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Prevention Guidelines and the Risk of Nursing Home Admission

Prevention Guidelines and the Risk of Nursing Home Admission. Elmira Valiyeva, Ph.D., Rutgers Louise Russell, Ph.D., Rutgers Jane Miller, Ph.D., Rutgers Monika Safford, M.D., U Alabama/Birmingham Funded in part by AHRQ grant HS11477. Prevention Guidelines.

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Prevention Guidelines and the Risk of Nursing Home Admission

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  1. Prevention Guidelines and the Risk of Nursing Home Admission Elmira Valiyeva, Ph.D., Rutgers Louise Russell, Ph.D., Rutgers Jane Miller, Ph.D., Rutgers Monika Safford, M.D., U Alabama/Birmingham Funded in part by AHRQ grant HS11477

  2. Prevention Guidelines • Clinical preventive services are “a ubiquitous part of primary care practice”. Berg AO, Allan JD. Am J Prev Med 2001;20 (3 Suppl):3-4. • Guidelines • US Preventive Services Task Force • National High Blood Pressure Education Program • National Cholesterol Education Program • Other national groups

  3. Lifestyle-related risk factors • Primary: Smoking, inactivity, obesity • Intermediate: blood pressure, cholesterol, diabetes • Impact on death and disease well studied • Impact on hospitalization: JE Miller, LB Russell, DM Davis, et al. Med Care. 1998;36:411-421 • Impact on nursing home admission likely, but not studied in representative populations that include the middle-aged

  4. NHANES I Epidemiologic Followup Study • NHANES I • Large nationally representative sample • Community-dwelling adults aged 45-74 • Baseline (1971-1975) largely predated current prevention campaigns • Comprehensive risk factors by interview, physician exam • NHEFS tracked outcomes, including nursing home admission, through 1992

  5. Analysis strategy • Cox proportional hazards regression analysis of periods of time (spells) at risk of nursing home admission • Middle-aged adults (45-64 at baseline) and elderly (65-74) analyzed separately • Linked to lifestyle-related risk factors and control variables present at baseline

  6. Sample Size

  7. Lifestyle-related risk factors • Thresholds taken from national guidelines: • Smoking: current • Inactivity: < very active in usual day and/or recreation • Obesity: Body Mass Index (BMI) ≥ 30 kg/m2 • Blood pressure: systolic BP ≥ 140 mm Hg • Cholesterol: ≥ 240 mg/dl • Diabetes: ever diagnosed by doctor

  8. Lifestyle-related risk factor prevalence, %

  9. Prevalence of control variables(% except age)

  10. Policy and Clinical Significance • Prevention guidelines have identified risk factors, and risk factor levels, that have major impacts on the risk of nursing home admission. • Prevention could reduce that risk • Better quality of life. • Lower costs for families and third-party payers.

  11. Elmira Valiyeva, Ph.D. Jane Miller, Ph.D. Louise Russell, Ph.D. Monika Safford, M.D. Institute for Health, Rutgers University, New Brunswick NJ Deep South Center on Effectiveness at the Birmingham VA Medical Center and University of Alabama at Birmingham, AL Authors’ affiliations

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