Abstract

Objective: Social engagement (SE), defined as interactions with others and participation in social or individual activities, has been linked to a multitude of health outcomes, including mortality, among both community dwelling elderly and nursing home (NH) residents. Despite more activities of daily living (ADL) limitations on average, community dwelling Blacks report higher levels of SE than their white counterparts. To date, no studies have examined racial differences in SE among NH residents and none have examined the effect of facility-level racial composition on levels of SE. This paper directly examines the influence of within- and between-facility differences in racial composition of nursing homes on resident SE scores.

Methods: We used 2000-2008 national person-level Minimum Data Set (MDS) data and facility-level Online Survey Certification and Reporting (OSCAR) system data. First, we used the MDS to calculate the SE score (0–6) for all cognitively intact NH residents. A resident was considered to have low SE if the score was ace, even after controlling for facility resources and other facility characteristics.

Implications: In addition to other known disparities, residents in minority-concentrated facilities are at risk for low SE. Additional research is needed to determine the causal mechanisms leading to lower levels of SE in higher minority NHs; once understood, interventions to address low SE should be developed. However, because the newest version of the MDS (collected quarterly for all US NH residents) no longer includes this scale, new ways of monitoring SE in US NHs will need to be developed.

Slides