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

Objectives. This article examines the impact of nursing home admission on mortality among persons with dementia, comparing social selection and social causation explanations of excess deaths occurring immediately after relocation. Methods. Data from a multiwave panel survey of caregivers to persons with Alzheimer's Disease (N = 555) are analyzed with proportional hazard models of time from illness onset to death of the care recipient and, for those admitted to a nursing home (N = 272), time from admission until death (N = 272). Results. Relocation is associated with a two-fold increase in mortality risk 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 following admission, which is inconsistent with a social selection interpretation. However, none of the specific indicators of stressful admission or unsatisfactory nursing home conditions are significantly related to mortality. Discussion. These data demonstrate selection processes for postadmission mortality, but indicate that the admission of patients in poor health may not fully account for the elevation in mortality that occurs immediately following admission.