Table 1.
Baseline characteristics of long-term care facility residents, 2013–2015
| Characteristics, n (%) | All N = 1,711,497 |
Short-stay (< 100 days) N = 1,118,054 |
Long-stay (≥100 days) N = 593,443 |
|---|---|---|---|
| Length of follow-up, days, mean ± SD | 112 ± 200 | 29 ± 20 | 269 ± 278 |
| Age at index date, years, mean ± SD | 81.6 ± 8.2 | 80.8 ± 8.1 | 82.9 ± 8.3 |
| 65–74 | 394,331 (23.0) | 281,767 (25.2) | 112,564 (19.0) |
| 75–84 | 639,132 (37.3) | 434,977 (38.9) | 204,155 (34.4) |
| 85+ | 678,034 (39.6) | 401,310 (35.9) | 276,724 (46.6) |
| Female sex | 1,191,557 (69.6) | 768,633 (68.8) | 422,924 (71.3) |
| Race/ethnicity | |||
| Non-Hispanic White | 1,420,689 (83.0) | 943,096 (84.4) | 477,593 (80.5) |
| Non-Hispanic Black | 147,231 (8.6) | 81,401 (7.3) | 65,831 (11.1) |
| Hispanic | 62,070 (3.6) | 36,682 (3.3) | 25,388 (4.3) |
| Location resident was admitted from | |||
| Community or home | 124,588 (7.3) | 37,208 (3.3) | 87,380 (14.7) |
| Another LTCF or swing beda | 61,435 (3.6) | 19,777 (1.8) | 41,658 (7.0) |
| Hospital | 1,486,083 (86.8) | 1,044,083 (93.4) | 442,000 (74.5) |
| LTCF admission is new | 1,441,102 (84.2) | 1,019,035 (91.1) | 422,067 (71.1) |
| Body mass index, kg/m2 | |||
| < 18.5, underweight | 117,888 (6.9) | 76,489 (6.8) | 41,392 (7.0) |
| 18.5–24.9, normal | 656,364 (38.4) | 424,751 (38.0) | 231,590 (39.0) |
| 25–29.9, overweight | 480,408 (28.0) | 313,886 (28.1) | 166,511 (28.1) |
| ≥ 30, obese | 456,890 (26.7) | 302,928 (27.1) | 153,950 (25.9) |
| Current tobacco use | 47,959 (2.8) | 24,811 (2.2) | 23,148 (3.9) |
| Clinical Characteristics from MDS | |||
| Cancer | 141,791 (8.3) | 108,447 (9.7) | 33,344 (5.6) |
| Atrial fibrillation or other dysrhythmias | 441,467 (25.8) | 307,971 (27.8) | 133,496 (22.5) |
| Coronary artery disease | 452,352 (26.4) | 304,647 (27.3) | 147,705 (24.9) |
| Heart failure | 385,850 (22.5) | 243,464 (21.9) | 142,386 (24.0) |
| Hypertension | 1,352,541 (79.0) | 877,554 (78.5) | 474,987 (80.0) |
| History of pneumonia | 125,660 (7.3) | 104,590 (9.4) | 21,070 (3.6) |
| Diabetes mellitus | 554,424 (32.4) | 347,402 (31.1) | 207,022 (34.9) |
| Arthritis | 517,064 (30.2) | 339,561 (30.4) | 177,503 (29.9) |
| Alzheimer’s disease | 107,700 (6.3) | 35,684 (3.2) | 72,016 (12.1) |
| Cerebrovascular accident, transient ischemic attack, or stroke | 197,397 (11.5) | 104,438 (9.3) | 92,959 (15.7) |
| Non-Alzheimer’s dementia | 406,597 (23.8) | 165,369 (14.8) | 241,228 (40.7) |
| Depression | 595,844 (34.8) | 314,369 (28.1) | 281,475 (47.4) |
| Asthma, chronic obstructive pulmonary disease, chronic lung disease | 410,086 (24.0) | 269,238 (24.1) | 140,848 (23.7) |
| Respiratory failure | 44,460 (2.6) | 33,858 (3.0) | 10,602 (1.8) |
| Parkinson’s disease | 74,036 (4.3) | 36,366 (3.3) | 37,670 (6.4) |
| Geriatric Syndromes | |||
| Cognitive Function Scale score | |||
| Intact/mild cognitive impairment (0–1) | 1,001,934 (58.5) | 778,937 (52.1) | 222,997 (37.6) |
| Moderate cognitive impairment (2, 3) | 680,284 (39.8) | 325,810 (29.1) | 354,474 (59.7) |
| Severe cognitive impairment (4–6) | 29,274 (1.7) | 13,307 (1.2) | 15,972 (2.7) |
| Activities of Daily Living 28-point Scale score | |||
| None to limited assistance required (0–14) | 795,028 (46.5) | 582,547 (46.5) | 212,481 (38.5) |
| Extensive assistance required (15–19) | 620,211 (36.2) | 385,371 (34.5) | 234,840 (39.5) |
| Extensive dependency (≥20) | 296,258 (17.3) | 150,136 (13.4) | 146,122 (24.6) |
| CHESS Scale score, overall health stability | |||
| No instability (0) | 990,561 (57.9) | 650,661 (58.2) | 339,900 (57.3) |
