Prospective Outcomes of Informal and Formal Home Care: Mortality and Institutionalization. SECTION 3: RESULTS

12/19/1990

Table 3-1 shows the results for mortality in each of the equation models: health variables only, social variables only, and the first and second trimmed models. Adjusted for age and sex, the following variables are significant: self-reported health status, activities of daily living, instrumental activities of daily living, cancer, cerebrovascular accident, and hospital inpatient stays. Persons reporting poor health were 2.59 times more likely to die in the follow-up period as those reporting excellent health status. Those reporting fair health status are nearly twice as likely to die. Each activity of daily living or instrumental activity of daily living increases the odds of mortality by about 1.1 or 10 percent. Cancer and cerebrovascular accident increase the odds of dying by 1.42 and each hospital stay increases the likelihood of dying by 38 percent. Among the social variables, in addition to age and sex, social contacts and control over health were the only variables significantly related to mortality. For each social contact the person is about 0.87 times as likely to die; that is, the more social contacts, the lower the odds of dying. Those saying that they have some, little or no control over health are significantly more likely to have died than those who said they have a great deal of control over their health. The association is especially strong for those with proxy reporting. In combining these models, only instrumental activities of daily living falls out of the equation. The final model includes age, sex, social contacts, control over health, self-reported health status, activities of daily living, cancer, cerebrovascular accident, and hospital inpatient stays. The overall chi-square is 3,419.49, which is significant.

TABLE 3-1. Odds of Dying During Two-Year Follow-Up As A Function of Social and Health Status at Baseline
  Crude Odds Ratios Net Odds Ratios
Health Variables Only Social Variables Only First Trimmed Model3 Second Trimmed Model4
Proxy 3.68**   1.58* 1.05  
Age2 1.07** 1.06** 1.05** 1.05** 1.06**
Sex .56** .49** .53** .52** .53**
Race1
   Black
   Hispanic
   Other
 
.78
.77
1.49
   
.79
.64
1.34
   
Education1
   High School
   College
 
.74**
.63**
   
1.03
.91
   
Income1
   Missing
   >Poverty, <$10,000
   $10,000-19,000
   $20,000-34,000
   >$35,000
 
.97
.97
.88
.96
1.06
   
.90
1.05
.91
.98
1.01
   
Living Arrangements1
   
Lives Alone
   Lives w/Other Persons
 
.90
1.48**
   
1.08
1.21
   
Social Contacts .76**   .87** .92* .91*
Volunteers in Community .37**   .71    
Control Over Health1
   Some
   Little
   None
   Unknown (Proxy)
 
1.43*
2.16**
1.87*
3.89**
   
1.34*
1.80*
1.59*
1.92*
 
1.14
1.26
1.16
1.56*
 
1.14
1.26
1.17
1.76*
Health Status1
   Very Good
   Good
   Fair
   Poor
 
1.18
1.48*
2.50**
5.20**
 
1.14
1.36
1.90**
2.59**
   
1.13
1.29
1.77*
2.37**
 
1.13
1.30
1.80*
2.45**
Activities of Daily Living2 1.43** 1.12*   1.11* 1.15**
Instrumental Activities of Daily Living2 1.43** 1.11*   1.06  
Confusion 1.53* 1.06      
Alzheimer's 3.56* 1.21      
Urinary Incontinence 2.29** 1.06      
Bowel Incontinence 2.59** 1.08      
Cancer 1.84** 1.42*   1.45* 1.45*
Heart Disease 1.60** .96      
Cerebrovascular Accident (stroke) 2.67** 1.42*   1.40* 1.42*
Osteoporosis .89 .70      
Hip Fracture 2.07** 1.32      
Fell 2 or More Times 1.86** .95      
Fell Because of Dizziness 2.37** 1.24      
Nursing Home Stay Prior to 1st Interview 2.59** 1.37      
Hospital Inpatient Stays2 1.68** 1.38**   1.38** 1.38**
Model CHI Square   3408.74 3281.32 3421.19 3419.49
  1. Omitted variables are: race = white; education = graduate school; income = below poverty line; health status = excellent; control over health = a lot.
  2. Range of continuous predictors are: age = 70-99; social contacts = 0-7; ADL = 0.7; IADL = 0-6; No. of nursing home stays = 0-19; No. of inpatient stays = 0-16. All other variables are 0-1 dichotomies.
  3. "First trimmed model" includes variables found to be significant predictors in either the model including "health variables only" or the model including "social variables only."
  4. "Second trimmed model includes variables found to be significant predictors in the "first trimmed model."

