ASSESSING LIFE EXPECTANCIES OF OLDER NURSING-HOME RESIDENTS

OBJECTIVE: Care of nursing home (NH) residents is often based on the u sual survival of the home's residents. In order to improve our underst anding of this population, and, thus, ultimately facilitate individual ization of their care, we developed a mathematical model that predicts their survival. SETTING: The Jewish Home and Hospital (JHH), a nursin g home. PARTICIPANTS: 1145 older residents who were at the JHH from Ja nuary 1, 1986, through July 1, 1986. MEASUREMENTS: Information abstrac ted from medical records and JHH computerized data: clinical, demograp hic, and dependencies in activities of daily living (ADLs). Main outco me measure: survival from July 1, 1986. DESIGN: Retrospective cohort s tudy via medical chart review. The study period covered admission to J HH through January 17, 1996. Accelerated failure time (AFT) models gen erated the life expectancy model derived from 50% of the study group a nd were validated on the remaining sample. We computed predicted AFT a nd proportional hazards (PH) life expectancies. RESULTS: Significant, independent predictors of decreased survival were male gender, increas ed age, increase in summary ADL index, and impairment of cardiac, resp iratory, neurological, and endocrine/metabolic systems. The interactio n between gender and respiratory system impairment was significant. Th e Spearman correlation coefficients between the observed survivals and those predicted by the Phase I model are 0.49 for Phase I residents a nd 0.42 for Phase II residents. Our sample life table includes NH resi dents with different risk profiles and their associated survival estim ates as well as interquartile ranges. AFT and PH survivals were simila r. CONCLUSION: This first comprehensive model that predicts survival o f NH residents can help formulate public health policies and identify appropriate NH residents for clinical trials. The model is a promising step toward improving the health care of NH residents.