School of Nursing, University of Michigan, Ann Arbor, Michigan, USA.
Applied Exercise Science, School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA.
J Am Geriatr Soc. 2024 Nov;72(11):3374-3384. doi: 10.1111/jgs.19147. Epub 2024 Aug 19.
Residents of assisted living facilities (ALF) transfer to a nursing home when they require a higher level of care, but limited research has examined risk factors for transfer to a nursing home. The aims of this study were to identify (1) baseline factors associated with transfer to a nursing home and (2) time-varying factors associated with transfer to a nursing home over 8 years, using a national dataset from the National Health Aging Trends Study (NHATS).
NHATS participants were included in this study if they: (1) resided in ALF from Round 1 (2011) through Round 8 (2018); (2) completed the sample person (SP) interview at baseline; (3) were admitted to ALF at age 65 years or older. We conducted Cox proportional hazards regression to examine candidate predictors (difficulty with basic activities of daily living (ADL), chronic conditions, hospitalization, sleep disturbances, mental health, physical performance, self-reported health, participation in social and physical activity, and sociodemographic) associated with transfer to a nursing home. Employing backward elimination, we built parsimonious final models for analysis.
The analytic sample included 970 participants of whom 143 transferred to nursing homes over 8 years. Those who had a better physical performance at baseline (HR = 0.83, 95% CI = 0.79-0.88) and were college educated (HR = 0.58, 95% CI = 0.36-0.92) demonstrated a significantly lower risk for transfer to a nursing home over 8 years. Residents who maintained physical activity (HR = 0.56, 95% CI = 0.37-0.86), better physical performance (HR = 0.87, 95% CI = 0.80-0.94), and difficulty with fewer basic ADLs (HR = 1.13, 95% CI = 1.02-1.26) were at lower risk for transfer to a nursing home over 8 years.
Our findings can be used to identify older adults in ALFs at risk of transfer to a nursing home. Strategies to promote physical function and physical activity could avoid/delay the need to transfer. Helping older residents to age in place will have important health and economic benefits.
当需要更高水平的护理时，居住在辅助生活设施 (ALF) 的居民会转移到养老院，但对转移到养老院的风险因素的研究有限。本研究的目的是确定 (1) 与转移到养老院相关的基线因素，以及 (2) 在 8 年内与转移到养老院相关的随时间变化的因素，使用来自国家健康老龄化趋势研究 (NHATS) 的全国性数据集。
本研究纳入了以下 NHATS 参与者：(1) 在第 1 轮（2011 年）至第 8 轮（2018 年）期间居住在 ALF 中；(2) 在基线时完成样本人员 (SP) 访谈；(3) 入 ALF 时年龄在 65 岁或以上。我们进行 Cox 比例风险回归分析，以检查与转移到养老院相关的候选预测因素（基本日常生活活动 (ADL) 困难、慢性疾病、住院、睡眠障碍、心理健康、身体表现、自我报告的健康、参与社会和身体活动以及社会人口统计学）。通过向后消除法，我们为分析建立了简洁的最终模型。
分析样本包括 970 名参与者，其中 143 名在 8 年内转移到养老院。那些在基线时身体表现更好的人（HR=0.83，95%CI=0.79-0.88）和受过大学教育的人（HR=0.58，95%CI=0.36-0.92）在 8 年内转移到养老院的风险显著降低。保持身体活动的居民（HR=0.56，95%CI=0.37-0.86）、身体表现更好的居民（HR=0.87，95%CI=0.80-0.94）和基本日常生活活动困难较少的居民（HR=1.13，95%CI=1.02-1.26）在 8 年内转移到养老院的风险较低。
我们的发现可用于识别有转移到养老院风险的 ALF 中的老年人。促进身体功能和身体活动的策略可以避免/延迟转移的需要。帮助老年居民就地养老将带来重要的健康和经济效益。
