Work

Clusters of home- and community- based service use and association with quality of life in older adults with and without dementia

Year: 2026

Type: article

Abstract: Home- and community-based services (HCBS) include multiple types of services, which makes evaluating HCBS challenging. We evaluated (1) whether there are groups (clusters) of older adults with similar patterns in HCBS use and (2) whether consumer-reported quality of life varies between these clusters of HCBS consumers, with or without dementia. We included 775 Medicaid HCBS consumers in Minnesota (2017–2018; age, ≥ 65 years). We linked claims data obtained from the Minnesota Department of Human Services with the National Core Indicators Adult Consumer Survey. We measured quality of life using a validated index reflecting care experiences, security, and autonomy. Hierarchical clustering identified clusters of consumers with similar patterns in HCBS use. We evaluated differences in mean quality of life scores (1) between clusters and (2) within each cluster among consumers with versus without dementia, using linear regression. We identified 4 clusters of HCBS consumers based on patterns in service type (home healthcare, non-medical transportation, personal care assistance, case management, adult day care, durable medical equipment, and homemaker services). The 4 clusters varied in composition based on race/ethnicity, proportion with dementia, and functional dependence. In regression analyses, mean quality of life scores were similar between all pairs of clusters (β estimates ranged between 0.00 and 0.02% points; p > 0.05). Within each cluster, mean quality of life scores were similar between those with versus without dementia (β estimates ranged between − 0.01 and 0.04% points; p > 0.05). There are distinct groups of older adults HCBS consumers based on patterns in HCBS use. There are no meaningful differences in quality of life within cluster between people with and without dementia or between clusters. These findings indicate HCBS service providers may be able to meet the unique needs of diverse client bases. Not applicable. ● Distinct groups of home- and community-based services (HCBS) consumers exist based on different combinations of services used. ● Consumer-reported quality of life is similar between different HCBS consumer groups and between those with and without dementia. ● Quality of life can be used as a quality indicator uniformly across all HCBS regardless of a dementia diagnosis.

Source: BMC Geriatrics

DOI: 10.1186/s12877-026-08442-2

Authors: Eric Jutkowitz, Romil R. Parikh, Jack M. Wolf, Yinfei Duan, Benjamin W. Langworthy, Tetyana P. Shippee

Institutions: University of Minnesota, University of Alberta

Language: English

Topic: Dementia and Cognitive Impairment Research

Subfield: Psychiatry and Mental health

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,190