(Author's Abstract): Factors that facilitate the continued community residence of elders categorized as being at high risk of nursing home placement including those so categorized by a state-of-the-art system developed by our group are not well understood. Although it is possible to characterize persons likely to be nursing home residents, many elders with the same characteristics remain in the community over protracted time periods. Studies to identify and evaluate the forces that intervene to facilitate continued community residency can help predict more accurately who among those with predisposing characteristics are likely to remain in the community. To this end, we will study a series of postulates focused on family perceptions and expectations about the current and future status of their elderly subject. Our postulates are based on the well-established role of families in caring and assuming responsibility for overall case-management of elders. In addition to studying the direct relationship between measures of family expectations and nursing home placement, we will also describe: (1) the extent to which these expectations change as the elder's condition deteriorates, and (2) the relation between such change in expectation and continued community residence. The sample to be studied will consist of 900 high-risk Massachusetts elders and their key informal helpers. Interviews will be completed on an annual basis, data will be gathered for a 3-year follow-up period, and comparisons will be studied within two analytic frameworks: an event history (proportional hazards) framework; and a structural equation modeling framework using LISCOMP (for categorical and other nonnormal data) and LISREL (for continuous normal data).
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