{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T17:04:44Z","timestamp":1787504684288,"version":"build-2736575974"},"reference-count":37,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,10,26]],"date-time":"2017-10-26T00:00:00Z","timestamp":1508976000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background\/Objectives<\/jats:title>\n                    <jats:p>\n                      Community\u2010based older adults are increasingly living alone. When they become ill, they might need greater support from the healthcare system than would those who live with others. There also has been a growing concern about the high use of postacute care such as skilled nursing facility (\n                      <jats:styled-content style=\"fixed-case\">SNF<\/jats:styled-content>\n                      ) care and the level of variation in this use between hospitals and regions. Our objective was to examine whether living alone contributed to the risk of being discharged to a\n                      <jats:styled-content style=\"fixed-case\">SNF<\/jats:styled-content>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Massachusetts General Hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Community\u2010dwelling individuals aged 50 and older admitted to the medical service and discharged alive between July 2014 and August 2015 (N = 7,029).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>\n                      We extracted demographic, clinical, and functional data from the electronic medical record and used multivariable logistic regression to determine whether living alone at the time of hospitalization was associated with subsequent discharge to a\n                      <jats:styled-content style=\"fixed-case\">SNF<\/jats:styled-content>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of eligible individuals, 24.8% reported living alone before admission. Those living alone were more likely to be female, older, and more independent before admission than those living with others. Of all participants, 10.9% were discharged to a\n                      <jats:styled-content style=\"fixed-case\">SNF<\/jats:styled-content>\n                      . After adjustment, participants living alone had more than twice the odds of being discharged to a\n                      <jats:styled-content style=\"fixed-case\">SNF<\/jats:styled-content>\n                      (odds ratio = 2.23, 95% confidence interval = 1.85\u20132.69,\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>\n                      People living alone are more likely to be discharged to\n                      <jats:styled-content style=\"fixed-case\">SNF<\/jats:styled-content>\n                      s, even when compared to other individuals with similar levels of clinical complexity and functional status. To the extent that this variation is due to a lack of home support, it could be possible to reduce\n                      <jats:styled-content style=\"fixed-case\">SNF<\/jats:styled-content>\n                      use through additional home services after hospital discharge.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.15150","type":"journal-article","created":{"date-parts":[[2017,10,26]],"date-time":"2017-10-26T11:02:45Z","timestamp":1509015765000},"page":"100-105","source":"Crossref","is-referenced-by-count":23,"title":["Living Alone and Discharge to Skilled Nursing Facility Care after Hospitalization in Older Adults"],"prefix":"10.1111","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6170-2597","authenticated-orcid":false,"given":"Daniel E.","family":"Lage","sequence":"first","affiliation":[{"name":"Massachusetts General Hospital Department of Medicine Boston Massachusetts"},{"name":"Harvard Medical School Department of Health Care Policy Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael C.","family":"Jernigan","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital Department of Medicine Boston Massachusetts"},{"name":"Harvard Medical School Department of Health Care Policy Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuchiao","family":"Chang","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital Department of Medicine Boston Massachusetts"},{"name":"Harvard Medical School Department of Health Care Policy Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David C.","family":"Grabowski","sequence":"additional","affiliation":[{"name":"Harvard Medical School Department of Health Care Policy Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Hsu","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital Department of Medicine Boston Massachusetts"},{"name":"Harvard Medical School Department of Health Care Policy Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua P.","family":"Metlay","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital Department of Medicine Boston Massachusetts"},{"name":"Harvard Medical School Department of Health Care Policy Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sachin J.","family":"Shah","sequence":"additional","affiliation":[{"name":"University of California San Francisco Department of Medicine San Francisco California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,10,26]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhealeco.2016.08.004"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhealeco.2011.05.014"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/40.6.646"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/hec.2959"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2015.10.010"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.2522\/ptj.20150090"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.13677"},{"key":"e_1_2_6_9_1","unstructured":"Medicare Payment Advisory Commission. 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