Risk Factors of Skilled Nursing Facility Admissions and the Interrelation With Hospitalization and Amount of Informal Caregiving Received

Abstract

Background: The correlations between skilled nursing facility (SNF) admissions, number of hospitalizations, and informal caregiving hours received after adjusting for physical and cognitive function and sociodemographic covariates are not well understood. Objective: The objective of this study was to better understand risk factors for SNF admissions and the interrelation with hospitalizations and amount of informal caregiving received, this study applied a novel joint modeling analysis to simultaneously explore the correlation and shared information between the 3 outcomes. Research Design: This was an observational follow-up study. Subjects: Data from 4836 older Americans included in the 2011–2015 rounds of the National Health and Aging Trends Study were linked with Centers for Medicare & Medicaid Services. Measures: We jointly modeled SNF admission, hospital admissions, and informal caregiving hours received while accounting for possible risk factors. We addressed missing values by multiple imputation with chained equations. Results: SNF admission evidenced a strong positive correlation with hospital admission, and SNF admission evidenced a weak positive correlation with the informal caregiving hours received after adjustment for important risk factors. Non-Hispanic White race/ethnicity, living alone, not being Medicaid eligible, Alzheimer disease and related dementias diagnosis, activities of daily living disabilities, and frailty were associated with increased risk of SNF admissions and any/number of hospital admission. Lower educational level was also associated with the latter. Medicaid eligibility was the only factor not associated with any nor numbers of informal caregiving hours received. Conclusions: Sociodemographic and health factors were important for predicting SNF admissions. After adjustment for important risk factors, SNF evidenced a strong positive correlation with the number of hospitalizations and a weak positive correlation with the hours of informal caregiving received.

Longitudinal Care Network Changes and Associated Healthcare Utilization Among Care Recipients

“…Similarly, the findings regarding SNF admissions indicate that merely having caregivers, whether paid or unpaid, does not serve as a protective factor against institutionalization. This could be interpreted in two ways: either the presence of more caregivers is reflective of the care recipients' greater needs and complexity that necessitate SNF care (Britton et al, 2017;Cao et al, 2022), or it could indicate that caregivers were not adequately prepared or involved in discharge planning, leading to increased SNF admissions (Burke et al, 2017;Rodakowski et al, 2017;Toles et al, 2022). While our analyses point to an elevated risk of SNF admission concurrent with an increased number of caregivers, we lack the necessary information on caregiver preparedness and their integration into discharge planning to draw definitive conclusions.…”

Review and evaluation of imputation methods for multivariate longitudinal data with mixed‐type incomplete variables

“…In some studies, researchers are interested in examining the associations between multiple factors and multiple outcomes simultaneously. [59][60][61] This can be achieved by jointly modeling multiple outcomes. Compared to a univariate model, joint models are computationally more complex.…”