Predictors of Institutionalization in Older Adults Living in Community: Findings from the National Study of Caregiving and the National Health Aging and Trend Study

Background and Purpose: Demographic changes such as smaller family sizes, more women in the workforce, rapid growth of people 65+, especially the oldest old group, and longer life expectancy but high rates of chronic illnesses and dementia will lead to a rise the number of older adults in need of institutionalized care.  The majority of older adults would prefer to age in place in the community  since care in institutional settings can result in the loss of personal attachment to community and home, public and private financial burden, questionable quality of care, and high rate of mortality after admission.

As for informal caregivers (CGs), they may experience a reduction in everyday care provision after institutionalization of a care recipient (CR). However, they may experience stress symptoms or depression and other care tasks (e.g., family visits, care participation, discussions with staff). While predictors (e.g. age, functional status, cognitive status) of nursing home admission among older people with dementia have well known, few studies have analyzed predictors of nursing home admission using national data on elder persons with a wide range of disabling conditions (not solely dementia).  Also, fewer studies have paid attention to CG factors that influence the transition into residential care for community dwelling older adults.  On the basis of the behavioral model (Andersen et al.1986), this study includes predisposing Variables, Need variables, and Enabling variables.

Methods:  Data is drawn from the National Study of Caregiving (NSOC) and the first and third waves of the National health aging and trend study (NHAT) and includes 846 CGs and 846 their CRs. Binary logistic regression analysis was used to identify CGs’ characteristics (predisposing: gender, need: lack of energy, and enabling variables : relationship quality with older adults) at wave 1 , and community dwelling CR’s characteristics (predisposing: gender, race, living with someone, need:  level of difficulties with laundry, banking, meal preparation, bathing, and eating, feeling of depression, no dementia, and enabling variables (older persons’ living arrangement)  at wave 1 that  impact residential status care at wave 3.

 

Results: Twenty three percentage of the sample was institutionalized during the 3 years. Baseline characteristics associated with a status change were predisposing variables (i.e. older age, being white), need variables ( i.e. older persons’ higher level of problem with bathing, having no dementia status,  older persons’ higher level of feeling of depression & CG’s lack of energy due to  caregiving) , and enabling variables ( CG’s worse relationship quality with older person).

 

Conclusions and Implications:

Intervention strategies that focus on alleviating the stress of caregiving on other life domains (work and other family obligations), relationship quality of the CG and CR, and improving the psychological well-being of older persons will help prevent or delay the transition to institutional settings.  At the macro level, policies supporting caregiver workplace leave can offset institutionalization, which can be costly to families and government.   Expanding community-level mental health services to both caregivers and older adults and initiating community respite programs can also reduce the risk for institutionalization.