title: Home accessibility, living circumstances, stage of activity limitation, and nursing home use.
abstract: OBJECTIVE
  To explore the influence of physical home and social environments and disability patterns on nursing home (NH) use.
  
  
  METHODS
  Longitudinal cohort study. Self- or proxy-reported perception of home environmental barriers accessibility, 5 stages expressing the severity and pattern of activities of daily living (ADLs) limitations, and other characteristics at baseline were applied to predict NH use within 2 years or prior to death through logistic regression.
  
  
  METHODS
  General community.
  
  
  METHODS
  Population-based, community-dwelling individuals (N=7836; ≥70y) from the Second Longitudinal Study of Aging interviewed in 1994 with 2-year follow-up that was prospectively collected.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  NH use within 2 years.
  
  
  RESULTS
  Perceptions of home environmental barriers and living alone were both associated with approximately 40% increased odds of NH use after adjustment for other factors. Compared with those with no limitations at ADL stage 0, the odds of NH use peaked for those with severe limitations at ADL stage III (odds ratio [OR]=3.12; 95% confidence interval [CI], 2.20-4.41), then declined sharply for those with total limitations at ADL stage IV (OR=.96; 95% CI, .33-2.81). Sensitivity analyses for missing NH use showed similar results.
  
  
  CONCLUSIONS
  Accessibility of home environment, living circumstance, and ADL stage represent potentially modifiable targets for rehabilitation interventions for decreasing NH use in the aging U.S. population.
authors.affiliation: Department of Biostatistics and Epidemiology, The Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA. mstinema@exchange.upenn.edu
authors.forename: Margaret G
authors.initials: MG
authors.lastname: Stineman
authors.forename: Dawei
authors.initials: D
authors.lastname: Xie
authors.forename: Joel E
authors.initials: JE
authors.lastname: Streim
authors.forename: Qiang
authors.initials: Q
authors.lastname: Pan
authors.forename: Jibby E
authors.initials: JE
authors.lastname: Kurichi
authors.forename: John T
authors.initials: JT
authors.lastname: Henry-Sánchez
authors.forename: Zi
authors.initials: Z
authors.lastname: Zhang
authors.forename: Debra
authors.initials: D
authors.lastname: Saliba
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001107:Architectural Accessibility; D002908:Chronic Disease; D006233:Persons with Disabilities; D004777:Environment; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D012307:Risk Factors; D012931:Social Environment; D012959:Socioeconomic Factors