Journal
JOURNAL OF STROKE & CEREBROVASCULAR DISEASES
Volume 24, Issue 10, Pages 2329-2337Publisher
ELSEVIER SCIENCE BV
DOI: 10.1016/j.jstrokecerebrovasdis.2015.06.013
Keywords
Disability; institutionalization; race; ethnicity; social support; long-term care
Categories
Funding
- National Heart, Lung, and Blood Institute, National Institutes of Health
- U.S. Department of Health and Human Services [HHSN268201100046C, HHSN2682011000 01C, HHSN268201100002C, HHSN268201100003C, HHSN2682011000 04C]
- WHI Extension Western Regional Subcontract through Stanford University from the National Heart, Lung, and Blood Institute, National Institutes of Health
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Background: We examined the social and economic factors associated with nursing home (NH) admission in older women, overall and poststroke. Methods: The Women's Health Initiative (WHI) included women aged 50-79 years at enrollment (1993-1998). In the WHI Extension Study (2005-2010), participants annually reported any NH admission in the preceding year. Separate multivariate logistic regression models analyzed social and economic factors associated with long-term NH admission, defined as an admission on 2 or more questionnaires, overall and poststroke. Results: Of 103,237 participants, 8904 (8.6%) reported NH admission (2005-2010); 534 of 2225 (24.0%) women with incident stroke reported poststroke NH admission. Decreased likelihoods ofNHadmission overall were demonstrated for Asian, Black, and Hispanic women (versus whites, adjusted odds ratio [aOR] = .35-.44, P < .001) and women with higher income (aOR = .75, 95% confidence interval [CI] = .63-.90), whereas increased likelihoods of NH admission overall were seen for women with lower social support (aOR = 1.34, 95% CI = 1.16-1.54) and with incident stroke (aOR = 2.59, 95% CI = 2.15-3.12). Increased odds of NH admission after stroke were demonstrated for women with moderate disability after stroke (aOR = 2.76, 95% CI = 1.73-4.42). Further adjustment for stroke severity eliminated the association found for race/ethnicity, income, and social support. Conclusions: The level of care needed after a disabling stroke may overwhelm social and economic structures in place that might otherwise enable avoidance of NH admission. We need to identify ways to provide care consistent with patients' preferences, even after a disabling stroke.
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