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Risk of Mortality and Nursing Home Institutionalization After Injury
Author(s) -
Porell Frank W.,
Carter Mary W.
Publication year - 2012
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2012.04053.x
Subject(s) - medicine , institutionalisation , hazard ratio , confidence interval , proportional hazards model , poison control , cohort study , injury prevention , retrospective cohort study , cohort , emergency medicine , occupational safety and health , gerontology , surgery , psychiatry , pathology
Objectives To evaluate the effects of unintentional injuries on the risks of nursing home institutionalization and mortality in older adults. Design A retrospective analysis of data from the M edicare C urrent B eneficiary S urvey, a nationally representative survey of M edicare beneficiaries. Setting Noninstitutionalized community residents. Participants Older adult panel members (N = 12,031) with continuous M edicare eligibility not enrolled in managed care in a cohort starting between 1998 and 2001. Measurements Cox regression and competing risk survival models were estimated using time‐varying injury‐status dummy variables and control variables for outcomes measured as time until death and institutionalization, respectively. Results Almost 4% of persons were institutionalized, 15% died, 14% had a sentinel injury, and 3% had two or more minor nonsentinel injuries within 1‐year period. Persons hospitalized for sentinel injury had elevated institutionalization and mortality risks during an injury episode and after the episode ended. Persons receiving outpatient treatment for sentinel injuries had elevated institutionalization risk during injury episodes (subhazard ratio [ SHR ] = 6.78, 95% confidence interval [ CI ] = 3.72–12.37) and elevated mortality risk after episodes (hazard ratio [ HR ] = 1.60, 95% CI = 1.28–2.00). Persons with multiple minor nonsentinel injuries within a year also had elevated mortality ( HR = 1.56, 95% CI = 1.15–2.11) and institutionalization ( SHR = 3.55, 95% CI = 2.25–5.67) risks. Conclusion Mortality and institutionalization risks extend well beyond the acute episode of treatment for sentinel and repeated minor injuries. More research is needed on longer‐term health outcomes of injury survivors to inform development of evidence‐based quality‐of‐care indicators.