Factors Associated with the Utilization of Home and Community-Based Services (HCBS) Among Older Adults: A Systematic Review of the Last Decade

Figures & data

Figure 1. Flow diagram of the selection process.

Table 1. Summary of the included studies.

Author, Year	Design	Study Site	Characteristics of the Study Population	HCBS Categories	Associated Factors
Almazán-Isla et al. (2017)	Cross-sectional	Spain	N = 1,216, Older adults aged 50+	Home-based services	Age, physical health, place of residence
Balia and Brau (2014)	Cross-sectional	Europe	N = 1,375, Elderly parents aged 65 years or older (M = 76), who have at least one child and up to four children and do not live with any of them.	Home-based services, nursing	Age, physical health, proximity to death
Brown et al. (2014)	Cross-sectional	USA	N = 537, Patients aged 65+ requiring physical care or assistance in ADL	Day services	Physical health, caregiver
Chamut et al. (2021)	Cross-sectional	USA	N = 3,995, Participants aged 65 + who received HCBS	Health and therapeutic services	Education, prior service utilization
Chesney et al. (2021)	Cohort study	Canada	N = 82,037, Patients aged 70+ who underwent cancer surgery	Home-based services, nursing caregiver support	Age, physical health
Davis et al. (2013)	Cohort study	Australia	N=825, Patients with type 2 diabetes (M = 65.2)	Nursing	Age, physical health, race
Døhl et al. (2016)	Cross-sectional	Norway	N = 2,493, Recipients of home care services aged 67+	Home-based services, nursing	Physical health, living arrangements, safety alarm
Dong et al. (2021)	Cross-sectional	USA	N = 42,112 (8083 individuals and 4781 households), Individuals aged 50+	Health and therapeutic services	Financial situation
Dupraz et al. (2020)	Cohort study	Switzerland	N = 2,155, Community-dwelling older adults aged 65+ (M = 73.2)	Home-based services	Physical health, financial situation
Ewen et al. (2017)	Cross-sectional	USA	N = 633, Older adults aged 60+	Home-based services, day services home-delivered meals, nonmedical transportation, mental health and behavioral services	Physical health, mental health concerns, social support
Fisher et al. (2016)	Cohort study	Canada	N = 376,421, Community-living older adults aged 66+with a diabetes diagnosis	Home-based services, nursing health and therapeutic services, case management	Physical health
Floridi et al. (2021)	Cross-sectional	Europe	N = 1,276, Older adults aged 65+ with long-term difficulties in performing at least one of a set of 23 activities	Home-based services	Financial situation, place of residence
Fu and Guo (2022)	Cross-sectional	China	N = 5,668, Older adults aged 65+	Home-based services, day services home-delivered meals, caregiver support, health and therapeutic services	Gender, education, financial situation, physical health, place of residence, social support
Gerst-Emerson and Jayawardhana (2015)	Cross-sectional	USA	N = 3,995, Community-dwelling persons aged 60+	Health and therapeutic services	Mental health concerns
Gruneir et al. (2016)	Cohort study	Canada	N = 29,673, community-dwelling individuals aged 66+	Nursing	Physical health
Guzzardo and Sheehan (2013)	Qualitative	USA	N = 28, Spanish-speaking older adults of Puerto Rico aged 62+, experiencing difficulty in performing at least one ADL or IADL, primary place of residence the United States, and living in their current residence for at least 12 months	Home-based services, nursing home-delivered meals	Social support, neighborhood problems
Hasche et al. (2013)	Cross-sectional	USA	N = 533, Medicaid-funded LTC clients aged 60+ (M = 72.51)	Home-based services, nursing	Age, physical health, mental health concerns, place of residence, race
Hsu et al. (2021)	Cross-sectional	Australia	N = 8,012, People aged 65+	Home-based services, community transition services, caregiver support, mental health and behavioral services	Gender, physical health, marital status, prior service utilization
Hu et al. (2022)	Cross-sectional	England	N = 13,425, Community-dwelling older people aged 65+	Home-based services	Age, gender, financial situation, housing problems, race
Huang et al. (2023)	Cross-sectional	China	N = 6,907, Chinese citizens aged 60+(M = 70.45)	Home-based services, home-delivered meals, mental health and behavioral services	Age, education, physical health, social support, place of residence
