Predicting nursing home admission: estimates from a 7-year follow-up of a nationally representative sample of older Americans.
This study determines whether prevalence and predictors of nursing home admission changed in the 1990s, during a period of dramatic changes in the service provision for and medical care of chronic impairments. Data from the 1993-2000 surveys of the Asset and Health Dynamics Among the Oldest Old (AHEAD) Study, a longitudinal and nationally representative sample, were used. Proportional hazard models were used to determine the effects of dementia, physical functioning, clinical conditions, and sociodemographics on the likelihood of nursing home admission. Of the 6,676 respondents, 17% were admitted to a nursing home. Models excluding functional impairment demonstrated significant effects of chronic medical conditions and dementia on the risk of institutionalization. After controlling for functional impairment, dementia still had significant and strong effects on institutionalization but clinical conditions did not, suggesting that the impact of dementia goes beyond its effect on physical functioning. Nursing home admissions did not decrease during the study period, and the impact of dementia on the risk of nursing home admission did not decrease. Interventions for individuals with dementia should impact the behavioral aspects of the condition and slow disease progression in addition to improving physical functioning.
Banaszak-Holl
Jane
J
Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, 48109-2029, USA. janebh@umich.edu
Fendrick
A Mark
AM
Foster
Norman L
NL
Herzog
A Regula
AR
Kabeto
Mohammed U
MU
Kent
David M
DM
Straus
Walter L
WL
Langa
Kenneth M
KM
D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000453:epidemiology*; D002908:Chronic Disease / Q000453:epidemiology*; D004185:Disability Evaluation; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D015577:Geriatric Assessment / Q000706:statistics & numerical data; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D015233:Models, Statistical; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D018570:Risk Assessment / Q000706:statistics & numerical data; D014481:United States