Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #105813

Qian Cassie Cai, MS¹, J. Warren Salmon, PhD¹, Swu-Jane Lin, PhD², and Stephanie Y. Crawford, PhD². (1) School of Public Health, University of Illinois at Chicago, 1603 W. Taylor Street (MC923), Chicago, IL 60612, 312-996-0612, qcai3@uic.edu, (2) Department of Pharmacy Administration, University of Illinois at Chicago, 833 South Wood Street (MC871), Chicago, IL 60612

This study aims to identify the determinants of time to permanent nursing home admission, which will give insight into identifying elderly who are at higher risk of permanent nursing home admission. The data are from four waves of the Health Retirement Study (HRS) and Assets and Health Dynamics among the Oldest Old (AHEAD) surveys, which were measured in 1995, 1998, 2000 and 2002. Permanent nursing home admission was defined as stays for those who live in a nursing home exceeding three months from date of admission, as well as stays that do not lead to discharge to the community. Independent variables were selected on basis of Andersen's behavioral model and include predisposing factors, need factors, and enabling factors measured in 1995.

6318 subjects with complete data on all relevant variables were included in the multivariate Extended Cox model, using 0.05 as the level of significance, because it was found that the variable for baseline IADL violated the proportionality assumption. Older age (Hazard Ratio [HR] =1.112), persons with psychiatric illness (HR=1.346) and falls (HR=1.153), living alone (HR=2.4) as well as lower self-perceived health status had increased risk of permanent nursing home admission and were determinants of being permanently admitted sooner. In contrast, being African American (HR=0.628) or Hispanic (HR=0.259), less impaired cognitively, being married (HR=0.437) and owning a home (HR=0.863) decreased risk and delayed the nursing home admission. The effect of baseline IADL showed an increased risk on permanent nursing home admission; however, the magnitude of the increased risk lessened over the study period. Gender, education, income, Medicaid, ADL, stroke, and incontinence were not significant.

Findings can contribute to the policy considerations about variables that influence time to permanent nursing home admission and help the elderly plan for their future care. This study indicates that the time to nursing home admission may be delayed and the need for nursing home services may be prevented by providing more community-based services for the elderly such as the in-home supports, mental health services and health education; therefore, the elderly can remain in the community as long as possible. This study also advocates the reconsideration of more government funding distribution toward community-based services. Additional research is needed to understand the cultural factors that affect time to permanent nursing home admission.

Learning Objectives:

• 1)Assess the determinants of time to permanent nursing home admission among the community-based elderly population.
• 2)Develop the extended Cox model to analyze the effect of time-dependent variables on permanent nursing home admission.

Keywords: Nursing Homes, Elderly

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation