Quality of private personal care for elderly people in Italy living at home with disabilities : risk of nursing home placement at a 1-year follow-up

The aim of this prospective study was to evaluate the correlation between the self-perceived quality of private personal care for elderly people living at home and the 1-year risk of hospital admission, nursing home placement and death. We enrolled 100 community-dwelling elderly outpatients (mean age 85 years), who had been receiving private personal care for any kind of disability for at least 1 month. Quality of care was described by both the elderly person without overt cognitive impairment and their informal caregivers, and this was categorised for analysis as 'poor or fair' or 'optimal or intermediate'. Rates of hospital admission, long-term care placement and death were assessed at a 1-year follow-up, between May 2006 and January 2008. One year after enrolment, 67 elderly people were still living at home, 10 had been institutionalised and 23 had died. Forty-six had experienced at least one hospital admission. The elderly people belonging to the 'poor or fair care' group (n = 16) showed a higher risk of nursing home placement when compared to the people belonging to the 'optimal or intermediate care' group (n = 84) (relative risk = 5.25, 95% confidence interval 1.72-16.06), without there being any significant difference between the two groups in terms of baseline assessment and basic functional status at follow-up. The quality of personal care was not a predictor of either hospital admission or death. Therefore, a poor or fair quality of personal care turned out to be a 1-year predictor of placement in a long-term care facility for community-dwelling older adults with a disability.