Facility ownership and mortality among older adults residing in care homes

• Published in: PloS one 2019-03, Vol.14 (3), p.e0197789-e0197789
• Main Authors: Damián, Javier, Pastor-Barriuso, Roberto, García-López, Fernando José, Ruigómez, Ana, Martínez-Martín, Pablo, de Pedro-Cuesta, Jesús
• Format: Article
• Language: English
• Subjects: Activities of daily living; Aged; Aged, 80 and over; Analysis; Biology and Life Sciences; Caregivers; Cohort Studies; Elderly; Female; Follow-Up Studies; Health aspects; Health Facilities, Proprietary - organization & administration; Health Facilities, Proprietary - statistics & numerical data; Homes for the Aged - organization & administration; Homes for the Aged - statistics & numerical data; Humans; Long-Term Care - organization & administration; Long-Term Care - statistics & numerical data; Male; Medicine and Health Sciences; Mortality; Nursing home patients; Nursing homes; Nursing Homes - organization & administration; Nursing Homes - statistics & numerical data; Ownership; People and Places; Physicians; Social Sciences; Spain; Spain - epidemiology
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0197789

Nursing or care home characteristics may have a long-term impact on the residents' mortality risks that has not been studied previously. The study's main objective was to assess the association between facility ownership and long-term, all-cause mortality. We conducted a mortality follow-up study on a cohort of 611 nursing-home residents in the city Madrid, Spain, from their 1998-1999 baseline interviews up to September 2013. Residents lived in three types of facilities: public, subsidized and private, which were also sub-classified according to size (number of beds). Residents' information was collected by interviewing the residents themselves, their caregivers and facility physicians. We used time-to-event multivariable models and inverse probability weighting to estimate standardized mortality risk differences. After a 3728 person-year follow-up (median/maximum of 4.8/15.2 years), 519 participants had died. In fully-adjusted models, the standardized mortality risk difference at 5 years of follow-up between medium-sized private facilities and large-sized public facilities was -18.9% (95% confidence interval [CI]: -33.4 to -4.5%), with a median survival (95% CI) of 3.6 (0.5 to 6.8) additional years. The fully-standardized 5-year mortality difference (95% CIs) between for-profit private facilities and not-for-profit public institutions was -15.1% (-31.1% to 0.9%), and the fully-standardized median survival difference (95% CIs) was 3.0 (-1.7 to 7.7) years. These results are compatible with an association between factors related with the ownership of facilities and the long-term mortality risk of their residents. One of these factors, the facility size, could partly explain this association.