Nursing home residents: a multivariate analysis of their medical, behavioral, psychosocial, and service use characteristics.
BACKGROUND: Elderly residents of nursing homes often have multiple comorbidities and functional limitations. The status of 4,525 residents of complex and standard care units in 177 nursing homes where the nursing home was determined to provide adequate care, and from 14 specialized Alzheimer's units, was evaluated on 111 measures of medical condition, functional status, psychological well-being and cognitive performance in a demonstration study assessing quality of care in six states. Detailed measurements were also made of the types and amounts of services used (in minutes per day) by the residents. METHODS: Given the number of health measures, and the possibility of assessment error, a multivariate analytic procedure called Grade of Membership (GoM) was used. This procedure identified profiles of health and functioning measures to identify the characteristics of clinically distinct groups of nursing home residents. RESULTS: The analysis identified 11 profiles of health and functioning characteristics which described the 111 resident measurements. The 11 profiles predicted differentials in nursing home length of stay, and service use by various classes of caregivers. The GoM profiles described the data better than several other classification procedures applied to the same data. CONCLUSIONS: In nursing homes, elderly and oldest-old residents often have multiple comorbidities and disabilities. A multivariate procedure was able to identify the fundamental dimensions describing residents' variation on a number of health measures. These profiles predicted differences in service use so they had predictive validity. Thus, multivariate procedures may help identify clinically distinct groups in studies where complex measures are made.