Abstract
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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 56-63 |
| Number of pages | 8 |
| Journal | Journal of the American Geriatrics Society |
| Volume | 66 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 1 2018 |
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Keywords
- cognitive status
- Medicare
- nursing home
- postacute care
- race and ethnicity
ASJC Scopus subject areas
- Geriatrics and Gerontology
Cite this
New Institutionalization in Long-Term Care After Hospital Discharge to Skilled Nursing Facility. / Middleton, Addie; Li, Shuang; Kuo, Yong Fang; Ottenbacher, Kenneth; Goodwin, James.
In: Journal of the American Geriatrics Society, Vol. 66, No. 1, 01.01.2018, p. 56-63.Research output: Contribution to journal › Article
}
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
AU - Goodwin, James
PY - 2018/1/1
Y1 - 2018/1/1
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 - cognitive status
KW - Medicare
KW - nursing home
KW - postacute care
KW - race and ethnicity
UR - http://www.scopus.com/inward/record.url?scp=85040819311&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85040819311&partnerID=8YFLogxK
U2 - 10.1111/jgs.15131
DO - 10.1111/jgs.15131
M3 - Article
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 -