* = significant at <0.05; ** = significant at <0.001

Table 3-2 shows the results for institutionalization in a nursing home. Following the same procedures, the health variables related to institutionalization, in addition to age and sex, are: self-reported health status, instrumental activities of daily living, Alzheimers, heart disease, having fallen twice or more, having fallen because of dizziness, and a prior nursing home stay. Especially strong associations are exhibited by prior nursing home stays, where persons who have had a prior stay are four times as likely to enter a nursing home as those without a prior stay. Persons with Alzheimers are 3.2 times more likely to enter a nursing home. Those with self-reported fair or poor health are about twice as likely, as are those who have fallen because of dizziness or who have fallen two or more times. Heart disease is inversely related to entering a nursing home, the odds ratio being 0.69.

Among the social variables, education, living arrangements, social contacts, and perceived control over health are significantly related to entering a nursing home. Those with some high school or a high school diploma are about 1.6 times as likely as those with education less than eighth grade to enter a nursing home. Those with education beyond high school graduation are not significantly different than those with an education of eighth grade or less. Persons living alone are twice as likely to enter a nursing home. Persons with more social contacts are less likely to enter a nursing home, the odds decreasing 28 percent for each additional social contact. Those expressing little control over health are 2.76 times as likely to enter a nursing home as those expressing a lot of control over health. Persons expressing some or no control over health are also more likely to enter a nursing home. When the health and social variables are combined, the inverse association of heart disease with entering a nursing home drops out, as does the association between instrumental activities of daily living and entering a nursing home. Although the odds ratio for Alzheimers disease is not statistically significant, it is of such substantial magnitude, 2.45, that we have left it in the equation. The overall chi-square for this model, 4171.99, is significant.

TABLE 3-2. Odds of Entering a Nursing Home During Two-Year Follow-Up As A Function of Social and Health Status at Baseline
  Crude Odds Ratios Net Odds Ratios
Health Variables Only Social Variables Only First Trimmed Model4 Second Trimmed Model5
Proxy 4.02**   1.67    
Age2 1.15** 1.12** 1.11** 1.11** 1.11**
Sex 1.24 1.04 .93    
Race1
   Black
   Hispanic
   Other
 
.05*
.61
1.30
   
.59
.69
1.17
   
Education1
   High School
   College
 
.96
.75
   
1.53*
1.18
 
1.60*
1.17
 
1.60*
1.17
Income1
   Missing
   >Poverty, <$10,000
   $10,000-19,000
   $20,000-34,000
   >$35,000
 
1.03
.87
.56**
.64
.86
   
1.08
1.01
.78
.78
1.05
   
Living Arrangements1
   Lives Alone
   Lives w/Other Persons
 
2.46**
2.74**
   
2.08**
1.38
 
1.99**
1.22
 
1.98**
1.25
Social Contacts .70**   .78** .81** .80**
Volunteers in Community .36**   .93    
Control Over Health
   Some
   Little
   None
   Unknown (Proxy)
 
1.74*
3.20**
2.74**
5.43**
   
1.73*
2.76**
2.33*
2.30*
 
1.53*
2.01*
1.77
2.04*
 
1.54*
2.09*
1.83*
2.27**
Health Status1
   Very Good
   Good
   Fair
   Poor
 
1.58
1.74*
3.07**
3.95**
 
1.56
1.64
2.30*
1.93*
   
1.53
1.61
2.21*
1.99*
 
1.52
1.61
2.20*
2.05*
Activities of Daily Living2 1.41** 1.03      
Instrumental Activities of Daily Living2 1.51** 1.14*   1.08  
Confusion 2.31** 1.67      
Alzheimer's3 8.73** 3.20*   2.23 2.45
Urinary Incontinence 2.30** .97      
Bowel Incontinence 2.61** .88      
Cancer 1.57** 1.11      
Heart Disease 1.08 .69*   .77  
Cerebrovascular Accident (stroke) 2.56** 1.43      
Osteoporosis 1.18 .84      
Hip Fracture 3.34** 1.37      
Fell 2 or More Times 3.52** 1.71*   1.72* 1.73*
Fell Because of Dizziness 4.93** 2.00*   1.99* 1.96*
Nursing Home Stay Prior to 1st Interview 10.40** 4.09**   4.10** 4.36**
Hospital Inpatient Stays2 1.30** 1.13      
Model CHI Square   4122.73 4090.21 4176.40 4171.99
  1. Omitted variables are: race = white; education = graduate school; income = below poverty line; health status = excellent; control over health = a lot.
  2. Range of continuous predictors are: age = 70-99; social contacts = 0-7; ADL = 0.7; IADL = 0-6; No. of nursing home stays = 0-19; No. of inpatient stays = 0-16. All other variables are 0-1 dichotomies.
  3. Alzheimers was retained in the final trimmed model because of an odds ratio greater than 2, although its significance level is p = 0.120.
  4. "First trimmed model" includes variables found to be significant predictors in either the model including "health variables only" or the model including "social variables only."
  5. "Second trimmed model includes variables found to be significant predictors in the "first trimmed model."

* = significant at <0.05; ** = significant at <0.001

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