title: Health of Older Adults in Assisted Living and Implications for Preventive Care.
abstract: Older adults in residential care and assisted living (RC/AL) are less healthy than the general elderly population, and some have needs similar to those in nursing homes, making this an important group in which to assess potential overuse or underuse of preventive services. We determined the health status of RC/AL residents and distinguished characteristics between those who may and may not benefit from preventive services requiring a life expectancy ≥5 years.
  
  
  
  Cross-sectional survey of a nationally representative sample of RC/AL residents using 2010 data from the National Survey of Residential Care Facilities. The primary outcome was the weighted frequency distribution of health states using three predictive mortality indices: Charlson Comorbidity Index, 4-year mortality index, and 9-year mortality index.
  
  
  
  A total of 666,700 of 733,300 (weighted) residents met criteria for inclusion. Based on the three indices, 10%-15% were in good health, 11%-70% in intermediate health, and 20%-76% in poor health.
  
  
  
  Using triangulation between 3 well-validated mortality indices, 10%-15% of RC/AL residents are in good health and highly likely to benefit from preventive services that require ≥5 year life expectancy. In addition, many residents have uncertain benefit and would benefit from shared decision making.
authors.affiliation: Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill.|Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill.
authors.forename: Christine E
authors.initials: CE
authors.lastname: Kistler
authors.affiliation: Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill.|School of Social Work, University of North Carolina at Chapel Hill.
authors.forename: Sheryl
authors.initials: S
authors.lastname: Zimmerman
authors.affiliation: Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill.
authors.forename: Kimberly T
authors.initials: KT
authors.lastname: Ward
authors.affiliation: Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill.
authors.forename: David
authors.initials: D
authors.lastname: Reed
authors.affiliation: Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill.|Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill.
authors.forename: Carol
authors.initials: C
authors.lastname: Golin
authors.affiliation: Department of Medicine, School of Medicine, University of Colorado, Denver.
authors.forename: Carmen L
authors.initials: CL
authors.lastname: Lewis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D040561:Assisted Living Facilities; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D009026:Mortality; D011314:Preventive Health Services; D011315:Preventive Medicine; D011795:Surveys and Questionnaires
keywords: Assisted living; Likelihood of benefit; Mortality indices; Preventive services