Social Support and Patterns of Institutionalization Among Older Adults: A Longitudinal Study

• Published in: Journal of the American Geriatrics Society (JAGS) 2019-12, Vol.67 (12), p.2622-2627
• Main Authors: Oh, Anna, Patel, Kanan, Boscardin, W. John, Max, Wendy, Stephens, Caroline, Ritchie, Christine S., Smith, Alexander K.
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Aged; Aged, 80 and over; Aging; Cognitive ability; Dementia disorders; Disability; Disabled Persons; Female; Humans; Institutionalization; Institutionalization - statistics & numerical data; Longitudinal Studies; Male; Medicaid; Medicaid - statistics & numerical data; Older people; Patient Transfer - statistics & numerical data; Prospective Studies; residential transitions; Sankey diagram; Social interactions; Social networks; Social organization; Social Support; Surveys and Questionnaires; United States
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/jgs.16184

OBJECTIVES To identify participants living at home and to estimate the risk of their transition into an institutional setting. DESIGN Prospective cohort study from the National Health and Aging Trends Study (NHATS), a nationally representative survey of US adults aged 65 and older. SETTING US national sample. PARTICIPANTS A total of 4712 NHATS participants were living at home in 2011. Residential transitions were described every year through 2017. MEASUREMENTS The primary outcome was transition time into an institutional setting. Primary predictors were social support factors (living spouse, lives with others, presence of social network, and participation in social activities). Covariates included age, sex, race, cognitive status, functional disability, multimorbidity, and Medicaid enrollment. A Fine and Gray hazards model estimated the risk of transition into an institutional setting, with death before institutionalization considered a competing risk. RESULTS In 2011, 4712 NHATS participants were living at home (78 ± 8 y; 57% female; 80% white; 10% probable dementia; 7% with three or more activities of daily living disabilities). By 2017, 58% remained at home, 17% had either transitioned to an institution or died in an institution, and 25% died before institutionalization. In multivariable analyses that adjusted for age, sex, race, cognitive status, functional disability, multimorbidity, and Medicaid enrollment, participants were more likely to move out of the home into an institution if they had no social network (0 vs three or more people; subhazard ratio [sHR] = 1.8; 95% confidence interval [CI] = 1.2–2.5; P = .003) or lived alone (sHR = 1.9; 95% CI = 1.6–2.2; P < .0001). Older adults who enjoyed going to the movies, dinner, or the casino and visiting family or friends had a lower probability of institutionalization compared with participants who did not enjoy these activities or did not visit family or friends (adjusted sHR = .7; 95% CI = .6–.9; adjusted sHR = .7; 95% CI = .6–.9, respectively). CONCLUSION Policy initiatives should target older adults with limited social support to reduce the risk of moving from home into an institution. J Am Geriatr Soc 67:2622–2627, 2019