Changes over Time in Racial/Ethnic Differences in Quality of Life for Nursing Home Residents: Patterns within and between Facilities

2020 ◽  
Vol 32 (10) ◽  
pp. 1498-1509
Author(s):  
Tetyana T. Shippee ◽  
Weiwen Ng ◽  
Yinfei Duan ◽  
Mark Woodhouse ◽  
Odichinma Akosionu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Nursing Home ◽  
Ethnic Minority ◽  
Ethnic Differences ◽  
Structural Characteristics ◽  
Nursing Home Residents ◽  
Data Set ◽  
Racial Ethnic ◽  
Over Time

Objectives: To investigate trends in racial/ethnic differences in nursing home (NH) residents’ quality of life (QoL) and assess these patterns within and between facilities. Method: Data include resident-reported QoL surveys ( n = 60,093), the Minimum Data Set, and facility-level characteristics ( n = 376 facilities) for Minnesota. Hierarchical linear models were estimated to identify differences in QoL by resident race/ethnicity and facility racial/ethnic minority composition for 2011–2015. Results: White residents in low-proportion racial/ethnic minority facilities reported higher QoL than both minority and white residents in high-proportion minority facilities. While the year-to-year differences were not statistically significant, the point estimates for white–minority disparity widened over time. Discussion: Racial/ethnic differences in QoL are persistent and may be widening over time. The QoL disparity reported by minority residents and all residents in high-proportion minority facilities underscores the importance of examining NH structural characteristics and practices to ultimately achieve the goal of optimal, person-centered care in NHs.

scholarly journals Are Quality-of-Life Scores Stable and Sensitive Over Time for Nursing Home Residents With and Without Dementia?

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 55-56
Author(s):  
Tetyana Shippee ◽  
Xuanzi Qin ◽  
Zachary Baker ◽  
Stephanie Jarosek ◽  
Mark Woodhouse
Keyword(s):  
Quality Of Life ◽  
Nursing Home ◽  
Nursing Home Residents ◽  
Self Report ◽  
Status Change ◽  
Data Set ◽  
Final Sample ◽  
Care Survey ◽  
Over Time

Abstract The proportion of older adults with Alzheimer’s Disease and Related Dementias (ADRD) in nursing homes (NHs) has been increasing over time and creates a mandate to meaningfully examine their care. There is also a growing recognition that person-centered measures are important for dementia care, and consensus about the need to maximize residents’ quality of life (QoL). Yet, because QoL is fundamentally subjective, and residents with ADRD experience declines in cognitive function, their ability to make complex judgements about QoL has been questioned. This presentation will longitudinally assess whether QoL scores for residents with ADRD are stable and sensitive over time compared to those without ADRD. We use 2012-2015 Minnesota Resident Quality of Life and Satisfaction with Care Survey data, which contain in-person resident responses from a random sample of residents of all Medicare/Medicaid certified NHs in the state, about 40% of whom have AD/ADRD. These data were linked to the Minimum Data Set (MDS) 3.0. and facility characteristics data. The final sample contained 12,949 cohort-resident pairs, 8,803 unique residents, and 3,120 residents participated in more than two surveys. QoL scores of residents with and without ADRD were similarly stable over time and sensitive to health status change. We also found that stability of QoL scores may be driven by cognitive impairment as opposed to ADRD diagnoses. Thus, self-report QoL scores can also represent the QoL status for nursing home residents with ADRD diagnoses, and residents with ADRD diagnoses shouldn’t be excluded from quality of life surveys based on ADRD diagnoses.

scholarly journals Decomposing Racial and Ethnic Disparities in Nursing Home Quality of Life

2020 ◽  
pp. 073346482094665
Author(s):  
John R. Bowblis ◽  
Weiwen Ng ◽  
Odichinma Akosionu ◽  
Tetyana P. Shippee
Keyword(s):  
Quality Of Life ◽  
Nursing Home ◽  
Structural Characteristics ◽  
Ethnic Disparities ◽  
People Of Color ◽  
Racial And Ethnic Disparities ◽  
Staffing Levels ◽  
Nursing Home Quality ◽  
Racial Ethnic

