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Predictors of nursing facility admission: a 12-year epidemiological study in the United States
Bharucha AJ, Pandav R, Shen C, Dodge HH, Ganguli M.. Journal of the American Geriatrics Society, 2004-03-01
Topic: Risk, prevention and care in population studies
Objectives To identify predictors of institutionalization in a community-based cohort of older adults. Design Prospective, longitudinal. After initial assessment at study entry, surviving participants were reassessed in a series of approximately biennial waves until October 2001; baseline for the current analysis was Wave 2 (1989-91). Setting Largely rural, blue-collar community in the mid-Monongahela Valley of southwestern Pennsylvania. Participants A population-based cohort of 1,147 adults, aged 66 and older (mean 74.1) at baseline, who were not already institutionalized and who had complete data on all variables of interest. Measurements Cox proportional hazards models were used to identify predictors of institutionalization from among selected variables measured at baseline, including age, sex, education, marital status, living arrangements, ability to perform instrumental activities of daily living (IADLs), depressive symptoms, number of prescription medications (as an index of overall morbidity), self-reported social support, hospitalization during the preceding year, and cognitive functioning. Dementia was defined according to the operational criteria of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, and by a Clinical Dementia Rating of 0.5 or greater, based on a standardized clinical assessment. The outcome variable was institutionalization, defined as entry into in a nursing home. Results Significant predictors of institutionalization were dementia (hazard ratio (HR)=5.09, 95% confidence interval (CI)=2.92-8.84), measured as a time-dependent variable; older age (HR=1.06, 95% CI=1.03-1.10); IADL disability (HR=1.31, 95% CI=1.15-1.50); worse/less social support (HR=1.27, 95% CI=1.10-1.46); and number of prescription medications (HR=1.21, 95% CI=1.11-1.32), measured at baseline. The interaction between number of prescription drugs and dementia was also significant, suggesting that prescription medication count had less effect on institutionalization in those with dementia than in those without. Conclusion Dementia emerged as the most potent risk factor for institutionalization in this 12-year community-based epidemiological study. Medical burden conferred greater vulnerability to institutionalization in nondemented persons than in those with dementia.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Bharucha, A. J., Pandav, R., Shen, C., Dodge, H. H., & Ganguli, M. (2004). Predictors of nursing facility admission: a 12-year epidemiological study in the United States. Journal of the American Geriatrics Society. https://doi.org/10.1111/j.1532-5415.2004.52118.x
Vancouver
Bharucha AJ, Pandav R, Shen C, Dodge HH, Ganguli M. Predictors of nursing facility admission: a 12-year epidemiological study in the United States. Journal of the American Geriatrics Society. 2004. doi:10.1111/j.1532-5415.2004.52118.x. PMID: 14962161.
BibTeX
@article{bharucha2004-14962161,
author = {Bharucha, A. J. and Pandav, R. and Shen, C. and Dodge, H. H. and Ganguli, M.},
title = {{Predictors of nursing facility admission: a 12-year epidemiological study in the United States}},
journal = {Journal of the American Geriatrics Society},
year = {2004},
doi = {10.1111/j.1532-5415.2004.52118.x},
pmid = {14962161},
url = {https://doi.org/10.1111/j.1532-5415.2004.52118.x}
}
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Key findings
- Measurements Cox proportional hazards models were used to identify predictors of institutionalization from among selected variables measured at baseline, including age, sex, education, marital status, living arrangements, ability to perform instrumental activities of daily living (IADLs), depressive symptoms, number of prescription medications (as an index of overall morbidity), self-reported social support, hospitalization during the preceding year, and cognitive functioning.
- Results Significant predictors of institutionalization were dementia (hazard ratio (HR)=5.09, 95% confidence interval (CI)=2.92-8.84), measured as a time-dependent variable; older age (HR=1.06, 95% CI=1.03-1.10); IADL disability (HR=1.31, 95% CI=1.15-1.50); worse/less social support (HR=1.27, 95% CI=1.10-1.46); and number of prescription medications (HR=1.21, 95% CI=1.11-1.32), measured at baseline.
- The interaction between number of prescription drugs and dementia was also significant, suggesting that prescription medication count had less effect on institutionalization in those with dementia than in those without.
Why it matters
In this community cohort followed for 12 years, dementia was the strongest predictor of being admitted to a nursing facility, along with older age. This shows that dementia greatly raises the chance that an older person will need nursing home care.
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Study details
- Study designlongitudinal study
- Participants1,147
- Effect sizeHR=1.06; HR=1.31; HR=1.27
- Evidence strengthModerate
How this study scored 62/100
Published in a peer-reviewed journal, and it is a longitudinal study following the same people over time. Scored zero for randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of the American Geriatrics Society) |
| Journal's citation record | 3 / 4 | Journal of the American Geriatrics Society: journal h-index 344 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A longitudinal study following the same people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2004 — older than 20 years, still counted |
| Sample size | 3 / 4 | 1,147 participants |
| Effect reported | 3 / 3 | Effect reported with a statistic (interval, p-value, ratio or similar) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 5 / 7 | Cited 209 times (OpenAlex, 2026-10-10) |
| Citations per year | 3 / 5 | 8.7 citations a year over 24 year(s) since 2004 |
| Impact for its field and year | 5 / 6 | Cited 20.5× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 2 / 6 | Cited by 4 other studies in this library |
| Still being cited | 1 / 4 | Cited 8 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Mary Ganguli: h-index 86 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | University of Pittsburgh: institution h-index 1,470 (OpenAlex) |
| Multi-centre collaboration | 0 / 3 | OpenAlex lists 1 institution(s) in 1 country — scores zero (affiliation lists can be incomplete) |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 14962161) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 62 / 100 | — |
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