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

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)577-588
Number of pages12
JournalThe journals of gerontology. Series B, Psychological sciences and social sciences
Volume77
Issue number3
DOIs
StatePublished - Mar 3 2022

Keywords

  • Aging
  • Assisted living
  • Cognition trajectories
  • Life course health
  • Mental illness

ASJC Scopus subject areas

  • Health(social science)
  • Sociology and Political Science
  • Life-span and Life-course Studies

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