Jeffares et al. (2022)	Cross-sectional	Ireland	N = 5,859, Community-dwelling adults aged 50+	Health and therapeutic services mental health and behavioral services	Physical health
Joostepn (2015)	Cross-sectional	USA	N = 247, Older adults aged 60+	Community transition services	Unmet needs
Kalwij et al. (2014)	Cross-sectional	Japan	N = 10,344, single persons aged 65+ and couples (married or cohabiting) of whom at least one member is aged 65+	Home-based services, nursing home-delivered meals	Age, physical health, social support
Kashiwagi et al. (2013)	Cross-sectional	Japan	N = 1,276, Older adults aged 65+, users of community-based services under the Long-term Care Insurance (LTCI) system	Home-based services, nursing	Physical health, financial situation, prior service utilization, living arrangements,
S. A. Kim et al. (2022)	Cohort study	Japan	N = 31,322, Older adults aged 75+ (M = 81.47)	Home-based services	Financial situation
Lam et al. (2014)	Cross-sectional	USA	N=39, Adults aged 65+ (M = 78.3)	Home-based services, day services nonmedical transportation	Physical health, mental health concerns, social support,
Larsson et al. (2014)	Panel study	Sweden	N = 567, Individuals aged 75+	Home-based services	Marital status, living arrangements
Lee et al. (2015)	Cross-sectional	USA	N = 31,341, HCBS participants aged 60 + (M = 76.6 ± 9.2)	Home-based services, home-delivered meals, caregiver support, equipment, technology, and modifications, health and therapeutic services	Age, gender, financial situation, marital status, living arrangements, race
Lehning et al. (2013)	Cross-sectional	USA	N = 1,099, African American older adults aged 65+ (M = 71.6)	Home-based services, day services, nursing, home-delivered meals, health and therapeutic services, nonmedical transportation, equipment, technology, and modifications, supported employment, services supporting participant direction	Age, living arrangements, neighborhood problems, social welfare programs
F. Li et al. (2017)	Cohort study	China	N = 7,100, Adults aged 60+	Home-based services, nursing, health and therapeutic services	Age, gender, financial situation, physical health, marital status, prior service utilization
H. Li et al. (2022)	Cross-sectional	China	N = 3,920, Older adults aged 60+ who experienced at least one disability (M = 73.82)	Home-based services, nursing	Gender, education, financial situation, physical health, social support
Liang et al. (2019)	Cross-sectional	China	N = 982, Community-dwelling adults aged 70+	Home-based services, nursing	Physical health, prior service utilization, social welfare programs
McKenzie et al. (2014)	Cohort study	Australia	N = 26,238, Older women born 1921–26, 1946–51,1978–78	Home-based services, nursing, equipment, technology, and modifications	Caregiver
Mellor et al. (2023)	Cohort study	USA	N = 90,681, Older adults aged 65+, eligible for long-term services and supports (LTSS) benefits, eligible for Virginia’s Commonwealth Coordinated Care Plus (CCCP) program	Home-based services, caregiver support	Social welfare programs
Miller et al. (2023)	Cross-sectional	USA	N = 6,678, Community-dwelling respondents aged 65+ with at least two reported limitations in Activities of Daily Living (ADLs) and/or Instrumental Activities of Daily Living (IADLs)	Home-based services	Place of residence
Murphy et al. (2015)	Cross-sectional	Ireland	N = 3,507, Community-living older adults aged 65+	Home-based services	Age, physical health, living arrangements
Peña-Longobardo et al. (2021)	Cohort study	Europe	N = 120,000, People aged 50+	Health and therapeutic services	Marital status
Peng et al. (2020)	Cross-sectional	China	N = 441, Community-dwelling older adults aged 60+ (M = 70.67)	Home-based services, day services home-delivered meals	Social support
Pepin et al. (2017)	Cross-sectional	USA	N = 5,582, Adults aged 60 + (M = 70.5)	Home-based services, home-delivered meals, caregiver support, health and therapeutic services nonmedical transportation,	Physical health, financial situation, mental health concerns
Rahman et al. (2019)	Cross-sectional	Australia	N = 8,768, Older women born 1921–1926	Home-based services, day services	Physical health, financial situation, mental health concerns, marital status, place of residence
Reckrey et al. (2020)	Cross-sectional	USA	N = 7,552, Community-dwelling, fee-for-service Medicare beneficiaries (M > 80)	Home-based services	Mental health concerns, prior service utilization, proximity to death, place of residence
