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Competing Risk of Household Expansion or Institutionalization in Late Life

^a Departments of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
^b Departments of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
^c Departments of Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina

Judith C. Hays, Box 3003, Duke University Medical Center, Durham, NC 27705 E-mail: judith.hays{at}duke.edu.

Decision Editor: Charles F. Longino, Jr., PhD

Objectives. The purpose of this study was to evaluate predictors of change in household size and institutionalization in late life.

Methods. The Duke Established Populations for Epidemiologic Studies of the Elderly cohort (n = 3730) was assessed annually (1986–1996). Independent variables included home ownership, income, cognitive and functional ability, chronic illness, mood, household size, social support, and stressful life events. Competing risk of household expansion or institutionalization was modeled using (a) hazard of either event and (b) odds of household expansion or institutionalization among elders who experienced an event.

Results. Hazard of either event was associated with younger age, Black race, lower income, cognitive problems and stability, functional abilities and deterioration, low chronic illness burden, being unmarried, having more living children, and recent life events. Among those who reported either event, odds of institutionalization (vs. household expansion) were associated with older age, White race, cognitive and functional problems, high chronic illness burden, being married, having fewer living children, smaller household size, social isolation, and exits of nonspouse coresidents.

Discussion. Modeling separate effects of whether there was a household expansion or institutionalization, and if so, which type of event occurred, and taking into account acute and evolving states, enabled more precise understanding of the complex mechanisms involved in determining continued community residence or institutionalization.