This study examines the racial/ethnic disparity among nursing home (NH) residents using a self-reported, validated measure of quality of life (QoL) among long-stay residents in Minnesota. Blinder–Oaxaca decomposition techniques determine which resident and facility factors are the potential sources of the racial/ethnic disparities in QoL. Black, Indigenous, and other People of Color (BIPOC) report lower QoL than White residents. Facility structural characteristics and being a NH with a high proportion of residents who are BIPOC are the factors that have the largest explanatory share of the disparity. Modifiable characteristics like staffing levels explain a small share of the disparity. To improve the QoL of BIPOC NH residents, efforts need to focus on addressing systemic disparities for NHs with a high proportion of residents who are BIPOC.

scholarly journals RACIAL-ETHNIC DIFFERENCES IN NURSING HOME QUALITY OF LIFE FOR ALZHEIMER’S DISEASE AND DEMENTIA RESIDENTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S410-S410
Author(s):  
Tetyana P Shippee ◽  
Stephanie Jarosek ◽  
Xuanzi Qin ◽  
Mark Woodhouse
Keyword(s):  
Quality Of Life ◽  
Native American ◽  
Native Americans ◽  
Ethnic Minority ◽  
Care Needs ◽  
Data Set ◽  
Random Intercept ◽  
Asian Pacific ◽  
Racial Ethnic

Abstract Nursing homes (NHs) are often racially segregated, and minority residents admitted to NHs usually have more advanced stages of dementia at the time of admission than their white counterparts, with different care needs. Previous work has shown that racial disparities in NH quality of life (QoL) were partially due to different case mix of white and minority residents; it is unclear if disparities persist when comparing residents with similar ADRD diagnoses. The 2011-2015 Minnesota Resident Quality of Life and Satisfaction with Care Survey data contain in-person resident responses from a random sample of residents of all Medicare/Medicaid certified NHs in the state, about 40% of whom have AD/ADRD. These data were linked to the Minimum Data Set (MDS) and facility characteristics data. The population consists of 25,039 White, 580 Black, 94 Hispanic, 229 Native Americans, and 99 Asian/Pacific Islander NH residents with ADRD residing in 376 NHs. Racial/ethnic minority residents reported significantly lower QoL scores compared to their white counterparts, with the largest disparities in the food and relationships domains. We adjusted for resident (age, marital status, education, sex, length of stay, anxiety/mood disorder, activities of daily living scores) and facility characteristics (proportion of minority residents, ownership, urban vs rural, size, and occupancy ratio) using a multivariate random intercept model. After adjustment, significant differences remained in total QoL score and several QoL domains for Black, Asian and Hispanic residents (no significant differences for Native American residents). Practice guidelines should consider different care needs of racial/ethnic minority NH residents with ADRD.

Quality of Life Scores for Nursing Home Residents are Stable Over Time: Evidence from Minnesota

2022 ◽  
pp. 1-14
Author(s):  
Weiwen Ng ◽  
John R. Bowblis ◽  
Yinfei Duan ◽  
Odichinma Akosionu ◽  
Tetyana P. Shippee
Keyword(s):  
Quality Of Life ◽  
Nursing Home ◽  
Nursing Home Residents ◽  
Over Time

scholarly journals RACIAL DISPARITIES IN NURSING HOME RESIDENTS: QUALITY OF LIFE: DOES THE GAP PERSIST OVER TIME?

