Predicting elderly people's risk for nursing home placement, hospitalization, functional impairment, and mortality: a synthesis

Abstract

Long-term care resources would be allocated more cost-effectively if care planning and medical/functional eligibility decisions were grounded more firmly in extant evidence regarding the risk of nursing home placement, hospitalization, functional impairment, and mortality. This article synthesizes the studies that longitudinally assess the predictors of each of these outcomes for the 65 and older population in the United States. A database was assembled containing 167 multivariate analyses abstracted from 78 journal articles published between 1985 and 1998. Findings show that 22 risk factors consistently predict two or more outcomes, including three that predict all four: worse performance on physical function measures not based on activities of daily living, greater illness severity, and prior hospital use. Findings should help prioritize variable selection choices of those setting eligibility criteria, allocating care resources, and doing descriptive studies. Gaps are shown to exist in the understanding of outcome effects of facility, market, policy, and other system attributes.