title: Predictors of Nursing Home Placement from Assisted Living Settings in Canada.
abstract: We sought to estimate the incidence of long-term care (LTC) placement and to identify resident- and facility-level predictors of placement among older residents of designated assisted living (AL) facilities in Alberta, Canada. Included were 1,086 AL residents from 59 facilities. Research nurses completed interRAI-AL resident assessments and interviewed family caregivers and administrators. Predictors of placement were identified with multivariable Cox proportional hazards models. The cumulative incidence of LTC admission was 18.3 per cent by 12 months. Significantly increased risk for placement was evident for older residents and those with poor social relationships, little involvement in activities, cognitive and/or functional impairment, health instability, recent falls and hospitalizations/emergency department visits, and severe bladder incontinence. Residents from larger facilities, with an LPN and/or RN on-site 24/7 and with an affiliated primary care physician, showed lower risk of placement. Our findings highlight clinical and policy areas where targeted interventions may delay LTC admissions.
authors.affiliation: Schools of Pharmacy and Public Health & Health Systems, University of Waterloo, Waterloo, ON N2L 3G1. colleen.maxwell@uwaterloo.ca
authors.forename: Colleen J
authors.initials: CJ
authors.lastname: Maxwell
authors.affiliation: Department of Community Health Sciences, University of Calgary.
authors.forename: Andrea
authors.initials: A
authors.lastname: Soo
authors.affiliation: Department of Community Health Sciences, University of Calgary.
authors.forename: David B
authors.initials: DB
authors.lastname: Hogan
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto.
authors.forename: Walter P
authors.initials: WP
authors.lastname: Wodchis
authors.affiliation: Department of Community Health Sciences, University of Calgary.
authors.forename: Erin
authors.initials: E
authors.lastname: Gilbart
authors.affiliation: Canadian Institute for Health Information, Ottawa.
authors.forename: Joseph
authors.initials: J
authors.lastname: Amuah
authors.affiliation: Department of Public Health and Community Medicine, Tufts University.
authors.forename: Misha
authors.initials: M
authors.lastname: Eliasziw
authors.affiliation: Faculty of Health Sciences, University of Lethbridge.
authors.forename: Brad
authors.initials: B
authors.lastname: Hagen
authors.affiliation: Department of Sociology, University of Alberta.
authors.forename: Laurel A
authors.initials: LA
authors.lastname: Strain
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D000374:Aggression; D000416:Alberta / Q000453:epidemiology; D040561:Assisted Living Facilities; D002170:Canada; D060825:Cognitive Dysfunction / Q000453:epidemiology*; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008134:Long-Term Care; D008297:Male; D015999:Multivariate Analysis; D009735:Nursing Homes; D010360:Patient Transfer / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D058992:Social Participation; D014549:Urinary Incontinence / Q000453:epidemiology*