Age and sex variation in prevalence of chronic medical conditions in older residents of U.S. nursing homes

Abstract

Objectives: To investigate patterns in prevalences of chronic medical conditions over the age span of long-term stay nursing home residents and between the sexes with data from the 2004 National Nursing Home Survey (NNHS).

Design: Retrospective, cross-sectional study.

Setting: U.S. nursing homes.

Participants: Nationally representative sample comprising 11,788 long-term stay residents (3,003 (25%) men, 8,785 (75%) women) aged 65 and older.

Measurements: Clinical Classifications Software was used to group International Classification of Diseases, Ninth Revision, codes to identify the 20 most-prevalent chronic medical conditions. SAS survey procedures were used to account for design effects of stratification and clustering to generate nationally representative estimates of prevalences of medical conditions.

Results: Average age was 84, with women older than men (85 vs 81, P = .02) and 67% of women aged 80 to 95. Women required more assistance with activities of daily living. The most frequent chronic medical conditions were hypertension (men 53%, women 56%), dementia (men 45%, women 52%), depression (men 31%, women 37%), arthritis (men 26%, women 35%), diabetes mellitus (men 26%, women 23%), gastroesophageal reflux disease (GERD) (men 23%, women 23%), atherosclerosis (men 24%, women 20%), congestive heart failure (CHF) (men 18%, women 21%), cerebrovascular disease (CVD) (men 24%, women 19%), and anemia (men 17%, women 20%). Sex differences in prevalences existed for all but constipation, GERD, and hypertension. Diabetes mellitus, CVD, and lipid disorders decreased with age in men and women. Atrial fibrillation, anemia, arthritis, CHF, dementia, and thyroid disease increased with age in men and women. Age-related patterns differed between the sexes for diabetes mellitus, hypertension, and Parkinson's disease.

Conclusion: The profile of chronic medical conditions varies over the age span of nursing home residents and differs between men and women. This knowledge should guide educational and care efforts in long-term care.

Figure 1

Prevalence (%) of chronic medical conditions in nursing home residents by age and sex with bars representing standard errors. Data for women are on the left, data for men are on the right. Tick marks across horizontal axes represent the age distribution for the given sex. The top panel presents data on common cardiovascular diseases with data on hyptertension represented by solid circles and long dashed lines (), cerebrovascuar disease repesented by triangles and short dash-dot lines (), CHF=congestive heart failure represented by squares and dotted lines (), atherosclerotic disease represented by×and short dashed lines (), AFIB=atrial fibrillation represented by plus symbols and solid lines (), and LIPID=lipid disorder represented by asterisks and long dash-dot lines (). The middle panel presents data on common organ conditions by organ affected with data on diabetes represented by squares and short dashed lines (), BPH= benign prostatic hyperplasia repesented by plus symbols and long dashed lines (), COPD= chronic obstructive pulmonary disease represented by×and solid lines (), Parkinson’s disease represented by triangles and dotted lines (), renal failure represented by circles and dash-dot lines (). The bottom panel presents data on common geriatric conditions with data on dementia represented by squares and dotted lines (), arthritis repesented by×and and short dashed lines (), anemia represented by plus symbols and solid lines (), thyroid disorders represented by circles and long dashed lines (), and osteoporosis represented by triangles and short dash-dot lines ().