Perception of risk of adverse outcomes of older people: comparison between nursing homes, day centers and home care services

Purpose -In Portugal, the three main kinds of care services available for older people are nursing homes, day centers and home care services. The use of these care services is mostly based on complex socioeconomic and functional criteria; however it is not clear if this placement corresponds to a higher/lower risk of adverse outcomes. The purposes of this paper are: to characterize clients of each type of service; to estimate the proportion of individuals at perceived risk of each adverse outcome according to type of service; to assess the ability of the Risk Instrument for Screening in the Community (RISC) to identify the risk profiles according to type of service. Design/methodology/approach -The sample comprised individuals aged 65+ (n = 224), receiving care at home, in day centers or in nursing homes. The identification of individuals at risk for three adverse outcomes (institutionalization, hospitalization and death) was performed using a short pre-screen instrument (RISC). Findings -The RISC identified mental state issues as the unique factor that differentiated clients according the type of care services (x(2) (6, N = 224) = 20.96, p = 0.002), with day center presenting the lowest percentage of mental health concerns and nursing home presenting the highest percentage (44.44 and 71.91 percent, respectively). Additionally, a gradient was found between perceived risk of adverse outcomes (institutionalization and hospitalization) and care of levels required. Originality/value -The RISC can be used to discriminate people in different settings of care and can be helpful in the selection of groups at risk that will benefit more from available services.