Risk Factors for Home Care Discontinuation Among Older People With Dysphagia: A Two‐Year Retrospective Cohort Study

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BACKGROUND: Receiving home care improves the quality of life of older adults. Nonetheless, limited studies have examined factors influencing pneumonia onset and home care discontinuation in older adults living at home. OBJECTIVE: To clarify the factors associated with home care discontinuation in older adults receiving home care for dysphagia and to identify risk factors for home care discontinuation. METHODS: This study included 162 adults (≥ 65 years) with dysphagia who were receiving home care. Nutritional status, history of pneumonia, swallowing function, activities of daily living, and comorbidities were assessed. The study participants were followed up for 2 years. Factors associated with home care discontinuation (death and hospitalisation) were analysed using the Kaplan-Meier method and Cox proportional hazards model. RESULTS: During the 2-year follow-up, 110 (67.9%) participants discontinued home care (35 due to pneumonia, 75 due to other causes). Severe dysphagia was the strongest risk factor for pneumonia-induced discontinuation (HR = 3.25, 95% CI: 1.35-7.83). Malnutrition (HR = 2.32, 95% CI: 0.93-5.76) and pneumonia history (HR = 2.00, 95% CI: 1.00-4.35) elevated pneumonia-related risk. Severe dysphagia (HR = 1.52, 95% CI: 0.65-3.55) and malnutrition (HR = 1.58, 95% CI: 0.95-2.64) were potential risk factors for non-pneumonia-induced discontinuation. CONCLUSION: In older adults receiving home care, severe dysphagia was a major risk factor for home care discontinuation, with malnutrition and a history of pneumonia suggested as potential contributing factors. These findings indicate that improving nutritional status, maintaining and enhancing swallowing function and providing appropriate management for individuals with a history of pneumonia are crucial for ensuring continuous home care.

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