Risk of Nursing Home Use among Older Americans: The Impact of Psychiatric History and Trajectories of Cognitive Function

Objectives: Mental illness and cognitive functioning may be independently associated with nursing home use. We investigated the strength of the association between baseline (1998) psychiatric history, 8-year cognitive function trajectories, and prospective incidence of nursing home use over a 10-year period while accounting for relevant covariates in U.S. adults aged 65 and older. We hypothesized that self-reported baseline history of psychiatric, emotional, or nervous problems would be associated with a greater risk of nursing home use and that cognition trajectories with the greatest decline would be associated with a subsequent higher risk of nursing home use. Methods: We used 8 waves (1998-2016) of Health and Retirement Study data for adults aged 65 years and older. Latent class mixture modeling identified 4 distinct cognitive function trajectory classes (1998-2006): low-declining, medium-declining, medium-stable, and high-declining. Participants from the 1998 wave (N = 5,628) were classified into these 4 classes. Competing risks regression analysis modeled the subhazard ratio of nursing home use between 2006 and 2016 as a function of baseline psychiatric history and cognitive function trajectories. Results: Psychiatric history was independently associated with greater risk of nursing home use (subhazard ratio [SHR] 1.26, 95% confidence interval [CI] 1.06-1.51, p <. 01), net the effects of life course variables. Furthermore, "low-declining"(SHR 2.255, 95% CI 1.70-2.99, p <. 001) and "medium-declining"(2.103, 95% CI 1.69-2.61, p <. 001) trajectories predicted increased risk of nursing home use. Discussion: Evidence of these associations can be used to educate policymakers and providers about the need for appropriate psychiatric training for staff in community-based and residential long-term care programs.