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Abstract Background Older people with diabetes who live at home and receive home care services (HCS) are vulnerable, which may result in a need for more care than the HCS can provide. In this study we aimed to explore associations between pharmacologically treated diabetes and the risk of short-term and long-term nursing home stays (NHS) among older people receiving HCS. Methods This nationwide registry study included older people ≥ 65 years receiving HCS, as registered in the Norwegian Information System for the Nursing and Care Sector (IPLOS) (2010–2014). Data from IPLOS were merged with data from the Norwegian Prescription Database and the Norwegian Patient Registry. Pharmacologically treated diabetes (hereafter referred to as diabetes) was defined based on prescriptions of glucose-lowering drugs (GLD) (≥ 1 prescription in the current or previous year). Persons not prescribed GLD were defined as not having diabetes. Based on Anatomical Therapeutic Chemical (ATC) codes we identified the following subgroups: persons without diabetes, persons using “non-insulin GLD only”, “insulin and non-insulin GLD” and “insulin only”. An NHS was defined as at least one stay during a given calendar year, where a short-term NHS is temporary, and a long-term NHS is permanent. Log-binomial regression was used to test for differences in NHS and results are reported as risk ratios (RR) with 95% CIs. Results Both insulin-treated subgroups had a higher risk of a short-term NHS (“insulin only” users RR 1.06 (CI 1.03–1.09) and “insulin and non-insulin GLD” users RR 1.04 (CI 1.02–1.06)) compared to those without diabetes. In general, persons with diabetes had a lower risk of a long-term NHS than those without diabetes (RR 0.92 (CI 0.89–0.94)). The subgroup using “insulin and non-insulin GLD” had the lowest risk of a long-term NHS (RR 0.86 (CI 0.81–0.91)). Conclusion Despite a lower risk of a long-term NHS among older people with diabetes, we found an increased risk of a short-term NHS among persons with insulin-treated diabetes who live at home and receive HCS. This calls for attention when planning health care, in order to provide coordinated and individualized care to prevent short-term NHS’s.

Background: Older people with diabetes who live at home and receive home care services (HCS) are vulnerable, which may result in a need for more care than the HCS can provide. In this study we aimed to explore associations between pharmacologically treated diabetes and the risk of short-term and long-term nursing home stays (NHS) among older people receiving HCS. Methods: This nationwide registry study included older people ≥ 65 years receiving HCS, as registered in the Norwegian Information System for the Nursing and Care Sector (IPLOS) (2010–2014). Data from IPLOS were merged with data from the Norwegian Prescription Database and the Norwegian Patient Registry. Pharmacologically treated diabetes (hereafter referred to as diabetes) was defined based on prescriptions of glucose-lowering drugs (GLD) (≥ 1 prescription in the current or previous year). Persons not prescribed GLD were defined as not having diabetes. Based on Anatomical Therapeutic Chemical (ATC) codes we identified the following subgroups: persons without diabetes, persons using "non-insulin GLD only", "insulin and non-insulin GLD" and "insulin only". An NHS was defined as at least one stay during a given calendar year, where a short-term NHS is temporary, and a long-term NHS is permanent. Log-binomial regression was used to test for differences in NHS and results are reported as risk ratios (RR) with 95% CIs. Results: Both insulin-treated subgroups had a higher risk of a short-term NHS ("insulin only" users RR 1.06 (CI 1.03–1.09) and "insulin and non-insulin GLD" users RR 1.04 (CI 1.02–1.06)) compared to those without diabetes. In general, persons with diabetes had a lower risk of a long-term NHS than those without diabetes (RR 0.92 (CI 0.89–0.94)). The subgroup using "insulin and non-insulin GLD" had the lowest risk of a long-term NHS (RR 0.86 (CI 0.81–0.91)). Conclusion: Despite a lower risk of a long-term NHS among older people with diabetes, we found an increased risk of a short-term NHS among persons with insulin-treated diabetes who live at home and receive HCS. This calls for attention when planning health care, in order to provide coordinated and individualized care to prevent short-term NHS's. [ABSTRACT FROM AUTHOR]

Objective: To examine longitudinal associations between time‐varying insomnia symptoms (difficulty initiating sleep, difficulty maintaining sleep, early‐morning awakenings, and nonrestorative sleep) and all‐cause health care services utilization (HSU), including overnight hospital stays, nursing home stays, and home health care services among middle‐aged and older adults. Data Sources: The Health and Retirement Study (HRS), a nationwide, population‐representative survey of primarily middle‐aged and older adults in the United States. Study Design: This study is an analysis of prospective data from the HRS for a cohort of 13,168 adults (aged ≥50 years; females = 57.7%). Study participants were followed for 16 years. This study focuses on the associations between time‐varying insomnia symptoms, both cumulatively and independently, and repeated HSUs. A marginal structural modeling approach was used to capture time‐varying biological, psycho‐cognitive, and behavioral health factors, and to adjust for selection bias such as differential loss to follow‐up. Generalized estimating equations were employed to compute average marginal effects and their 95% confidence intervals. Data Collection/Extraction Methods: We extracted longitudinal data from 2002 through 2018 waves of the HRS. Principal Findings: Experiencing higher numbers of insomnia symptoms on a cumulative scale was associated with higher probabilities of HSU. For instance, the likelihood of overnight hospital stays for individuals reporting one symptom increased from 4.7 percentage points on average (95% CI: 3.7–5.6, p < 0.001), to 13.9 percentage points (95% CI: 10.3–17.5, p < 0.001) for those reporting four symptoms, relative to individuals experiencing no insomnia symptoms. Further, experiencing each of difficulty initiating and maintaining sleep, and nonrestorative sleep, as standalone symptoms, was associated with a higher likelihood of HSU when compared to those not experiencing the symptoms. Conclusions: The results demonstrate the potential consequences and adverse impacts of insomnia symptoms on HSU among middle‐aged and older adults. Future investigations should focus on the underlying causes and health systems pathways linking insomnia symptoms to HSU. [ABSTRACT FROM AUTHOR]