Race and mental health disorders' impact on older patients' nursing home admissions upon hospital discharge.

INTRODUCTION: Despite policy efforts to reduce unwanted nursing home (NH) admissions, NH residents increasingly are being admitted from hospitals, with a significant share diagnosed with mental health disorders.

OBJECTIVES: We examined interactive effect of Black race and mental health disorder's impact on older patients' (age 65 and older) NH admission upon hospital discharge.

MATERIAL AND METHODS: We analyzed 186,646 older patients using pooled data from the 2007 through 2010 National Hospital Discharge Survey. Logistic regression analyses were used to examine the risk factors for NH admission.

RESULTS: Diagnosis of mental health disorders increased the odds of NH admission among the older sample patients (OR = 1.15, 95%CI[1.04,1.28]). Black race was not associated with higher odds, whereas black patients experienced higher odds if they were diagnosed with mental health disorders (OR = 1.60, 95%CI[1.43,1.79]). Medicare as primary payer was associated with greater odds of NH admission. Admission from nursing facilities substantially increased the odds of NH admission upon hospital discharge. Patients discharged with diagnoses of stroke, lower-limb fractures, and a chronic ulcer, as well as those with a longer length-of-stay (> 5 days) experienced increased odds of NH admission. Being discharged from a larger hospital (with >200 beds) decreased the odds for NH admission; as did being discharged from a government-owned hospital.

CONCLUSIONS: Older Black patients with mental health disorder experienced significantly greater odds of NH admission after adjusting for other factors. Public policy initiatives are needed to address the specific needs in the vulnerable population to avoid unwanted NH admission.