Characteristics of Working-Age Adults With Schizophrenia Newly Admitted to Nursing Homes

J Am Med Dir Assoc. 2022 Jul;23(7):1227-1235.e3. doi: 10.1016/j.jamda.2021.11.019. Epub 2021 Dec 14.


Objectives: Persons aged <65 years account for a considerable proportion of US nursing home residents with schizophrenia. Because they are often excluded from psychiatric and long-term care studies, a contemporary understanding of the characteristics and management of working-age adults (22-64 years old) with schizophrenia living in nursing homes is lacking. This study describes characteristics of working-age adults with schizophrenia admitted to US nursing homes in 2015 and examines variations in these characteristics by age and admission location. Factors associated with length of stay and discharge destination were also explored.

Design: This is a cross-sectional study using the Minimum Data Set 3.0 merged to Nursing Home Compare.

Setting and participants: This study examines working-age (22-64 years) adults with schizophrenia at admission to a nursing home.

Methods: Descriptive statistics of resident characteristics (sociodemographic, clinical comorbidities, functional status, and treatments) and facility characteristics (ownership, geography, size, and star ratings) were examined overall, stratified by age and by admission location. Generalized estimating equation models were used to explore the associations of age, discharge to the community, and length of stay with relevant resident and facility characteristics. Coefficient estimates, adjusted odds ratios, and 95% CIs are presented.

Results: Overall, many of the 28,330 working-age adults with schizophrenia had hypertension, diabetes, and obesity. Those in older age subcategories tended to have physical functional dependencies, cognitive impairments, and clinical comorbidities. Those in younger age subcategories tended to exhibit higher risk of psychiatric symptoms.

Conclusions and implications: Nursing home admission is likely inappropriate for many nursing home residents with schizophrenia aged <65 years, especially those in younger age categories. Future psychiatric and long-term care research should include these residents to better understand the role of nursing homes in their care and should explore facility-level characteristics that may impact quality of care.

Keywords: Schizophrenia; delivery of health care; long-term care; nursing homes; psychiatric care.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Cross-Sectional Studies
  • Humans
  • Long-Term Care
  • Middle Aged
  • Nursing Homes
  • Patient Discharge
  • Schizophrenia* / therapy
  • Young Adult