Objective

To explore the association between baseline life-space mobility and nursing home (NH) admission among community-dwelling older adults over 6 years.

Methods

Using data from a prospective, observational cohort study consisting of a random sample of 1,000 Medicare beneficiaries ≥ 65 years of age stratified by race (African American and non-Hispanic White), sex, and rural/urban residence. Baseline life-space mobility was assessed during in-home interviews. Participants were contacted by telephone every 6 months to ascertain NH admissions, Life-Space Assessment (LSA) scores, and vital status (living or deceased). Using multivariate logistic regression, the significance and independence of the relationship of life-space mobility with NH admission were examined.

Results

Over 6 years, the odds of NH admission increased 2% for every one point lower baseline life-space score independent of previously recognized risk factors.

Discussion

The LSA may be a useful tool to identify older adults at risk of NH admission.

Context

Symptom burden has been associated with functional decline in community-dwelling older adults and may be responsive to interventions. Known predictors of nursing home (NH) admission are often nonmodifiable.

Objectives

To determine if symptom burden independently predicted NH admission among community-dwelling older adults over an eight and a half-year follow-up period.

Methods

A random sample of community-dwelling Medicare beneficiaries in Alabama, stratified by race, gender, and rural/urban residence had baseline in-home assessments of sociodemographic measurements, Charlson comorbidity count, and symptoms. Symptom burden was derived from a count of 10 patient-reported symptoms. Nursing home admissions were determined from telephone interviews conducted every six months over the eight and a half years of study. Cox proportional hazard modeling was used to examine the significance of symptom burden as a predictor for NH admission after adjusting for other variables.

Results

The mean ± SD age of the sample (N = 999) was 75.3 ± 6.7 years, and the sample was 51% rural, 50% African American, and 50% male. Thirty-eight percent (n = 380) had symptom burden scores ≥2. Seventy-five participants (7.5%) had confirmed dates for NH admission during the eight and a half years of follow-up. Using Cox proportional hazard modeling, symptom burden remained an independent predictor of time to NH placement (hazard ratio = 1.11; P = 0.02), even after adjustment for comorbidity count, race, sex, and age.

Conclusion

Symptom burden is an independent risk factor for NH admission. Aggressive management of symptoms in older adults may reduce or delay NH admission.