title: Factors Associated with Nursing Home Admission after Stroke in Older Women.
abstract: BACKGROUND
  We examined the social and economic factors associated with nursing home (NH) admission in older women, overall and poststroke.
  
  
  METHODS
  The Women's Health Initiative (WHI) included women aged 50-79 years at enrollment (1993-1998). In the WHI Extension Study (2005-2010), participants annually reported any NH admission in the preceding year. Separate multivariate logistic regression models analyzed social and economic factors associated with long-term NH admission, defined as an admission on 2 or more questionnaires, overall and poststroke.
  
  
  RESULTS
  Of 103,237 participants, 8904 (8.6%) reported NH admission (2005-2010); 534 of 2225 (24.0%) women with incident stroke reported poststroke NH admission. Decreased likelihoods of NH admission overall were demonstrated for Asian, Black, and Hispanic women (versus whites, adjusted odds ratio [aOR] = .35-.44, P < .001) and women with higher income (aOR = .75, 95% confidence interval [CI] = .63-.90), whereas increased likelihoods of NH admission overall were seen for women with lower social support (aOR = 1.34, 95% CI = 1.16-1.54) and with incident stroke (aOR = 2.59, 95% CI = 2.15-3.12). Increased odds of NH admission after stroke were demonstrated for women with moderate disability after stroke (aOR = 2.76, 95% CI = 1.73-4.42). Further adjustment for stroke severity eliminated the association found for race/ethnicity, income, and social support.
  
  
  CONCLUSIONS
  The level of care needed after a disabling stroke may overwhelm social and economic structures in place that might otherwise enable avoidance of NH admission. We need to identify ways to provide care consistent with patients' preferences, even after a disabling stroke.
authors.affiliation: Department of Geriatric Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii. Electronic address: bellcl@hawaii.edu.
authors.forename: Christina L
authors.initials: CL
authors.lastname: Bell
authors.affiliation: Women's Health Center of Excellence, Department of Family and Preventive Medicine, University of California, San Diego, California.
authors.forename: Andrea Z
authors.initials: AZ
authors.lastname: LaCroix
authors.affiliation: Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, California.
authors.forename: Manisha
authors.initials: M
authors.lastname: Desai
authors.affiliation: Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, California.
authors.forename: Haley
authors.initials: H
authors.lastname: Hedlin
authors.affiliation: Department of Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Rapp
authors.affiliation: Division of General Internal Medicine and Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
authors.forename: Crystal
authors.initials: C
authors.lastname: Cene
authors.affiliation: Center for Gerontology and Department of Human Development, Virginia Tech, Blacksburg, Virginia.
authors.forename: Jyoti
authors.initials: J
authors.lastname: Savla
authors.affiliation: Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Tetyana
authors.initials: T
authors.lastname: Shippee
authors.affiliation: Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Wassertheil-Smoller
authors.affiliation: Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Marcia L
authors.initials: ML
authors.lastname: Stefanick
authors.affiliation: Department of Geriatric Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii. Electronic address: km1@hawaii.rr.com.
authors.forename: Kamal
authors.initials: K
authors.lastname: Masaki
mesh_terms: D000368:Aged; D015331:Cohort Studies; D004185:Disability Evaluation; D005006:Ethnicity; D005260:Female; D015577:Geriatric Assessment; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data*; D016017:Odds Ratio; D020521:Stroke / Q000453:epidemiology / Q000208:ethnology / Q000451:nursing*
keywords: Disability; ethnicity; institutionalization; long-term care; race; social support