Factors Associated with Nursing Home Admission after Stroke in Older Women

• Published in: Journal of stroke and cerebrovascular diseases Vol. 24; no. 10; pp. 2329 - 2337
• Main Authors: Bell, Christina L., MD, PhD, LaCroix, Andrea Z., PhD, Desai, Manisha, PhD, Hedlin, Haley, PhD, Rapp, Stephen R., PhD, Cene, Crystal, MD, Savla, Jyoti, PhD, Shippee, Tetyana, PhD, Wassertheil-Smoller, Sylvia, PhD, Stefanick, Marcia L., PhD, Masaki, Kamal, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2015
• Subjects: Aged; Cardiovascular; Cohort Studies; Disability; Disability Evaluation; Ethnicity; Female; Geriatric Assessment; Hospitalization - statistics & numerical data; Humans; institutionalization; Logistic Models; long-term care; Middle Aged; Neurology; Nursing Homes - statistics & numerical data; Odds Ratio; race; social support; Stroke - epidemiology; Stroke - ethnology; Stroke - nursing; Disability; institutionalization; social support; race; ethnicity; long-term care
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2015.06.013

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.