OUTCOME OF NURSING-HOME CARE FOR RESIDENTS WITH ALCOHOL-USE DISORDERS

Objectives. To describe the outcome of nursing home (NH) care for a pr eviously established cohort of residents with active, inactive or no a lcohol use disorder (AUD), and to examine demographic variables, healt h services utilization, mortality and drinking behaviors in this group . Design. Retrospective cohort study with participant interviews at NH admission and 3 years later. Setting. Urban Veterans Affairs (VA) Med ical Center and Nursing Home Care Unit (NHCU). Participants. Patients older than age 50 admitted consecutively to a VA NHCU between July 199 1 and February 1993 who completed a structured interview, N = 117. Mai n outcome measures. AUD as determined by DSM-III-R criteria. Demograph ics, health services utilization and mortality as abstracted from the VA medical record. Results. Health service utilization as measured by care episodes was not significantly different in the three groups (act ive, inactive and no AUD), but subjects with AUD had documented health services use related to alcoholism, including hospitalizations for al cohol-related illness, placements in long-term care facilities to cont rol drinking and death from alcohol-related causes. The mean age at de ath was significantly younger for study participants with active or in active AUD compared to those with no AUD: 67.7, 70.4 and 77.9 years, r espectively (p < 0.004). Of the 21 participants with active AUD at NHC U entry, 11 resumed drinking after discharge and six still met criteri a for active AUD 3 years later. Conclusions. The subset of NHCU patien ts with active AUD continued to incur alcohol-related hospitalizations and institutionalizations following NHCU discharge and suffered early mortality relative to their peers. Effective models of care for this subset of patients should be sought. (C) 1997 by John Wiley & Sons, Lt d.