definition in this article overlaps with many of the determinants listed in the table above, but is more elaborate and specific. This definition is:

The extent to which an individual is socially connected depends on multiple factors,

including:

1. Connections to others via relationships and roles (marital status, social networks,

social integration, living alone, social isolation).

2. Actual or perceived support or inclusion (received support, perceptions of social

support, perceived loneliness).

3. Quality of social relationships (marital quality, relationship strain, social inclusion or

exclusion). (Holt-Lunstat, 2022).

After learning about these determinants of health, I was curious to discover which determinants are most closely linked to Long Term Care (LTC) utilization. Most of the determinants listed in the literature were consistent with my clinical experience. These determinants included advanced age, living alone, physical and cognitive limitations, assistance for instrumental activities of daily living, loss of a spouse, acute health events, chronic health conditions, education level, gender, and preceding hospitalizations (Branch & Jette, 1984, Garner et al., 2018, Hedinger et al, 2015).

The relationship between social vulnerability and LTC utilization is interesting. I had anticipated that higher social vulnerability would be linked with higher LTC admissions. However, one study found that this relationship was impacted by age and frailty. For individuals in their seventies, high social vulnerability was actually related to lower rates of LTC admission, even for the most frail individuals. This may suggest that other factors influence their ability to access the services they need. The relationship between social vulnerability and LTC admission changed with advancing age. For individuals in their nineties, frailty was found to have a more significant relationship with LTC admission than social vulnerability. Less frail individuals in this age group were more likely to be admitted to LTC if they were socially vulnerable. Social vulnerability had no impact on likelihood of admission to LTC for highly frail individuals in this age category.

Admission to LTC is a significant life event that many Canadians hope to avoid (Colledge, 2020). Awareness of the determinants with the strongest correlation to LTC admission can support public health initiatives to address these factors and improve resources available for those who wish to remain in their own private homes. These determinants can also inform decision making and program planning for LTC facilities, to promote initiatives that are aligned with the needs of the population we serve.

References

Branch, L.G., & Jette. A.M. (1984). A prospective study of long-term care institutionalization among the aged. American Journal of Public Health. https://ajph.aphapublications.org/doi/epdf/10.2105/AJPH.72.12.1373

College, M. (2020). Safer at home: Eight in ten Canadians (85%) vow to do all they can to avoid going into long term care. Ipsos. https://www.ipsos.com/en-ca/news-polls/safer-at-home-eight-in-ten-canadians-vow-to-do-all-they-can-to-avoid-going-into-long-term-care


Garner, R., Tanuseputro, P, Manuel, D.G., & Sanmartin, C. (2018). Transitions to long-term and residential care among older Canadians. Statistics Canada. https://www150.statcan.gc.ca/n1/pub/82-003-x/2018005/article/54966-eng.htm

Government of Canada (2020).Social determinants of health and health inequalities. https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html

Hedinger, D., Hämmig, O., Bopp, M. (2015). Social determinants of duration of last nursing home stay at the end of life in Switzerland: a retrospective cohort study. BMC Geriatr 15, 114. https://doi.org/10.1186/s12877-015-0111-3

Holt-Lunstat, J. (2022). Social connection as a public health issue: The evidence and systemic framework for prioritizing the "social" in social determinants of health. Annual Review of Public Health. https://www.annualreviews.org/doi/epdf/10.1146/annurev

World Health Organization (n.d.). Social determinants of health. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1

 
 
 

Comments

bottom of page