Black nursing home residents and terminal residents were identified as at-risk for greater health care needs in our previous research. Little is known about these at-risk residents, although their numbers are increasing and 29% of adults die in nursing homes. All nursing homes now use the Minimum Data Set (MDS) to assess and direct care planning, but it is not known if the MDS can sensitively and specifically address race and gender variations in health status or in terminal care needs. The proposed prospective study will a) document one-year race and gender variations in health status and health status stability, b) develop and evaluate four race and gender specific MDS triggers for death (death prediction models), and c) evaluate accuracy of nursing home staff MDS assessments. Evaluation of race variations will control for socioeconomic status, access to nursing homes by Black older adults, and type of nursing home. A minimum of 150 Black male, 150 Black female, 150 White male, and 150 White female residents, including residents able and residents unable to give consent, will be assessed as admitted to two large Southern nursing homes. Residents will be assessed on admission and 3, 6, and 12 months post-admission with admission MDS and quarterly MDS items. Concurrently, research staff will transcribe nursing home staff MDS assessments on 200 residents. Data analysis will compare male vs female Black, male vs female White, and Black vs White residents, and include ANOVA and ANCOVA for health status and health status stability at admission and 3, 6, and 12 months; multiple logistic regression and ROC curves for MDS triggers for death at 6 and 12 months; and Kappa coefficients and Cronbach's alpha for nursing home staff data accuracy. Results will a) document longitudinal race and gender variations in health status using the federally mandated MDS; b) develop race and gender specific MDS triggers for death (death prediction models); and c) establish if cost-effective nursing home staff MDS data can be used for future research. Results of this study will permit early identification of terminal residents and their care needs. This information is essential for future development and evaluation of culturally sensitive individualized interventions to promote quality of life and quality of dying in nursing homes.
| Graney, M J; Engle, V F (2000) Stability of performance of activities of daily living using the MDS. Gerontologist 40:582-6 |
