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Socially-isolated neighborhoods and the risk of all-cause mortality among nursing home residents in the United States: A multilevel study.

ABSTRACT: The total number of Americans age 65 and older is expected to nearly double by 2060, and the number of Americans admitted to nursing homes is likewise anticipated to escalate. Studies have found living alone to be an important risk factor for mortality. Yet little is known about possible spillover health effects of living in a community where many elderly residents live alone. Even less is known about whether these risks persist after entering nursing homes. Our study population consisted of 874,162 US elderly adults newly admitted to nursing homes in 2011, as identified from the 3.0 Minimum Data Set. Data on these individuals were linked to Medicare claims and 2010 Census data. In this cohort study, we estimated multivariable-adjusted hazard ratios for the associations between the quartiles of county-level percentage of households with those age 65 or older living alone and the individual-level risks of all-cause mortality until December 31, 2013, controlling for county-, nursing home facility-, and individual-level factors. Older adults in counties belonging to the highest quartile of elderly single-occupancy households had a 8% higher risk of dying (HR = 1.08; 95% CI = 1.04-1.12, p < 0.001) after entering nursing homes compared to those in counties belonging to the lowest quartile. There was evidence of a linear trend (p for trend < 0.001). Should these findings be confirmed in future studies, it would suggest that living arrangements in elderly communities may have spillover health effects onto their residents. Programs and interventions that modify such living arrangements may yield more favorable health trajectories among older Americans, who are increasingly aging in place and at growing risk of entering nursing homes.

SUBMITTER: Kim D

PROVIDER: S-EPMC7804969 | biostudies-literature | 2021 Mar

REPOSITORIES: biostudies-literature

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Socially-isolated neighborhoods and the risk of all-cause mortality among nursing home residents in the United States: A multilevel study.

Kim Daniel D Park Chanhyun C Briesacher Becky A BA

Preventive medicine reports 20201213

The total number of Americans age 65 and older is expected to nearly double by 2060, and the number of Americans admitted to nursing homes is likewise anticipated to escalate. Studies have found living alone to be an important risk factor for mortality. Yet little is known about possible spillover health effects of living in a community where many elderly residents live alone. Even less is known about whether these risks persist after entering nursing homes. Our study population consisted of 874 ...[more]

PMID: 33489720

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Project description:BackgroundLow nursing home staffing in the United States is a growing safety concern. Socioeconomic deprivation in the local areas surrounding a nursing home may be a barrier to improving staffing rates but has been poorly studied. Thus, the objective of this paper was to assess the relationship between neighborhood deprivation and nursing home staffing in the United States.MethodsThis cross-sectional study used 2018 daily payroll-based staffing records and address data for 12,609 nursing homes in the United States linked with resident assessment data. Our primary exposure of interest was severe economic deprivation at the census block group (neighborhood) level, defined as an area deprivation index score ≥85/100. The primary outcome was hours worked per resident-day among nursing home employees providing direct resident care. Marginal linear regression models and generalized estimating equations with robust sandwich-type standard errors were used to estimate associations between severe neighborhood deprivation and staffing rates.ResultsCompared to less deprived neighborhoods, unadjusted staffing rates in facilities located within severely deprived neighborhoods were 38% lower for physical and occupational therapists, 30% lower for registered nurses (RNs), and 5% lower for certified nursing assistants. No disparities in licensed practical nurse (LPN) staffing were observed. In models with state-level and rurality fixed effects and clustered on the county, a similar pattern of disparities was observed. Specifically, RN staffing per 100 resident-days was significantly lower in facilities located within severely deprived neighborhoods as compared to those in less deprived areas (mean difference: 5.6 fewer hours, 95% confidence interval [CI] 4.2-6.9). Disparities of lower magnitude were observed for other clinical disciplines except for LPNs.ConclusionsSignificant staffing disparities were observed within facilities located in severely deprived neighborhoods. Targeted interventions, including workforce recruitment and retention efforts, may be needed to improve staffing levels for nursing homes in deprived neighborhoods.

Project description:ImportanceThe coronavirus disease 2019 (COVID-19) pandemic has severely affected nursing homes. Vulnerable nursing home residents are at high risk for adverse outcomes, but improved understanding is needed to identify risk factors for mortality among nursing home residents.ObjectiveTo identify risk factors for 30-day all-cause mortality among US nursing home residents with COVID-19.Design, setting, and participantsThis cohort study was conducted at 351 US nursing homes among 5256 nursing home residents with COVID-19-related symptoms who had severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection confirmed by polymerase chain reaction testing between March 16 and September 15, 2020.ExposuresResident-level characteristics, including age, sex, race/ethnicity, symptoms, chronic conditions, and physical and cognitive function.Main outcomes and measuresDeath due to any cause within 30 days of the first positive SARS-CoV-2 test result.ResultsThe study included 5256 nursing home residents (3185 women [61%]; median age, 79 years [interquartile range, 69-88 years]; and 3741 White residents [71%], 909 Black residents [17%], and 586 individuals of other races/ethnicities [11%]) with COVID-19. Compared with residents aged 75 to 79 years, the odds of death were 1.46 (95% CI, 1.14-1.86) times higher for residents aged 80 to 84 years, 1.59 (95% CI, 1.25-2.03) times higher for residents aged 85 to 89 years, and 2.14 (95% CI, 1.70-2.69) times higher for residents aged 90 years or older. Women had lower risk for 30-day mortality than men (odds ratio [OR], 0.69 [95% CI, 0.60-0.80]). Two comorbidities were associated with mortality: diabetes (OR, 1.21 [95% CI, 1.05-1.40]) and chronic kidney disease (OR, 1.33 [95%, 1.11-1.61]). Fever (OR, 1.66 [95% CI, 1.41-1.96]), shortness of breath (OR, 2.52 [95% CI, 2.00-3.16]), tachycardia (OR, 1.31 [95% CI, 1.04-1.64]), and hypoxia (OR, 2.05 [95% CI, 1.68-2.50]) were also associated with increased risk of 30-day mortality. Compared with cognitively intact residents, the odds of death among residents with moderate cognitive impairment were 2.09 (95% CI, 1.68-2.59) times higher, and the odds of death among residents with severe cognitive impairment were 2.79 (95% CI, 2.14-3.66) times higher. Compared with residents with no or limited impairment in physical function, the odds of death among residents with moderate impairment were 1.49 (95% CI, 1.18-1.88) times higher, and the odds of death among residents with severe impairment were 1.64 (95% CI, 1.30-2.08) times higher.Conclusions and relevanceIn this cohort study of US nursing home residents with COVID-19, increased age, male sex, and impaired cognitive and physical function were independently associated with mortality. Understanding these risk factors can aid in the development of clinical prediction models of mortality in this population.

Dataset Information

Socially-isolated neighborhoods and the risk of all-cause mortality among nursing home residents in the United States: A multilevel study.

Publications

Socially-isolated neighborhoods and the risk of all-cause mortality among nursing home residents in the United States: A multilevel study.

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