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S780-S780
Author(s):  
Tetyana P Shippee ◽  
Weiwen Ng ◽  
John Bowblis ◽  
Yinfei Duan ◽  
Odichinma Akosionu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Racial Disparities ◽  
Random Effects ◽  
Nursing Home Residents ◽  
Well Being ◽  
Fixed And Random Effects ◽  
Facility Level ◽  
Racial Ethnic ◽  
Over Time

Abstract The proportion of racial/ethnic minorities in nursing homes (NHs) has increased steadily in recent years. This study longitudinally examines minority NH residents’ quality of life (QoL); a key measure of overall well-being. We used unique data from Minnesota annual QoL interviews (2011-2015), merged with resident and facility characteristics to model QoL. Mixed models with various resident and facility level controls, facility random effects, and both fixed and random effects for year were fit to estimate the effect of being a minority and living in a high-proportion minority facility on QoL. While white residents’ unadjusted QoL scores remained stable over time, scores for minority residents declined. In full models, white residents in low-minority facilities consistently had the highest QoL scores while minority residents in high-minority facilities had the lowest scores. More policy attention is needed to address these persistent and possibly widening racial disparities, with targeted attention needed for high-minority facilities.

scholarly journals Longitudinal Comparison of Stability and Sensitivity in Quality of Life Scores Among Nursing Home Residents With and Without Diagnoses of Alzheimer’s Disease and Related Dementias

2021 ◽  
Author(s):  
Xuanzi Qin ◽  
Zachary G Baker ◽  
Stephanie Jarosek ◽  
Mark Woodhouse ◽  
Haitao Chu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Nursing Home ◽  
Functional Status ◽  
Nursing Home Residents ◽  
Data Set ◽  
The Stability ◽  
Linear Probability

Abstract Background and Objectives Prevalence of nursing home residents with Alzheimer’s Disease and Related Dementias (ADRD) has increased along with a growing consensus that person-centered ADRD care in nursing homes should maximize quality of life (QoL). However, concerns about whether residents with ADRD can make appropriate QoL judgements persist. This study assesses the stability and sensitivity of a self-reported, multi-domain well-being QoL measure for nursing home residents with and without ADRD. Research Design and Methods This study linked the 2012-2015 Minnesota Nursing Home Resident QoL and Satisfaction with Care Survey, Minimum Data Set 3.0 (nursing home assessments), and Minnesota Department of Human Services Cost Reports. The QoL survey included cohort-resident pairs who participated for two consecutive years (N=12,949; 8,803 unique residents from 2012-2013, 2013-2014 and 2014-2015 cohorts). Change in QoL between two years was conceptualized as stable when within 1.5 standard deviations of the sample average. We used linear probability models to estimate associations of ADRD/cognitive function scale status with the stability of QoL summary and domain scores (e.g., social engagement) and the absolute change in QoL summary score, controlling for resident and facility characteristics. Results Most (86.82%) residents had stable QoL summary scores. Residents with moderate to severe cognitive impairment, irrespective of ADRD, were less likely to have stable summary scores than cognitively capable residents without ADRD (P<0.001), but associations varied by QoL domains. Among those with stable summary QoL scores, changes in health/functional status were associated with absolute changes in summary QoL score (P<0.001), suggesting sensitivity of the QoL measure. Discussion and Implications QoL scores were similarly stable over time for most residents with and without ADRD diagnoses and were sensitive to changes in health/functional status. This self-reported QoL measure may be appropriate for nursing home residents, regardless of ADRD diagnosis and can efficaciously be recommended to other states.

scholarly journals Does Living in a Higher Proportion Minority Facility Improve Quality of Life for Racial/Ethnic Minority Residents in Nursing Homes?

