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a Health Analysis and Modelling Group, Statistics Canada, Ottawa, Ontario
b Manitoba Centre for Health Policy and Evaluation, Canada.
Jean-Marie Berthelot, Social & Economic Studies Division, Statistics Canada, R. H. Coats Building, 24th Floor, Tunney's Pasture, Ottawa, Ontario K1A 0T6, Canada E-mail: jean-marie.berthelot{at}statcan.ca.
Decision Editor: William B. Ershler, MD
Background. As the population ages, a greater demand for long-term care services and, in particular, nursing homes is expected. Policy analysts continue to search for alternative, less costly forms of care for the elderly and have attempted to develop programs to delay or prevent nursing-home entry. Health care administrators require information for planning the future demand for nursing-home services. This study assesses the relative importance of predisposing, enabling, and need characteristics in predicting and understanding nursing-home entry.
Methods. Proportional hazard models, incorporating changes in needs over time, are used to estimate the hazard of nursing-home entry over a 5-year period, using health and sociodemographic characteristics of a representative sample of elderly residents from Manitoba, Canada.
Results. After age, need factors have the greatest impact on nursing-home entry. Specific medical conditions have at least as great a contribution as functional limitations. The presence of a spouse significantly reduces the hazard of entry for males only.
Conclusions. The results suggest that the greatest gains in preventing or delaying nursing-home entry can be achieved through intervention programs targeted at specific medical conditions such as Alzheimer's disease, musculoskeletal disorders, and stroke.
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