Prospective Outcomes of Informal and Formal Home Care: Mortality and Institutionalization. 3.1 Crude Associations of Caregiving with Outcomes

12/19/1990

We calculated the crude odds of dying and the crude odds of institutionalization in a nursing home, given the various caregiving arrangements. Table 3-3 reports results for mortality. Under the heading of caregiving arrangements we list 6 comparisons pertaining to our hypotheses. For each level of the comparison we list the number of persons alive at follow-up, the number of persons who had died, and then calculate a crude odds ratio of mortality.

TABLE 3-3. Odds of Dying During Two-Year Follow-Up by Characteristics of Disability and Caregiving
Caregiving Arrangements Number Alive Number Dead Crude Odds Ratio
Disability vs.
No Disability
1,013
3,021
250
287
2.60**
Help vs.
No Help
859
154
237
13
3.27**
Any Unpaid Help vs.
All Paid Help
675
174
203
34
1.52*
Any Close Family Unpaid Help vs.
No Close Family Unpaid Help
269
416
61
142
0.66
All Unpaid Help vs.
Some Paid, Some Unpaid
139
546
43
160
1.06
All Unpaid Help, Close Family vs.
All Unpaid Help, Not Close Family
77
62
19
24
0.64
* = significant at <0.05; ** = significant at <0.001

Given that having a disability is a necessary condition for receiving help under our operationalization, we include a comparison of disabled and non-disabled persons. Among 1,263 persons disabled at baseline, 250 had died; whereas among 3,308 non-disabled persons at baseline, 287 had died. This results in an odds ratio of 2.60 that is significant at p<.001. The odds ratio indicates that a person disabled at baseline is 2.6 times as likely to die as one not disabled.

The next comparison is that between persons with a disability who received help versus those with a disability who received no help. Among 1,096 of the former, 237 died during the follow up period, whereas among 167 of the latter, 13 had died. This results in a crude odds ratio of 3.27, indicating that disabled persons receiving help were 3.27 times more likely to die over the follow-up period than those receiving no help. Is receiving help a risk factor for mortality? Probably we should not rule out these explanations, although one would expect to be given help in proportion to need. In later analyses we will control for severity of illness, which may be a distorter variable in this instance.

The remaining four comparisons distinguish among types of help received. Persons who received any unpaid help versus only paid help were 1.52 times more likely to die over the follow-up period. When we compare unpaid help from close family members to unpaid help from more distant relatives or non-relatives the crude odds ratio is 0.66 and is not statistically significant. The next caregiving comparison places all unpaid help opposite persons receiving some paid and some unpaid help: the odds ratio is 1.06 and not significant. Finally, receiving all unpaid help from close family members compared to all unpaid help from more distant relatives and non-relatives results in a crude odds ratio of 0.64, also not statistically significant.

Table 3-4 presents the association between caregiving arrangements and entering a nursing home during the two-year follow up. Among 1,053 disabled persons, 163 entered a nursing home; whereas among 3,031 non-disabled persons, 110 experienced a nursing home admission. Thus, the crude odds ratio is 4.37, indicating that disabled persons are 4.37 times as likely as non-disabled to enter a nursing home in a two-year period. This odds ratio is statistically significant, p<.001. Disabled persons receiving help are 1.73 times as likely to enter a nursing home as those disabled persons without help. Though not statistically significant, this is a fairly sizable odds ratio and, once again, may reflect the association between receiving help and illness severity on one hand and illness severity and entering a nursing home on the other hand. Among those who receive help, those receiving any unpaid versus all paid help are 1.24 times as likely to enter a nursing home, though the odds ratio is not significant. Those with unpaid help from any close family members versus unpaid help from distant relatives and non-relatives have similar odds of entering a nursing home. Persons receiving all unpaid help versus some paid and some unpaid help were 1.41 times as likely to enter a nursing home. Among the former, those with unpaid help all from close family members were 1.36 times as likely to enter a nursing home as those with all unpaid help from more distant relatives or non-relatives.

TABLE 3-4. Odds of Entering a Nursing Home During Two-Year Follow-Up by Characteristics of Disability and Caregiving
Caregiving Arrangements Number Alive Number Dead Crude Odds Ratio
Disability vs.
No Disability
990
2,921
163
110
4.37**
Help vs.
No Help
861
129
150
13
1.73
Any Unpaid Help vs.
All Paid Help
696
165
126
24
1.24
Any Close Family Unpaid Help vs.
No Close Family Unpaid Help
260
436
48
78
1.03
All Unpaid Help vs.
Some Paid, Some Unpaid
135
561
32
94
1.41
All Unpaid Help, Close Family vs.
All Unpaid Help, Not Close Family
70
65
19
13
1.36
* = significant at <0.05; ** = significant at <0.001

In summary, disability has a positive association with both mortality and institutionalization in a nursing home. In both cases this is statistically significant, although it is stronger for mortality. Receiving help for a disability is also positively associated with both of these outcomes, although it not statistically significant for entering a nursing home. Receiving any unpaid help versus all paid help is positively associated with mortality and is statistically significant.

For the remaining caregiving comparisons the associations are much weaker and are not statistically significant. Illness severity and social resources also may be related to caregiving arrangements. Therefore, controlling for these confounders may result in our observing stronger and statistically significant associations between caregiving arrangements and outcomes. Before taking these steps we turn to analysis of the associations of confounder variables with the outcomes.

View full report

Preview
Download

"prosoutc.pdf" (pdf, 129.52Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®