2020 ◽  
Vol 4 (3) ◽  
Author(s):  
Tetyana P Shippee ◽  
Weiwen Ng ◽  
John R Bowblis
Keyword(s):  
Quality Of Life ◽  
Nursing Homes ◽  
Ethnic Minority ◽  
Racial Disparities ◽  
Ethnic Composition ◽  
System Level ◽  
Data Set ◽  
Culturally Sensitive Care ◽  
Racial Ethnic

Abstract Background and Objectives The proportion of racial/ethnic minority older adults in nursing homes (NHs) has increased dramatically and will surpass the proportion of white adults by 2030.Yet, little is known about minority groups’ experiences related to the quality of life (QOL). QOL is a person-centered measure, capturing multiple aspects of well-being. NH quality has been commonly measured using clinical care indicators, but there is growing recognition for the need to include QOL. This study examines the role of individual race/ethnicity, facility racial/ethnic composition, and the interaction of both for NH resident QOL. Research Design and Methods We used a unique state-level data set that includes self-reported QOL surveys with a random sample of long-stay Minnesota NH residents, using a multidimensional measure of QOL. These surveys were linked to resident clinical data from the Minimum Dataset 3.0 and facility-level characteristics. Minnesota is one of the two states in the nation that collects validated QOL measures, linked to data on resident and detailed facility characteristics. We used mixed-effects models, with random intercepts to model summary QOL score and individual domains. Results We identified significant racial disparities in NH resident QOL. Minority residents report significantly lower QOL scores than white residents, and NHs with higher proportion minority residents have significantly lower QOL scores. Minority residents have significantly lower adjusted QOL than white residents, whether they are in low- or high-minority facilities, indicating a remaining gap in individual care needs. Discussion and Implications The findings highlight system-level racial disparities in NH residents QOL, with residents who live in high-proportion minority NHs facing the greatest threats to their QOL. Efforts need to focus on reducing racial/ethnic disparities in QOL, including potential public reporting (similar to quality of care) and resources and attention to provision of culturally sensitive care in NHs to address residents’ unique needs.

scholarly journals A tablet-based intervention for activating nursing home residents with dementia: results from a cluster-randomized controlled trial

2021 ◽  
pp. 1-13
Author(s):  
Julie L. O’Sullivan ◽  
Sonia Lech ◽  
Paul Gellert ◽  
Ulrike Grittner ◽  
Jan-Niklas Voigt-Antons ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Randomized Controlled Trial ◽  
Nursing Home ◽  
Nursing Homes ◽  
Psychotropic Medication ◽  
Controlled Trial ◽  
Nursing Home Residents ◽  
Randomized Controlled ◽  
Cluster Randomized

Abstract Objectives: To investigate global and momentary effects of a tablet-based non-pharmacological intervention for nursing home residents living with dementia. Design: Cluster-randomized controlled trial. Setting: Ten nursing homes in Germany were randomly allocated to the tablet-based intervention (TBI, 5 units) or conventional activity sessions (CAS, 5 units). Participants: N = 162 residents with dementia. Intervention: Participants received regular TBI (n = 80) with stimulating activities developed to engage people with dementia or CAS (n = 82) for 8 weeks. Measurements: Apathy Evaluation Scale (AES-I, primary outcome), Quality of Life in Alzheimer’s Disease scale, QUALIDEM scale, Neuropsychiatric Inventory, Geriatric Depression Scale, and psychotropic medication (secondary outcomes). Momentary quality of life was assessed before and after each activity session. Participants and staff were blinded until the collection of baseline data was completed. Data were analyzed with linear mixed-effects models. Results: Levels of apathy decreased slightly in both groups (mean decrease in AES-I of .61 points, 95% CI −3.54, 2.33 for TBI and .36 points, 95% CI −3.27, 2.55 for CAS). Group difference in change of apathy was not statistically significant (β = .25; 95% CI 3.89, 4.38, p = .91). This corresponds to a standardized effect size (Cohen’s d) of .02. A reduction of psychotropic medication was found for TBI compared to CAS. Further analyses revealed a post-intervention improvement in QUALIDEM scores across both groups and short-term improvements of momentary quality of life in the CAS group. Conclusions: Our findings suggest that interventions involving tailored activities have a beneficial impact on global and momentary quality of life in nursing home residents with dementia. Although we found no clear advantage of TBI compared to CAS, tablet computers can support delivery of non-pharmacological interventions in nursing homes and facilitate regular assessments of fluctuating momentary states.

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