Older patients with mental health conditions were more likely to be admitted to nursing homes upon hospital discharge than older patients without mental health diagnoses, and black patients with mental health conditions had higher odds of nursing home admission than their white counterparts, an analysis of National Hospital Discharge Survey (NHDS) data has shown.
The investigators analyzed more than 186,000 older patients (aged 65 and over) using pooled data from the 2007–2010 NHDS (Arch Gerontol Geriatr 2018;78:269–274). The finding that a diagnosis of a mental health condition increased the odds of admission to a nursing home versus returning to the community (odds ratio 1.15 in a multivariate analysis) echoes the prior research showing an association between mental health conditions and patterns of nursing home admission.
Black race in and of itself was not associated with increased odds of nursing home admission. This finding was “a bit surprising,” the study’s lead author, Yu Kang, PhD, told Caring, given the prior findings that the growth in minority individuals admitted to nursing homes over the past few decades has exceeded their share in the general population. Nursing home admission in this study included both skilled nursing and long-term care institutions.
Dr. Kang and her colleagues were particularly interested in the interactive effect between mental health conditions and race on nursing home admissions, and they found a significant association. Although being black was “not associated with increased odds of [nursing home] admission,” the “association between the interaction variable (black race by mental health conditions) and nursing home admission was statistically significant (odds ratio = 1.60), after controlling for other predisposing, enabling, need and facility factors,” such as insurance status, other discharge diagnoses, admissions sources, and facility characteristics.
“The public policy trends over the years have been aimed at trying to give individuals freedom as to where they receive long-term care,” said Dr. Kang, an assistant professor in the University of Baltimore’s School of Health and Human Services. “So why are some individuals, especially racial minorities, still not free to receive care [at home or in the community setting]? And, as suggested by this study, how can policy makers better address the long-term care needs of blacks with mental health conditions?”
Dr. Kang and her colleagues are performing further analyses to look at the impact of specific mental health diagnoses. Prior research into potential racial disparities in nursing home admissions has indicated that a larger share of black individuals are given diagnoses of schizophrenia at admission, whereas a higher proportion of whites receive diagnoses of depression or anxiety disorder. “The prevalence and severity of mental health conditions may [help explain the increase in] the black segment of the nursing home population,” the investigators noted.
Source: Kang YS, Miller NA, Tzeng HH, Zhang T. Race and mental health disorders’ impact on older patients’ nursing home admissions upon hospital discharge. Arch Gerontol Geriatr 2018;78:269–274.