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Predictors of Nursing Home Placement from Assisted Living Settings in Canada*

Published online by Cambridge University Press:  04 November 2013

Colleen J. Maxwell ,
Andrea Soo ,
David B. Hogan ,
Walter P. Wodchis ,
Erin Gilbart ,
Joseph Amuah ,
Misha Eliasziw ,
Brad Hagen  and
Laurel A. Strain
Colleen J. Maxwell*
Affiliation:
Schools of Pharmacy and Public Health & Health Systems, University of Waterloo
Andrea Soo
Affiliation:
Department of Community Health Sciences, University of Calgary
David B. Hogan
Affiliation:
Department of Community Health Sciences, University of Calgary Division of Geriatric Medicine, Department of Medicine, University of Calgary
Walter P. Wodchis
Affiliation:
Institute for Clinical Evaluative Sciences, Toronto Institute of Health Policy Management & Evaluation, University of Toronto
Erin Gilbart
Affiliation:
Department of Community Health Sciences, University of Calgary
Joseph Amuah
Affiliation:
Canadian Institute for Health Information, Ottawa
Misha Eliasziw
Affiliation:
Department of Public Health and Community Medicine, Tufts University
Brad Hagen
Affiliation:
Faculty of Health Sciences, University of Lethbridge
Laurel A. Strain
Affiliation:
Department of Sociology, University of Alberta
*
†Correspondence and requests for reprints should be sent to / La correspondance et les demandes de tirés-à-part doivent être adressées à: Colleen J. Maxwell, Ph.D. Schools of Pharmacy and Public Health & Health Systems University of Waterloo 200 University Avenue West Waterloo, ON N2L 3G1 (colleen.maxwell@uwaterloo.ca)
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Abstract

We sought to estimate the incidence of long-term care (LTC) placement and to identify resident- and facility-level predictors of placement among older residents of designated assisted living (AL) facilities in Alberta, Canada. Included were 1,086 AL residents from 59 facilities. Research nurses completed interRAI-AL resident assessments and interviewed family caregivers and administrators. Predictors of placement were identified with multivariable Cox proportional hazards models. The cumulative incidence of LTC admission was 18.3 per cent by 12 months. Significantly increased risk for placement was evident for older residents and those with poor social relationships, little involvement in activities, cognitive and/or functional impairment, health instability, recent falls and hospitalizations/emergency department visits, and severe bladder incontinence. Residents from larger facilities, with an LPN and/or RN on-site 24/7 and with an affiliated primary care physician, showed lower risk of placement. Our findings highlight clinical and policy areas where targeted interventions may delay LTC admissions.

Résumé

Cette étude visait à évaluer l’incidence de placement dans un établissement de soins de longue durée (SLD) et d’identifier les facteurs prédictifs de placement résidentiel et d’installation parmi résidents âgés dans établissements aidant à la vie autonome en Alberta, au Canada. 1,086 résidents de 59 installations en Alberta ont été inclus. Infirmières de recherche ont effectué des évaluations de résidents interRAI-AL et ont interrogé les aidants familiaux et les administrateurs. Les prédicteurs de placement ont été identifiés avec des modèles de risques proportionnels de Cox multivariés. L’incidence cumulative SLD de l’admission était de 18,3 pour cent en 12 mois. Le risque de placement a augmenté significativement pour les résidents âgés et ceux avec des relations sociales médiocres, peu d’implication dans les activités, la dépreciation cognitive et/ou fonctionnelle, l’instabilité de la santé,une histoire des chutes et des hospitalisations récentes/visites à l’urgence, et l’incontinence urinaire sévère. Une diminution du risque de placement a été montré pour les résidents de grandes établissements avec une infirmière autorisée et/ou une infirmière auxiliaire autorisée disponible 24 heures par jour et un médecin de premier recours affilié. Nos résultats font ressortir les domaines cliniques et politiques ou des interventions ciblées peuvent retarder les admissions SLD.

Keywords

agingassisted livinglong-term care placementstaffingquality of careCanadavieillissmentaide à la vie autonomeplacement dans un établissement de soins de longue duréepourvoir en personnelqualité de soinsCanada
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 32 , Issue 4 , December 2013 , pp. 333 - 348
Copyright
Copyright © Canadian Association on Gerontology 2013 

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Footnotes

*

Special thanks are given to Deanna Wanless, Anna Charlton, Cheri Komar (study coordinators); to Gary Teare, David Zimmerman, and Jean Parboosingh (study advisors); to our research staff; and to the facilities, residents, and their family members who participated in Alberta Continuing Care Epidemiological Studies (ACCES).

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