Sociodemographic Factors and Characteristics of Caregivers as Determinants of Skilled Nursing Facility Admissions When Modeled Jointly With Functional Limitations

Objectives: We examined whether previously identified relationships between sociodemographic factors and caregivers for skilled nursing facility (SNF) admissions are replicated when jointly accounting for longitudinal change in functional limitations. We further explored the impact of caregivers by investigating the relationship between caregiver's characteristics and SNF admissions. Design: Longitudinal follow-up study. Setting: The United States of America. Participants: In total, 3875 older Americans from the 2011-2015 rounds of the National Health and Aging Trends Study linked with Centers for Medicare and Medicaid Services. Measures: Sociodemographic factors and caregiver's characteristics were used to predict change in functional limitations from baseline and time to first SNF admission using a joint modeling approach. Results: In total, 11.3% of the study population had a SNF admission during follow-up. For sociodemographic factors, non-Hispanic white, <9th grade education, and having at least 1 caregiver were associated with higher hazards of SNF admission than other race/ethnicity, college or higher education, and no caregiver, respectively. In contrast, living with a partner or living with others was associated with lower hazard of SNF admissions. For characteristics of caregivers, medical-supportive caregiver was associated with increased hazard of SNF admissions, whereas partner caregiver was protective of SNF admissions. Jointly modeling SNF admissions and change in functional limitations resulted in greater precision of effect estimates than modeling these outcomes separately. Conclusions and implications: The study provides insight that can help identify high-risk populations for future interventions to prevent or delay SNF admissions. The relation between caregivers and SNF admissions depended on caregiver's characteristics. Future work should focus on providing help to those without a partner caregiver or needing help managing their health to ensure independent living and improve the well-being of older adults. Precision increased when jointly modeling the SNF admission with change in functional limitations.