Men without caregivers at greater risk for nursing home placement following stroke

National Institute of Neurological Disorders and Stroke, National Institutes of Health via Flickr

Male stroke survivors over age 65 may be three times as likely to end up in a nursing home within five years if they lack a caregiver compared with those who have someone to assist them, according to a new study. A similar risk was not seen in female stroke survivors.

The findings suggest that clinicians should remain aware of the critical role of caregivers in helping older adults remain independent.

“Our research highlights older adults as being vulnerable to the loss of independent living if they cannot identify anyone to care for them,” said lead author Justin Blackburn, Ph.D., of the Department of Health Care Organization and Policy at the University of Alabama, Birmingham, in a press statement. “This is particularly true for older men, who may be unable to access or reluctant to use formal services delivered within their home or community.”

Researchers examined 10 years of Medicare claims and analyzed interview results from the “Reasons for Geographic and Racial Differences in Stroke” (REGARDS) study of stroke survivors aged 65 to 100 (which included 256 men, 304 women). REGARDS is an NIH-sponsored national observational study of risk factors for stroke in adults 45 years or older.

Caregiver support was measured by asking, “If you had a serious illness or became disabled, do you have someone who would be able to provide care for you on an on-going basis?” Diagnosis of ischemic stroke was derived from inpatient claims.

Within five years of a stroke, 119 (21.3 percent) participants entered a nursing home. The risk of nursing home placement was greater in those lacking available caregivers by 70 percent after one year, and by 68 percent after five years. Interestingly, the effect of caregiver availability on nursing home placement within five years was limited to men. The findings were published in the Oct. 26 issue of the Journal of the American Geriatrics Society.

Other older adults who might otherwise need nursing home care tend to rely on programs such as Programs of All-Inclusive Care for the Elderly (PACE), which provides all-inclusive care for the elderly. PACE is a nationally recognized model, available in 31 states. Many community-based programs are limited to people who dually-eligible for Medicare and Medicaid or receive direct state funding. This AARP issue brief breaks down funding for community-based care.

The budget resolution recently passed by the House and Senate seems to put on the chopping block many programs that help seniors remain at home, according to an analysis by Justice in Aging. This Vox story looks at how it will harm Medicaid. This CNN story explains that Medicare could lose $473 billion in the next decade. That may put more pressure on states such as Tennessee, which already struggle to serve older adults and must figure out how to make up some of the projected shortfalls.

Journalists may want to examine local programs that help high-need older adults remain at home and look at what it may mean if Medicaid and Medicare funding are cut. Are local nursing homes seeing trends similar to what the JAGS study found?

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