What are the predictors of nursing home admission?
Nursing home admission has been on the rise in the United States since 1994, with most people being admitted after discharge from a hospital after surgery or a sudden illness.[1] While admitting a loved one into a nursing home can be difficult, sometimes it is necessary for the well-being of the loved one, as well as the well-being of the caregiver. The following predictors can help determine if a nursing home is the best option for your loved one.
Physical Disabilities
Disability or impairment with three or more activities of daily living (ADLs) is the most common factor that places older people into nursing homes.[1][2] Activities of daily living are the things we normally do on a daily basis, including any daily activity we perform for self-care.[3] The following are examples of ADLs.[4]
- Bathing
- Dressing and undressing
- Eating
- Transferring from bed to chair, and back
- Voluntarily control of urinary and fecal discharge
- Using the toilet
- Walking (not bedridden)
Instrumental ADLs
Unlike the tasks listed above, instrumental activities of daily living are not necessary for fundamental functioning, but they enable an individual to live independently within a community. The following are the six instrumental ADLs.[5]
- Light housework
- Preparing meals
- Taking medications
- Shopping for groceries or clothes
- Using the telephone
- Managing money
About one-fourth of nursing-home residents need help with one or two ADLs and three-fourths need assistance with three or more. More than half of residents are incontinent, and more than a third have difficulty with hearing or seeing.[1]
Cognitive Impairment
Aside from physical impairments, mental disturbances are common in nursing home residents with dementia affecting about 50 percent to 70 percent of residents.[1] Dementia is the gradual deterioration of intellectual abilities and behavior that eventually interfere with customary daily living activities, such as balancing the checkbook, driving the car, and engaging in social activities. Dementia can also contribute to changes in personality and emotions.[6] Additionally, more than three-fourths of nursing home residents have difficulty making daily decisions, and two-thirds have problems with memory or knowing where they are occasionally.[1]
Problematic behaviors, such as verbal and physical abuse, acting inappropriately in public, resisting necessary care, and wandering are also apparent in at least one-third of nursing home residents. Communication challenges, such as difficulty being understood and understanding others affect almost half of nursing home residents.[1]
Incapable Caregiver
At some point, caring for a loved one can take a heavy toll on the caregiver, even harming his or her well-being. A report published by the U.S. Department of Health and Human Services states that highly stressed caregivers are more likely to report being in fair or poor health and to have experienced a decline in health since becoming a caregiver.[7] Furthermore, the report found that caregiver stress is an important and highly significant predictor of nursing home entry and that having a highly stressed caregiver at baseline increases the likelihood of nursing home entry within one year by 12 percentage points, rising to about 17 percentage points for the two-year follow-up.[7] The report also discovered the following:
- Physical strain from caregiving is by far the strongest predictor of nursing home placement, raising the likelihood that a caregiver is highly stressed by 22 percentage points.
- Frequently having sleep disturbed by caregiving responsibilities or dealing with a recipient’s problem and financial hardship from caregiving are other important predictors.
Whether physical or cognitive impairments are affecting someone close to you, or you are no longer capable of providing the necessary caregiving assistance to an elder, Emeritus can ensure a safe and nurturing environment for your loved one.
References
1. The American Geriatrics Society Foundation for Health in Aging. (n.d.) Nursing Home Care. Retrieved May 30, 2009, from http://www.healthinaging.org/agingintheknow/chapters_print_ch_trial.asp?ch=15#Lives.
2. Gaugler, Joseph E, Duval, Sue, Anderson Keith A and Kane Robert L. (June 19, 2007). Predicting Nursing Home Admission in the U.S.: A Meta-Analysis. Retrieved June 1, 2009, from http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1914346.
3. MedicineNet.com. (October 21, 1998). Definition of ADLs (activities of daily living). Retrieved June 1, 2009, from http://www.medterms.com/script/main/art.asp?articlekey=2152.
4. McDowell, Ian and Newell, Claire. Measuring Health: A Guide to Rating Scales and Questionnaires, second edition. Oxford University Press, 1996.
5. Bookman, Ann, Harrington, Mona, Pass, L, and Reisner, Elizabeth. Family Caregiver Handbook. Massachusetts Institute of Technology, 2007.
6. Northwestern University. (February 12, 2005). Dementia: Causes, Symptoms, Diagnoses. Retrieved July 28, 2009, from http://www.brain.northwestern.edu/mdad/dementia.html.
7. Spillman, Brenda C and Long, Sharon K. (January 26, 2007). Does High Caregiver Stress Lead to Nursing Home Entry? Retrieved June 1, 2009, from http://aspe.hhs.gov/daltcp/reports/2007/NHentry.htm.
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