TY - JOUR
T1 - New Institutionalization in Long-Term Care After Hospital Discharge to Skilled Nursing Facility
AU - Middleton, Addie
AU - Li, Shuang
AU - Kuo, Yong Fang
AU - Ottenbacher, Kenneth J.
AU - Goodwin, James S.
N1 - Funding Information:
Financial Disclosure: The study was supported by National Institutes of Health Grants R01AG33134, K05CA134923, R01HD069443, K12HD055929, U54GM104941, P2CHD065702, and P30AG024832; Agency for Healthcare Research and Quality Grant R24HS22134; and a Foundation for Physical Therapy Center of Excellence in Physical Therapy Health Services and Health Policy Research and Training Grant.
Funding Information:
Financial Disclosure: The study was supported by National Institutes of Health Grants R01AG33134, K05CA134923, R01HD069443, K12HD055929, U54GM104941, P2CHD065702, and P30AG024832; Agency for Healthcare Research and Quality Grant R24HS22134; and a Foundation for Physical Therapy Center of Excellence in Physical Therapy Health Services and Health Policy Research and Training Grant. Conflict of Interest: The authors have no financial or personal conflicts of interest to disclose. Author Contributions: Study concept and design: All authors. Acquisition of data: Goodwin. Analysis and interpretation of data: All authors. Preparation of the manuscript: Middleton. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: Li, Kuo. Obtained funding: Goodwin. Study supervision: Goodwin. Sponsor's Role: The funding organizations had no role in the design of the study; the collection, management, analysis, and interpretation of the data; or the preparation of the manuscript.
Publisher Copyright:
© 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society
PY - 2018/1
Y1 - 2018/1
N2 - Background/Objectives: Approximately half of individuals newly admitted to long-term care (LTC) nursing homes (NHs) experienced a prior hospitalization followed by discharge to a skilled nursing facility (SNF). The objective was to examine characteristics associated with new institutionalizations of older adults on this care trajectory. Design: Retrospective cohort study. Setting: SNFs and LTC NHs. Patients: Medicare fee-for-service beneficiaries admitted to 7,442 SNFs in 2013 (N = 597,986). Measurements: We used demographic and clinical characteristics from Medicare data and the Minimum Data Set. We defined “new institutionalization” as LTC NH residence for longer than 90 non-SNF days, starting within 6 months of hospital discharge. Results: For individuals who survived 6 months after hospital discharge, the overall rate of new LTC institutionalizations was 10.0% (N = 59,736). Older age, white race, being unmarried, Medicaid eligibility, higher income, more comorbidities, cognitive impairment, depression, functional limitations, hallucinations and delusions, aggressive behavior, incontinence, and pressure ulcers were associated with higher adjusted odds of new LTC institutionalization. In analyses stratified according to race and ethnicity, higher income was associated with lower odds of LTC institutionalization for whites (odds ratio (OR) = 0.92, 95% confidence interval (CI) = 0.89–0.96) and greater odds for blacks (OR = 1.40, 95% CI = 1.27–1.55) and Hispanics (OR = 1.44, 95% CI = 1.25–1.66). Moderate or severe depression, functional limitations, hallucinations and delusions, aggressive behavior, and being unmarried were stronger risk factors for LTC for cognitively intact individuals than for those with moderate to severe cognitive impairment. Being unmarried and having more comorbidities were stronger predictors in those aged 66 to 70 than in those aged 81 to 85 and 91 and older. Conclusion: Associations between risk factors and new LTC institutionalizations varied according to race and ethnicity, age, and level of cognitive function. Programs that target older adults at greater risk may be an effective strategy for reducing new institutionalizations and fostering aging in place.
AB - Background/Objectives: Approximately half of individuals newly admitted to long-term care (LTC) nursing homes (NHs) experienced a prior hospitalization followed by discharge to a skilled nursing facility (SNF). The objective was to examine characteristics associated with new institutionalizations of older adults on this care trajectory. Design: Retrospective cohort study. Setting: SNFs and LTC NHs. Patients: Medicare fee-for-service beneficiaries admitted to 7,442 SNFs in 2013 (N = 597,986). Measurements: We used demographic and clinical characteristics from Medicare data and the Minimum Data Set. We defined “new institutionalization” as LTC NH residence for longer than 90 non-SNF days, starting within 6 months of hospital discharge. Results: For individuals who survived 6 months after hospital discharge, the overall rate of new LTC institutionalizations was 10.0% (N = 59,736). Older age, white race, being unmarried, Medicaid eligibility, higher income, more comorbidities, cognitive impairment, depression, functional limitations, hallucinations and delusions, aggressive behavior, incontinence, and pressure ulcers were associated with higher adjusted odds of new LTC institutionalization. In analyses stratified according to race and ethnicity, higher income was associated with lower odds of LTC institutionalization for whites (odds ratio (OR) = 0.92, 95% confidence interval (CI) = 0.89–0.96) and greater odds for blacks (OR = 1.40, 95% CI = 1.27–1.55) and Hispanics (OR = 1.44, 95% CI = 1.25–1.66). Moderate or severe depression, functional limitations, hallucinations and delusions, aggressive behavior, and being unmarried were stronger risk factors for LTC for cognitively intact individuals than for those with moderate to severe cognitive impairment. Being unmarried and having more comorbidities were stronger predictors in those aged 66 to 70 than in those aged 81 to 85 and 91 and older. Conclusion: Associations between risk factors and new LTC institutionalizations varied according to race and ethnicity, age, and level of cognitive function. Programs that target older adults at greater risk may be an effective strategy for reducing new institutionalizations and fostering aging in place.
KW - Medicare
KW - cognitive status
KW - nursing home
KW - postacute care
KW - race and ethnicity
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U2 - 10.1111/jgs.15131
DO - 10.1111/jgs.15131
M3 - Article
C2 - 29112226
AN - SCOPUS:85040819311
VL - 66
SP - 56
EP - 63
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
SN - 0002-8614
IS - 1
ER -