Patterns and Predictors of Transitions Across Residential Care Settings and Nursing Homes Among Community-Dwelling Older Adults in the United States

Abstract

Background and Objectives Older adults prefer to age in place, but sociodemographic, health, and socioeconomic factors may influence their decision to remain in the community. Guided by Andersen’s behavioral model, we characterize incident transitions out of the community into residential care settings or nursing homes and identify predictors of these transitions. Research Design and Methods Study participants include 2,725 (weighted n=13,704,390) community-dwelling U.S. older adults of the National Health and Aging Trends Study from 2011 to 2018. We examined the associations between sociodemographic, socioeconomic and health factors and the probability of transition using a multinomial logit model. Result 86.2% of older adults remained in the community, whereas 9.0% and 4.9% transitioned to residential care settings and nursing homes, respectively. Older age, living alone, having functional and cognitive limitations, and hospitalization were associated with increased risk of transitioning to residential care settings or nursing homes from the community. Blacks and Hispanics were less likely to transition to residential care settings or nursing homes. Adults with lower income had a greater risk of transitioning to nursing homes. Medicaid enrollment did not impact the likelihood of transition. Discussion and Implications Majority of older adults remained in the community and incident transition to residential care settings was more common than to nursing homes. Policy should target sociodemographic, health, and socioeconomic factors that enable older adults to age in place. Future work should examine whether these new residential care settings enhance quality of life or result in subsequent transitions back into the community.

Healthcare Professionals’ Perceptions of Loneliness amongst Older Adults: A Qualitative Study

“…This results in limited social interactions [51] due to physical consequences such as decreased mobility [52] or due to the architectural impediments of their surroundings [53][54][55]. However, cultural factors or negatives ideas surrounding care homes lead to some older adults preferring being lonely within their own homes than being in the company of people they do not know [56,57]. Nevertheless, the discomfort and the measures taken to fight loneliness are, to a great extent, determined by the decision-making process of the older adults [58,59], hence why some of the participants referred to health conditions or the circumstances of family members as being deciding factors in older adults, leading older adults to suffer imposed loneliness [56,58,60].…”

“…However, cultural factors or negatives ideas surrounding care homes lead to some older adults preferring being lonely within their own homes than being in the company of people they do not know [56,57]. Nevertheless, the discomfort and the measures taken to fight loneliness are, to a great extent, determined by the decision-making process of the older adults [58,59], hence why some of the participants referred to health conditions or the circumstances of family members as being deciding factors in older adults, leading older adults to suffer imposed loneliness [56,58,60]. This also occurs when their economic resources are limited and they are not able to access professional care to mitigate loneliness [56,58,61], as well as when there is a lack of availability in care homes [62].…”

Community health worker interventions for older adults with complex health needs: A systematic review

“…Search terms for CHWs were kept broad given the variability in titles used to describe this type of interventionist, and were based on search strategies used in previous systematic reviews of CHW interventions 16,17,25,28‐32 . For complex health needs, we searched for terms related to multimorbidity, frailty, disability, and high‐utilization as four broad, often overlapping categories associated with complex needs and adverse outcomes in older adults 2‐12 …”

Revisiting the Role of Physicians in Assisted Living and Residential Care Settings

“…Cognitive decline and dementia progression can lead to numerous care transitions, which are associated with declines in health and quality of life for people living with dementia (PLWD) and their caregivers (Chyr et al, 2020; Ryman et al, 2018). Older adults and their families may seek advice from their physicians as they decide whether to move into an AL/RC (Alzheimer’s Association, 2020; Chen et al, 2008; Reinardy & Kane, 2003).…”