Length of Stay for Older Adults Residing in Nursing Homes at the End of Life

Veterans Affairs Medical Center, San Francisco, California, USA.
Journal of the American Geriatrics Society (Impact Factor: 4.57). 09/2010; 58(9):1701-6. DOI: 10.1111/j.1532-5415.2010.03005.x
Source: PubMed


To describe lengths of stay of nursing home decedents.
Retrospective cohort study.
The Health and Retirement Study (HRS), a nationally representative survey of U.S. adults aged 50 and older.
One thousand eight hundred seventeen nursing home residents who died between 1992 and 2006.
The primary outcome was length of stay, defined as the number of months between nursing home admission and date of death. Covariates were demographic, social, and clinical factors drawn from the HRS interview conducted closest to the date of nursing home admission.
The mean age of decedents was 83.3 ± 9.0; 59.1% were female, and 81.5% were white. Median and mean length of stay before death were 5 months (interquartile range 1-20) and 13.7 ± 18.4 months, respectively. Fifty-three percent died within 6 months of placement. Large differences in median length of stay were observed according to sex (men, 3 months vs women, 8 months) and net worth (highest quartile, 3 months vs lowest quartile, 9 months) (all P <.001). These differences persisted after adjustment for age, sex, marital status, net worth, geographic region, and diagnosed chronic conditions (cancer, hypertension, diabetes mellitus, lung disease, heart disease, and stroke).
Nursing home lengths of stay are brief for the majority of decedents. Lengths of stay varied markedly according to factors related to social support.

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Available from: John Boscardin, Feb 17, 2015
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    • "Dual-eligible beneficiaries are more likely to live alone (Howell et al. 2007; Cai, Salmon, and Rodgers 2009; Martikainen et al. 2009; Kelly et al. 2010) and have lower socio-economic status (Martikainen et al. 2009), lower household's net worth (Kelly et al. 2010), higher dissatisfaction with living conditions at home (Howell et al. 2007), and lower rates of home ownership (Cai, Salmon, and Rodgers 2009). Third, dual eligibles are more likely to have poorer health status (Howell et al. 2007; Cai, Salmon, and Rodgers 2009; Martikainen et al. 2009; Kelly et al. 2010). Such difference in health status is likely to contribute to the difference in nursing home length of stay. "
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    • "For many older adults, the costs shown in this study over the first year may in fact be an accurate reflection of the true costs of long-term residency. Results from other settings suggest that virtually all elderly residents do not return to the community following placement in a long-term care facility;(38) between 45%(39) and 65%(40) die within the first year, while upwards of 30% can remain in institutional care for three years or more.(39) "
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    • "Second, dual eligibility is highly correlated with the factors that are documented to prolong nursing home length of stay. Such factors include living alone (Cai, Salmon, & Rodgers, 2009; Howell, Silberberg, Quinn, & Lucas, 2007; Kelly et al., 2010; Martikainen et al., 2009), low socioeconomic status (Martikainen et al., 2009), lower household's net worth (Kelly et al., 2010), dissatisfaction with living conditions at home (Howell et al., 2007), and lower rates of home ownership (Cai et al., 2009). Thus, quality of living at nursing home relative to that in community is higher for dual-eligibles than for Medicare-only patients. "
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