Abstract
Objective
Older adults account for a significant portion of Canadian immigrants, yet characteristics
and health outcomes of older immigrants in nursing homes have not been studied. We
aimed to describe the prevalence of immigrants living in nursing homes, their characteristics,
and their hospitalization and mortality rates compared to long-term residents in the
first year of entry to nursing homes.
Design
Population-based, retrospective cohort study using linked health administrative databases.
Setting and Participants
We assessed all incident admissions into publicly funded nursing homes in Ontario
between April 2013 and March 2016. Immigrants were defined as those who arrived in
Canada after 1985; long-term residents are those who arrived before 1985 or are Canadian-born.
Methods
The primary outcome was all-cause hospitalization and mortality rates within 1 year
of nursing home entry. Nested Cox proportional hazards models were estimated to explore
the associations of facility, demographic, and clinical characteristics to the primary
outcomes.
Results
Immigrants comprised 4.4% of residents in Ontario's nursing homes, compared to 13.9%
in the general population. The majority were from East and Southeast Asia (52.2%),
and more than half (53.9%) had no competency in either official language on arrival
in Canada. At the time of nursing home entry, immigrants were younger than long-term
residents but had greater functional and cognitive impairments. Immigrants had a lower
rate of mortality [hazard ratio 0.58, 95% confidence interval (CI) 0.51, 0.68; P < .001] but were more likely to be hospitalized (hazard ratio 1.14, 95% CI 1.06,
1.23; P < .001). Adjusting for language ability, the effect of immigrant status on hospitalization
was not statistically significant.
Conclusions and Implications
Despite greater functional and cognitive impairments, immigrants in nursing homes
had lower mortality than long-term residents, potentially reflecting the “healthy
immigrant effect.” Inability to speak English was associated with increased risk of
hospitalization, highlighting the need for strategies to overcome communication barriers.
Keywords
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Article info
Footnotes
This work was supported by a research grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC) to the Ontario QUILT (QUality for Individuals who require Long-Term support) Network (Grant ID no. 255). This work was supported in part with funding from the Government of Ontario through the Ontario Centre for Learning, Research and Innovation in Long-Term Care hosted at Bruyère. This work was also supported by a grant from the Canadian Institutes of Health Research (Grant no. 137008), and by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results, and conclusions reported in this article are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred.
The authors declare no conflicts of interest.
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