Reported expectations for nursing home placement among older adults and their role as risk factors for nursing home admissions.
OBJECTIVE
Individual expectations among community-dwelling older adults and their subsequent effect on placement status have recently been considered. Previous studies, however, have been limited by eligibility and exclusion criteria, treating expectations as a continuous measure, omitting potential confounders, and ignoring Race x Gender interactions.


METHODS
We used data on 6,242 Black or White self-respondents who were 70 years old or older when they were enrolled in the survey of Assets and Health Dynamics Among the Oldest Old. We modeled expectations for nursing home placement over the next 5 years, as well as actual placement status, by using multivariable multinomial and binomial logistic regression models.


RESULTS
Expectations are not normally distributed: 14% of the participants refused to answer, 51% estimated no chance, 10% indicated a 1% to 50% chance, 21% indicated an 11% to 50% chance and 4% indicated a 51% to 100% chance. Age, gender, education, social supports, and health status were associated with expectations, as well as an interaction effect for Black men. Age, social supports, health status, prior hospital or nursing home use, and expectations were associated with subsequent placement.


CONCLUSIONS
Black and White older adults' expectations for nursing home placement rationally reflect their individual risk profiles and are associated with subsequent placement status. The expectations question may facilitate the early identification of high-risk individuals for further evaluation.
Akamigbo
Adaeze B
AB
Department of Health Management and Policy, College of Public Health, University of Iowa, 5231 Westlawn Building, Iowa City, IA 52241, USA. adaeze-akamigbo@uiowa.edu
Wolinsky
Frederic D
FD
D000367:Age Factors; D000368:Aged; D005260:Female; D006304:Health Status; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D009735:Nursing Homes; D010343:Patient Admission; D012307:Risk Factors; D012737:Sex Factors; D012944:Social Support; D012959:Socioeconomic Factors