| Minimal instability (1, 2) | 701,695 (41.0) | 456,279 (40.8) | 245,416 (41.4) |
| Moderate to very high instability (3+) | 19,241 (1.1) | 11,114 (1.0) | 8127 (1.4) |
| Charlson comorbidity score (MDS) | |||
| 0 | 155,594 (9.1) | 117,051 (10.5) | 38,543 (6.5) |
| 1–2 | 719,649 (42.1) | 484,120 (43.3) | 235,529 (39.7) |
| ≥ 3 | 836,254 (48.9) | 516,883 (46.2) | 319,371 (53.8) |
| Urinary incontinence: frequent/always | 529,756 (31.0) | 238,989 (21.4) | 290,767 (49.0) |
| Bowel incontinence: frequent/always | 403,981 (23.6) | 190,054 (17.0) | 403,981 (23.6) |
| Shortness of breath | 258,935 (15.1) | 172,789 (15.5) | 86,146 (14.5) |
| Swallowing disorder | 65,162 (3.8) | 46,058 (4.1) | 19,104 (3.2) |
| Tube feeding | 33,988 (2.0) | 17,140 (1.5) | 16,848 (2.8) |
| Ventilator or respirator use | 1741 (0.1) | 678 (0.1) | 1063 (0.2) |
| Prognosis: less than 6 months to live | 7145 (0.4) | 5274 (0.5) | 1871 (0.3) |
| Died during study period 2013–2015 | 812,036 (47.4) | 459,028 (41.1) | 353,008 (59.5) |
| Medication Use 6 months before index | |||
| Beers criteria medication,b any use | 1,098,173 (64.2) | 672,349 (60.1) | 425,824 (71.8) |
| Antipsychotics, any use | 96,289 (5.6) | 39,659 (3.6) | 56,630 (9.5) |
| Opioid analgesics, any use | 127,139 (7.4) | 99,251 (8.9) | 27,888 (4.7) |
| Antibiotics, any usec | 704,363 (41.2) | 461,537 (41.3) | 242,826 (40.9) |
| Corticosteroids, any use | 99,079 (5.8) | 72,409 (6.5) | 26,670 (4.5) |
| Proton pump inhibitors, any use | 328,345 (19.2) | 229,345 (20.5) | 99,000 (16.7) |
| Influenza vaccine received for season of cohort entry | 1,021,615 (59.7) | 628,356 (56.2) | 393,259 (66.3) |
| Pneumococcal vaccination up to date | 1,177,063 (68.8) | 749,307 (67.0) | 427,756 (72.1) |
| Health Service Use 6 months before index | |||
| Any hospitalization use | 1,388,076 (81.1) | 1,037,211 (92.8) | 350,865 (59.1) |
| Any ICU use | 454,699 (26.6) | 340,691 (30.5) | 114,008 (19.2) |
| Facility Structural Characteristics | |||
| Urban location | 1,298,856 (75.9) | 886,434 (79.3) | 412,422 (69.5) |
| Total bed size | |||
| < 100 | 630,730 (36.9) | 415,999 (37.2) | 214,731 (36.2) |
| 100–200 | 882,091 (51.5) | 570,832 (51.1) | 311,259 (51.5) |
| > 200 | 198,676 (11.6) | 131,223 (11.7) | 67,453 (11.4) |
| For-profit facility | 1,159,613 (67.8) | 746,395 (66.8) | 413,218 (69.6) |
| Facility Staffing Type and Hours | |||
| Ratio of RN to RN + LPN, mean ± SD | 0.4 ± 0.2 | 0.4 ± 0.2 | 0.3 ± 0.2 |
| SLP on-staff, hours / 100 Beds, mean ± SD | 0.5 ± 1.6 | 0.6 ± 1.6 | 0.4 ± 1.4 |
| LIP on-site | 773,827 (45.2) | 515,034 (46.1) | 258,793 (43.6) |
| Total nursing hours/resident/day, mean ± SD | 4.9 ± 9.4 | 5.3 ± 10.5 | 4.3 ± 6.8 |
| Facility Care Quality | |||
| Antipsychotic use, % of residents, mean ± SD | 18.9 ± 11.2 | 17.2 ± 10.3 | 22.1 ± 12.2 |
| Restraint use, % of residents, mean ± SD | 2.0 ± 4.5 | 1.8 ± 4.3 | 2.4 ± 4.8 |
| Pressure ulcers, % of residents, mean ± SD | 6.5 ± 4.7 | 6.7 ± 4.8 | 6.2 ± 4.3 |
Abbreviations: LTCF long-term care facility, MDS Minimum Data Set, CHESS Changes in Health, End-stage disease and Symptoms and Signs, RN Registered Nurse, LPN Licensed Practical Nurse, SLP Speech Language Pathologist, LIP Licensed Independent Practitioner
a Swing beds are LTCF beds that can serve both short-stay and long-stay residents depending on need
b The Beers criteria is a specific list of potentially inappropriate medications that are not recommended for use among older adults in most circumstances or under specific situations
c Antibiotics recommended in the Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults