Socioeconomic, behavioral, and health determinants of functional status decline and institutionalization

Given the upward trajectory of life expectancies and the increased number of individuals with disabilities, the United States and much of the industrialized world is facing soaring demand for long-term care services. The changing demographics have placed substantial pressure on already strained federally funded health and income maintenance support programs, resulting in one of the most significant public policy issues facing society today. With the vast majority of federally funded long-term care dollars spent on institutionalized care, and the national trend for the aged and disabled to more frequently select care outside of these restrictive settings, research on factors associated with the maintenance of function and health is critical for improving quality of life within our society. Nonetheless, there has been a lack of longitudinal research on progression to disability and need for nursing home care. To address this gap, the present study examined transitions in functional health status over time across institutional and non-institutional settings using a wide range of potential explanatory demographic, economic, and behavioral variables, including but not limited to chronic health conditions, modifiable lifestyle risk factors, and personal and equipment supports. Multinomial logistic regression and survival analysis is used to model proximal and distal mechanisms by which transitions in functional capacity probabilities vary over time. The results identify divergent pathways to dependency and highlight the need for more effective health care policy interventions within a structural framework as a strategy to decrease the risk for disability and institutional care placement.