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About 5% of the older population resides in nursing homes at any point in time. Only 1% of men and women age 65 to 74 reside in nursing homes, but 15% of men and 25% of women > 85 yr old do so (see FIG. 105-5). However, prevalence rates at a given point do not indicate the chance of being in a nursing home over the course of a lifetime. Among those turning 65, 52% of women and 33% of men will spend some time in a nursing home. Among women who die after age 89, 70% have lived in a nursing home for at least some time. Among all those using nursing homes, 45% will spend < 1 yr and 55% will spend > 1 yr; 21% will spend > 5 yr (see also Chs. 24 and 25).
In 1990, about 1.5 million older persons in the USA lived in nursing homes. Of this population, 75% were women, 16% were age 65 to 74, 39% were age 75 to 84, and 45% were age > 85. Nursing home patients are often cognitively or physically impaired. About 63% of residents are disoriented or have impaired memory, 92% need help with one or more ADLs, 46% have difficulty controlling bowels or bladder, and 47% are confined to a wheelchair or bed.
Risk factors for institutionalization include being widowed; living alone; having reduced family and social support, lower income, mental disorientation or cognitive impairment, and an increased number of medical conditions; being disabled in ADLs or I ADLs; and needing an aid for ambulation. Nursing home admission rates for blacks are lower than those for whites, suggesting that factors such as cultural preferences and access to care may be involved.
Use of Services in the Last Year of Life
Over 25% of total Medicare expenditures for a given year go to en-rollees who, it turned out, were in the last year of life. In fact, health care expenditures for persons in this group are seven times higher than those for other enrollees. However, Medicare covers only a portion of a person’s health care costs. For example, in the last year of life, Medicare pays for only about Vi of all care expenses. Expenditures and use of health services in the last year of life are also related to the cause of death. For example, Medicare expenditures in the last year of life are about twice as high for those dying of cancer as for those dying of heart disease or stroke.

Tags: Institutionalization

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