Assessing the Risk of Institutional Entry: A Semi-nonparametric Framework Using a Population-based Sample of Older Women

ObjectiveInstitutional entry or long-term care (LTC) is an important area to investigate owing to global aging. This study examines which types of disabilities lead to institutionalization for older White and Black women in the United States.MethodsUsing the 3-year (2009-2011) American Community Survey cross-sectional data, this study applies semi-nonparametric maximum likelihood estimation methods to examine the association between disability and institutional entry on a sample of 222,562 older White women and 19,229 older Black women. This approach provides consistent estimators because no assumptions are made about the distribution of the error terms.ResultsFor older White women, the risk of entering LTC is high in the presence of self-care and independent living difficulties (1.10 [p < .01] and 0.54 [p < .01], respectively). For older Black women, the risk of entering LTC is elevated in the presence of self-care difficulty and cognitive impairment (1.56 [p < .01] and 0.48 [p < .01], respectively) but widowed/divorced/separated marital states do not show this association.ConclusionsDisability, marital status, and race are important considerations for assessing the risk of institutional entry. Impairments that limit personal hygiene and self-care are associated with increased risk for older women. Additionally, limitations that affect reasoning and memory are associated with increased risk for older Black women.