Reckrey et al. (2023)	Cross-sectional	USA	N = 974, Homebound older adults aged 65+	Home-delivered meals, nursing, nonmedical transportation, round-the-clock services, equipment, technology, and modifications	Physical health, living arrangements
Robinson et al. (2021)	Cross-sectional	USA	N = 601, Older adults aged 60+ who self-reported “fair” or “poor” health status & live near or below the federal poverty level	Home-based services, home-delivered meals, day services, caregiver support, health and therapeutic services, mental health and behavioral services, nonmedical transportation	Caregiver, living arrangements
Rodríguez (2014)	Cross-sectional	Spain	N = 10,703, Dependent older people aged 65+, living at home	Home-based services	Age, gender, physical health
Schmidt (2017)	Cross-sectional	Austria	N = 31,336, LTC beneficiaries aged 60+, living in Vienna	Home-based services	Age, financial situation
Shih et al. (2020)	Cross-sectional	Taiwan	N = 101,457, LTC recipients aged 50+ (93.75% of the sample were aged 60+)	Home-based services, home-delivered meals, nursing, caregiver support, nonmedical transportation	Gender, financial situation, physical health, mental health concerns, place of residence, caregiver
Sonnega et al. (2017)	Cross-sectional	USA	N = 4,948, Older adults aged 60+	Home-based services, day services, home-delivered meals, caregiver support, nonmedical transportation, mental health and behavioral services, health and therapeutic services	Age, physical health, marital status, race
Steinbeisser et al. (2022)	Cohort study	Germany	N = 4,812, Individuals aged 65+	Home-based services	Age, education, physical activities, living arrangements
Takahashi (2022)	Cross-sectional	Japan	N = 11,994, Care recipient of long-term care aged 65+	Home-based services, nursing, day services	Social welfare programs
Tocchi et al. (2017)	Cross-sectional	USA	N = 312, Older adults aged 65+	Home-based services, day services home-delivered mealy, case management	Age, physical health, race
Tokunaga et al. (2015)	Cross-sectional	Japan	N = 11,994, Care recipient of long-term care aged 65+	Home-based services, day services, caregiver support	Financial situation; caregiver
Tsai (2015)	Cross-sectional	USA	N = 6,838, Medicare-insured seniors aged 70+ (M = 77), with a household social security income of more than $100/month	Home-based services	Social welfare programs
Van Cleve and Degenholtz (2022)	Cross-sectional	USA	N = 36,193, Community-dwelling disabled older Pennsylvanians from 2014 to 2016 who were enrolled in the 1915(c) Medicaid aging waiver program (M = 78).	Home-based services, day services, home-delivered meals	Gender, physical health, place of residence, living arrangments, race
Van der Burg et al. (2020)	Cohort study	Netherland	N = 34,034, Older people aged 55+ with a fracture of the femur or stroke in 2013	Home-based services, nursing	Physical health, marital status, social support
Weaver and Roberto (2017)	Cross-sectional	USA	N = 76, Older adults aged 65+ (M = 83.2) indicated a primary disability of cognitive impairment or required assistance with 2–4 ADL, had an informal caregiver demonstrating difficulty in meeting their needs, enrolled in a Community Living Program for 31+ days, and purchased two or more services	Home-based services, day services, home-delivered meals, nonmedical transportation, equipment, technology, and modifications	Living arrangements, caregiver, social support
Wu et al. (2014)	Cross-sectional	Taiwan	N = 2,608, Older adults aged 65+ (M = 74)	Home-based services, nursing, day services, caregiver support	Education, physical health marital status
Young et al. (2022)	Cross-sectional	Taiwan	N = 14,483, Older adults aged 65+, residing in Changhua County, used LTC services from 4/1/2017 to 11/1/2019	Health and therapeutic services mental health and behavioral services	Education, physical health, prior service utilization
Yu et al. (2019)	Cohort study	Taiwan	N = 3,429, Older people aged 50+ with a fracture of the femur or stroke in 2014	Home-based services, nursing, day services, caregiver support	Age, education, physical health
Yu et al. (2020)	Cross-sectional	Taiwan	N = 78,205, Care recipients of the National 10-Year Long-Term Care Plan (M = 79.52)	Home-based services, nursing, day services, caregiver support, nonmedical transportation	Physical health, caregiver, place of residence, living arrangements

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