The transition from home to nursing home mortality among people with dementia

Objectives. This article examines the impact of nursing home admission on m ortality among persons with dementia, comparing social selection and social causation explanations of excess deaths occurring immediately after reloca tion. Methods. Data from a multiwave panel survey of caregivers to persons with A lzheimer's Disease (N = 555) are analyzed with proportional hazard models o f time from illness onset to death of the care recipient and, for those adm itted to a nursing home (N = 272), time from admission until death (N = 272 ). Results. Relocation is associated with a two-fold increase in mortality ris k net of health status. Social selection effects were found for poor health , advanced age, bring male, and bring White. Patients admitted fur reasons other than poor health also experienced elevated mortality immediately foll owing admission, which is inconsistent with a social selection interpretati on. However, none of the specific indicators of stressful admission or unsa tisfactory nursing home conditions are significantly related to mortality. Discussion. These data demonstrate selection processes for postadmission mo rtality, but indicate that the admission of patients in poor health may not fully account for the elevation in mortality that occurs immediately follo wing admission.