NURSING-HOME RESIDENTS - A MULTIVARIATE-ANALYSIS OF THEIR MEDICAL, BEHAVIORAL, PSYCHOSOCIAL, AND SERVICE USE CHARACTERISTICS

Background. Elderly residents of nursing homes often have multiple com orbidities and functional limitations. The status of 4,525 residents o f complex and standard care units in 177 nursing homes where the nursi ng home was determined to provide adequate care, and from 14 specializ ed Alzheimer's units, was evaluated on 111 measures of medical conditi on, functional status, psychological well-being and cognitive performa nce in a demonstration study assessing quality of care in six states. Detailed measurements were also made of the types and amounts of servi ces used (in minutes per day) by the residents. Methods. Given the num ber of health measures, and the possibility of assessment error, a mul tivariate analytic procedure called Grade of Membership (GoM) was used . This procedure identified profiles of health and functioning measure s to identify the characteristics of clinically distinct groups of nur sing home residents. Results. The analysis identified 11 profiles of h ealth and functioning characteristics which described the 111 resident measurements. The 11 profiles predicted differentials in nursing home length of stay, and service use by various cf asses of caregivers. Th e GoM profiles described the data better than several other classifica tion procedures applied to the same data. Conclusions. In nursing home s, elderly and oldest-old residents often have multiple comorbidities and disabilities. A multivariate procedure was able to identify the fu ndamental dimensions describing residents' variation on a number of he alth measures. These profiles predicted differences in service use so they had predictive validity. Thus, multivariate procedures may help i dentify clinically distinct groups in studies where complex measures a re made.