Risk factors for nursing home admissions and exits: a discrete-time hazard function approach
Article Abstract:
Several studies have looked at nursing home admissions, but most have measured only life-table data rather than individual characteristics as predictors of who is likely to enter a nursing home. Studies summarized in this article have found several predictors, particularly advanced age, to be useful. Only one found that women were at greater risk than men, but having a spouse or roommate reduced risk for both sexes. In general, mental or physical impairments or serious illness affecting the ability to carry out daily activities increased the likelihood of institutionalization. Analysis of 3,332 individuals admitted to nursing homes over a one-year period determined some of the individual characteristics of these patients. Three categories of factors were considered: need, enabling, and predisposing. Need factors included mental and physical disabilities that prevented the person from carrying out daily activities. An enabling factor was the supply of hospital beds in an area. Informal caregiving did not affect probability of admission, but was more likely to be associated with a lower probability of discharge, perhaps due to caregiver burnout. Income did not affect entry, but a higher income was associated with exit from the nursing home. Of the enabling factors, race and ethnicity were important, with blacks and Hispanics less likely to enter a nursing home than whites, either because of different values among those communities, or because of discrimination on the part of nursing homes. Blacks were also less likely to leave, once admitted. Homeowners were more likely to leave, either for financial reasons (heirs not wanting to draw down assets) or because the person had a place to go in the community. The ability to identify these individual and aggregate characteristics associated with greater likelihood of nursing home entry is a useful tool in planning and case management in targeting services to those most at risk, as well as in long-term planning and forecasting. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Journals of Gerontology
Subject: Seniors
ISSN: 0022-1422
Year: 1990
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Predictors of institutionalization among Alzheimer's disease victims with caregiving spouses
Article Abstract:
By the year 2000 the number of people in nursing homes will double, to over two million. The total dependent aged population will number almost 6.5 million. Studies indicate that the probability of being placed in an institution is greater than one in five, and may be close to one in three. By age 90 the probability is almost one in two. Certain characteristics make it more likely that a person will be placed in a nursing home, including being poor, female, white, childless, older, and living alone. Mental and physical health are also important, as are the characteristics of caregivers, and the burden on them. Two hundred twenty people who were married to victims of Alzheimer's disease, and who participated in a survey and a follow-up one year later were studied. The best single predictor of institutionalization was the desire, expressed on the first survey, to place the spouse in a nursing home. This suggests that the decision is a process, not an event, and intervention programs should help the caregiver to make the best decision, especially about when to give up care. There are personal and societal aspects to the commitment that must be considered. A larger number of children may provide more alternative roles for the caregiver, and as a consequence the decision to institutionalize the spouse and thus give up the caretaker role, is more easily accepted. Being Jewish is associated with greater likelihood of institutionalization, perhaps because Jews are less inclined to take on the caregiving role, or because other late-life family relationships exist. Another possible explanation is that Jewish nursing homes have a more positive image because they have generally been very innovative in environment and program development. Future research should concentrate not only on the aspects of the impaired person, but the stresses upon and personality traits of the caregiver. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Journals of Gerontology
Subject: Seniors
ISSN: 0022-1422
Year: 1990
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Other roles of caregivers: competing responsibilities or supportive resources
Article Abstract:
With the increasing number of elderly people in the population, family members are frequently taking on the role of caregiver. Caregivers are not professionals, but informal helpers, providing assistance to the old or disabled person with such essential activities as eating, dressing, and transportation to appointments. Providing this care can be enormously time-consuming, and both emotionally and physically draining. Caregivers frequently experience conflict among their various roles in life, as caregiving often interferes with employment, family obligations, and personal activities such as seeing friends. The research on caregiving has traditionally assumed that the roles played by caregivers other than caregiving put extra stress on the individual by competing for his or her time and energy. However, recent research has viewed these additional life roles as supportive resources that are actually beneficial to the caregiver's mental health. In this study, 173 elderly persons receiving assistance and the 135 caregivers who help them on an informal basis (spouses were excluded) were interviewed. Most of the caregivers were relatives, and over half were children of the elderly person. The results showed that additional roles played by caregivers did add to the burden they felt, but these roles (especially when they involved activities outside family life) were associated with greater caregiver well-being. For example, caregivers who were employed experienced less depression than those were not working. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Journals of Gerontology
Subject: Seniors
ISSN: 0022-1422
Year: 1989
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