Length of Stay for Older Adults Residing in Nursing Homes at the End of Life

Authors

  • Anne Kelly MSW,

    1. From the Veterans Affairs Medical Center, San Francisco, California
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  • Jessamyn Conell-Price BA,

    1. Division of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, California.
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  • Kenneth Covinsky MD, MPH,

    1. From the Veterans Affairs Medical Center, San Francisco, California
    2. Division of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, California.
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  • Irena Stijacic Cenzer MA,

    1. From the Veterans Affairs Medical Center, San Francisco, California
    2. Division of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, California.
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  • Anna Chang MD,

    1. From the Veterans Affairs Medical Center, San Francisco, California
    2. Division of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, California.
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  • W. John Boscardin PhD,

    1. From the Veterans Affairs Medical Center, San Francisco, California
    2. Division of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, California.
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  • Alexander K. Smith MD, MS, MPH

    1. From the Veterans Affairs Medical Center, San Francisco, California
    2. Division of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, California.
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Address correspondence to Alexander K. Smith, Division of Geriatrics, UCSF, 4150 Clement St (181G), San Francisco, CA 94121. E-mail: aksmith@ucsf.edu

Abstract

OBJECTIVES: To describe lengths of stay of nursing home decedents.

DESIGN: Retrospective cohort study.

SETTING: The Health and Retirement Study (HRS), a nationally representative survey of U.S. adults aged 50 and older.

PARTICIPANTS: One thousand eight hundred seventeen nursing home residents who died between 1992 and 2006.

MEASUREMENTS: The primary outcome was length of stay, defined as the number of months between nursing home admission and date of death. Covariates were demographic, social, and clinical factors drawn from the HRS interview conducted closest to the date of nursing home admission.

RESULTS: The mean age of decedents was 83.3±9.0; 59.1% were female, and 81.5% were white. Median and mean length of stay before death were 5 months (interquartile range 1–20) and 13.7±18.4 months, respectively. Fifty-three percent died within 6 months of placement. Large differences in median length of stay were observed according to sex (men, 3 months vs women, 8 months) and net worth (highest quartile, 3 months vs lowest quartile, 9 months) (all P<.001). These differences persisted after adjustment for age, sex, marital status, net worth, geographic region, and diagnosed chronic conditions (cancer, hypertension, diabetes mellitus, lung disease, heart disease, and stroke).

CONCLUSION: Nursing home lengths of stay are brief for the majority of decedents. Lengths of stay varied markedly according to factors related to social support.

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