Length of Stay for Older Adults Residing in Nursing Homes at the End of Life

OBJECTIVES To describe lengths of stay of nursing home decedents. DESIGN Retrospective cohort study. SETTING The Health and Retirement Study (HRS), a nationally representative survey of U.S. adults aged 50 and older. PARTICIPANTS One thousand eight hundred seventeen nursing home residents who died between 1992 and 2006. MEASUREMENTS The primary outcome was length of stay, defined as the number of months between nursing home admission and date of death. Covariates were demographic, social, and clinical factors drawn from the HRS interview conducted closest to the date of nursing home admission. RESULTS The mean age of decedents was 83.3 +/- 9.0; 59.1% were female, and 81.5% were white. Median and mean length of stay before death were 5 months (interquartile range 1-20) and 13.7 +/- 18.4 months, respectively. Fifty-three percent died within 6 months of placement. Large differences in median length of stay were observed according to sex (men, 3 months vs women, 8 months) and net worth (highest quartile, 3 months vs lowest quartile, 9 months) (all P <.001). These differences persisted after adjustment for age, sex, marital status, net worth, geographic region, and diagnosed chronic conditions (cancer, hypertension, diabetes mellitus, lung disease, heart disease, and stroke). CONCLUSION Nursing home lengths of stay are brief for the majority of decedents. Lengths of stay varied markedly according to factors related to social support.