Health Care Needs in Assisted Living: Survey Data May Underestimate Chronic Conditions

Abstract

Research using electronic and administrative databases has become increasingly common in post-acute and long-term care—so much so that its use has been conjectured to surpass that based on primary purposive data collection. 1 Sloane P.D. Mor V. Preisser J.S. Administrative data for research: an increasingly powerful tool, but still with caveats. J Am Med Dir Assoc. 2018; 19: 97-99 Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar The benefits of these databases include the large number of observations they contain and the relative ease with which they can be accessed. Data from the National Nursing Home Survey enabled widescale research on nationally representative US samples over more than 30 years, 2 Centers for Disease Control and PreventionNational Nursing Home Survey. https://www.cdc.gov/nchs/nnhs/index.htmDate accessed: October 20, 2020 Google Scholar and the availability of the Minimum Data Set (MDS) in 1991 3 Rahman A.N. Applebaum R.A. The nursing home Minimum Data Set assessment instrument: manifest functions and unintended consequences—past, present, and future. Gerontologist. 2009; 49: 727-735 Crossref PubMed Scopus (68) Google Scholar expanded nursing home research across the globe; to date, PubMed shows more than 1200 research papers have been published using MDS data. However, although MDS data seem to contain valid indicators of conditions such as nutritional status, incontinence, and many others, 4 Blaum C.S. O'Neill E.F. Clements K.M. et al. Validity of the Minimum Data Set for assessing nutritional status in nursing home residents. Am J Clin Nutr. 1997; 66: 787-794 Crossref PubMed Scopus (62) Google Scholar ,5 Resnick N.M. Brandeis G.H. Baumann M.M. Morris J.N. Evaluating a national assessment strategy for urinary incontinence in nursing home residents: Reliability of the Minimum Data Set and validity of the Resident Assessment Protocol. Neurourol Urodyn. 1996; 15: 583-598 Crossref PubMed Scopus (49) Google Scholar data accuracy in other areas has been challenged, including related to sleep, medication use, oral hygiene, and payment source. 6 Martin J.L. Alessi C.A. Limited validity of Minimum Data Set items on sleep and hypnotic use in predicting falls and hip fracture in nursing home residents. J Am Geriatr Soc. 2006; 54: 1150-1151 Crossref PubMed Scopus (14) Google Scholar ,7 Zimmerman S. Austin S. Cohen L. et al. Readily identifiable risk factors of nursing home residents' oral hygiene: Dementia, hospice, and length of stay. J Am Geriatr Soc. 2017; 65: 2516-2521 Crossref PubMed Scopus (18) Google Scholar Thus, research based on administrative databases must be cautiously interpreted.