title: Multilevel examination of facility characteristics, social integration, and health for older adults living in nursing homes.
abstract: OBJECTIVE
  Testing a model based on past research and theory, this study assessed relationships between facility characteristics (i.e., culture change efforts, social workers) and residents' social networks and social support across nursing homes; and examined relationships between multiple aspects of social integration (i.e., social networks, social capital, social engagement, social support) and mental and functional health for older adults in nursing homes.
  
  
  METHODS
  Data were collected at nursing homes using a planned missing data design with random sampling techniques. Data collection occurred at the individual-level through in-person structured interviews with older adult nursing home residents (N = 140) and at the facility-level (N = 30) with nursing home staff.
  
  
  RESULTS
  The best fitting multilevel structural equation model indicated that the culture change subscale for relationships significantly predicted differences in residents' social networks. Additionally, social networks had a positive indirect relationship with mental and functional health among residents primarily via social engagement. Social capital had a positive direct relationship with both health outcomes.
  
  
  CONCLUSIONS
  To predict better social integration and mental and functional health outcomes for nursing homes residents, study findings support prioritizing that close relationships exist among staff, residents, and the community as well as increased resident social engagement and social trust.
authors.affiliation: Departments of Human Development and Family Studies & Political Science, Aging and Health Faculty Fellows Program, University of Rhode Island.
authors.forename: Skye N
authors.initials: SN
authors.lastname: Leedahl
authors.affiliation: School of Social Welfare, Center for Research on Aging and Disability Options (CRADO), University of Kansas.
authors.forename: Rosemary K
authors.initials: RK
authors.lastname: Chapin
authors.affiliation: Department of Educational Psychology and Leadership, Institute for Measurement, Methodology, Analysis, and Policy (IMMAP), "Stats Camp," Texas Tech University.
authors.forename: Todd D
authors.initials: TD
authors.lastname: Little
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005195:Family Relations; D005260:Female; D006304:Health Status; D006707:Homes for the Aged / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007398:Interpersonal Relations; D007615:Kansas; D008297:Male; D008603:Mental Health / Q000706:statistics & numerical data*; D009735:Nursing Homes / Q000592:standards* / Q000706:statistics & numerical data; D011369:Professional-Patient Relations; D012111:Residence Characteristics / Q000706:statistics & numerical data; D066270:Social Capital; D012944:Social Support
keywords: Culture change; Nursing homes; Social engagement; Social networks; Structural equation modeling.