Predictors of Nursing Home Admission in the Older Population in Belgium

Abstract

BackgroundThis study examines the risk factors associated with nursing home admission (NHA) in Belgium to contribute to a better planning of the future demand for nursing home (NH) services and health care resources.MethodsIndividual level linkage of the 2013 Belgian health interview survey data and health insurance data (2012 to 2018) was done. Only non-institutionalized participants, aged ≥65 years at the time of the survey were included in this study (n=1930). Participants were followed until NHA, death or end of study period, i.e., December 31, 2018. The risk of NHA was calculated using a competing risk analysis.ResultsOver the follow-up period (median 5.29 years), 226 individuals were admitted to a NH and 268 died without admission to a NH. The overall cumulative risk of NHA was 1.4%, 5.7% and 13.1% at, respectively 1 year, 3 years and the end of follow-up. After multivariable adjustment, higher age, low educational attainment, belonging to low income household, living alone, use of home care services and a number of need factor (e.g., history of falls, suffering from urinary incontinence, depression or Alzheimer disease, etc.) were significantly associated with a higher risk of NHA, while female, individuals with multimorbidity and increased contacts with health care providers were significantly associated with a decreased risk of NHA. Subjective health and limitations are both significant determinants of NHA, but subjective health is an effect modifier on the effect of limitations and vice versa.ConclusionsOur findings pinpoint important predictors of NHA in older adults, and offer possibilities of prevention to avoid or delay NHA for this population. The strong impact of need factors on the risk of NHA may indicate equitable access to NHA (i.e., those in need for support have access to NH). Practical implications include prevention of falls and appropriate and timely management of physical chronic conditions and neurodegenerative disorders. Focus should also be on people living alone to provide the appropriate social support and/or home care services. Further investigation of predictors of NHA should include contextual factors such as the availability of nursing-home beds, hospital beds, physicians and waiting lists for NHA.