Christina L Bell1, Andrea Z LaCroix2, Manisha Desai3, Haley Hedlin3, Stephen R Rapp4, Crystal Cene5, Jyoti Savla6, Tetyana Shippee7, Sylvia Wassertheil-Smoller8, Marcia L Stefanick9, Kamal Masaki10. 1. Department of Geriatric Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii. Electronic address: bellcl@hawaii.edu. 2. Women's Health Center of Excellence, Department of Family and Preventive Medicine, University of California, San Diego, California. 3. Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, California. 4. Department of Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina. 5. Division of General Internal Medicine and Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina. 6. Center for Gerontology and Department of Human Development, Virginia Tech, Blacksburg, Virginia. 7. Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota. 8. Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, Bronx, New York. 9. Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, California. 10. Department of Geriatric Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii. Electronic address: km1@hawaii.rr.com.
Abstract
BACKGROUND: We examined the social and economic factors associated with nursing home (NH) admission in older women, overall and poststroke. METHODS: The Women's Health Initiative (WHI) included women aged 50-79 years at enrollment (1993-1998). In the WHI Extension Study (2005-2010), participants annually reported any NH admission in the preceding year. Separate multivariate logistic regression models analyzed social and economic factors associated with long-term NH admission, defined as an admission on 2 or more questionnaires, overall and poststroke. RESULTS: Of 103,237 participants, 8904 (8.6%) reported NH admission (2005-2010); 534 of 2225 (24.0%) women with incident stroke reported poststroke NH admission. Decreased likelihoods of NH admission overall were demonstrated for Asian, Black, and Hispanic women (versus whites, adjusted odds ratio [aOR] = .35-.44, P < .001) and women with higher income (aOR = .75, 95% confidence interval [CI] = .63-.90), whereas increased likelihoods of NH admission overall were seen for women with lower social support (aOR = 1.34, 95% CI = 1.16-1.54) and with incident stroke (aOR = 2.59, 95% CI = 2.15-3.12). Increased odds of NH admission after stroke were demonstrated for women with moderate disability after stroke (aOR = 2.76, 95% CI = 1.73-4.42). Further adjustment for stroke severity eliminated the association found for race/ethnicity, income, and social support. CONCLUSIONS: The level of care needed after a disabling stroke may overwhelm social and economic structures in place that might otherwise enable avoidance of NH admission. We need to identify ways to provide care consistent with patients' preferences, even after a disabling stroke.
BACKGROUND: We examined the social and economic factors associated with nursing home (NH) admission in older women, overall and poststroke. METHODS: The Women's Health Initiative (WHI) included women aged 50-79 years at enrollment (1993-1998). In the WHI Extension Study (2005-2010), participants annually reported any NH admission in the preceding year. Separate multivariate logistic regression models analyzed social and economic factors associated with long-term NH admission, defined as an admission on 2 or more questionnaires, overall and poststroke. RESULTS: Of 103,237 participants, 8904 (8.6%) reported NH admission (2005-2010); 534 of 2225 (24.0%) women with incident stroke reported poststroke NH admission. Decreased likelihoods of NH admission overall were demonstrated for Asian, Black, and Hispanic women (versus whites, adjusted odds ratio [aOR] = .35-.44, P < .001) and women with higher income (aOR = .75, 95% confidence interval [CI] = .63-.90), whereas increased likelihoods of NH admission overall were seen for women with lower social support (aOR = 1.34, 95% CI = 1.16-1.54) and with incident stroke (aOR = 2.59, 95% CI = 2.15-3.12). Increased odds of NH admission after stroke were demonstrated for women with moderate disability after stroke (aOR = 2.76, 95% CI = 1.73-4.42). Further adjustment for stroke severity eliminated the association found for race/ethnicity, income, and social support. CONCLUSIONS: The level of care needed after a disabling stroke may overwhelm social and economic structures in place that might otherwise enable avoidance of NH admission. We need to identify ways to provide care consistent with patients' preferences, even after a disabling stroke.
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