Detecting Acute Deterioration in Older Adults Living in Residential Aged Care: A Scoping Review

Daltrey, Julie; Boyd, Michal; Burholt, Vanessa; Robinson, Jacqualine

doi:10.1016/j.jamda.2022.05.018

Cited by 3 publications

(5 citation statements)

References 70 publications

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“…An additional factor associated with ED visits by PwD in the month before death was male gender (odds ratio: 1.41, p = 0.03), which is consistent with the findings of prior studies (Daltrey et al, 2022; Fassmer et al, 2020). In Japan, men tend to continue living at home using home care services, even at a highly dependent level of daily living, while women tend to live in facilities (Tamiya, 2008).…”

Section: Discussionsupporting

confidence: 90%

“…PwD visit EDs due to acute conditions such as abnormal blood pressure or respiratory rate, breathing difficulty, altered mental status, and uncontrolled pain (Daltrey et al, 2022). These individuals have higher rates of returns to EDs within 30 days of an ED visit, and mortality after an ED visit than do those without dementia (Lamantia et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

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Ambulance use and emergency department visits among people with dementia: A cross‐sectional survey

Nasu,

Miyashita,

Hirooka

et al. 2023

Nursing & Health Sciences

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This study aimed to explore factors associated with ambulance use and emergency department (ED) visits among people with dementia in the month before death. A web‐based survey of bereaved family caregivers of people with dementia was conducted in March 2020. Multivariate logistic regression analyses were conducted with ambulance use and ED visits in the month before death as dependent variables. Age and gender of people with dementia and their family caregivers, home care use, decision‐makers, comorbidities, degree of independence in daily living, and caregivers' preparedness for death were independent variables. Data were collected from 817 caregivers of people with dementia who had died at hospitals (52.4%), long‐term care facilities (25.0%), or own homes (22.4%). Caregivers' lack of preparedness for death was significantly associated with ambulance use in the month before death. Comorbidites and males with dementia were significantly associated with ED visits in the month before death. Better death preparedness of family caregivers may reduce ambulance use for symptoms that can be more effectively addressed by palliative care than acute care for people with dementia.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Ambulance use and emergency department visits among people with dementia: A cross‐sectional survey

Nasu,

Miyashita,

Hirooka

et al. 2023

Nursing & Health Sciences

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“…Collectively, the indicators of acute deterioration described in ED-based research, closely resemble the de nition of an acute deterioration in the RAC population namely; "a sudden, clinically important deviation from the persons baseline cognitive, behavioural, functional or physical domains ... that without intervention, may result in complications or death. "(28) Speci cally ED research names these indicators as, loss of consciousness, altered mental status, speech disorders, dizziness (cognitive domain), not eating and drinking (behavioural domain), functional decline, mobility changes and falls (functional domain) new urinary incontinence, weakness, fatigue, dyspnoea (physical domain) (17,20,26,29) These are consistent with RAC reports that clinical indicators of acute deterioration are unresponsiveness, altered mental status, behavior change, reduced food or uid intake, functional decline, falls, continence changes, fatigue, dyspnoea, uncontrolled pain, nausea and vomiting and vital sign abnormalities (9,18,19,30).…”

supporting

confidence: 69%

“…This novel use of the data has provided rst step evidence for the future development of tools to support RAC staff with the identi cation of acute deterioration. Currently there are no validated acute deterioration detection tools in RAC (19) with which to compare our results. Using routinely collected health data from an internationally available data set (interRAI-LCFT) means our research could be replicated in other localities and validate our ndings.…”

Section: Discussionmentioning

confidence: 99%

“…Their likelihood of experiencing disability or death is increased compared to those of the same age without frailty (6, 15,16). Advanced age and frailty together mean that not only do this population have a higher risk of death than those without frailty but they are also more likely to have nonspeci c clinical indicators (symptoms) of illness when they are acutely unwell (17)(18)(19). Nonspeci c indicators of acute deterioration are those not easily attributable to a particular underlying condition.…”

mentioning

confidence: 99%

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Association of clinical indicators of acute deterioration and morbidity and mortality in the residential aged care population: a retrospective cohort study of routinely collected health data (interRAI-LTCF New Zealand)

Daltrey,

Boyd,

Burholt

et al. 2024

Preprint

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Background: The timely identification of acute deterioration in people living in residential aged care is critical to avoiding or reducing rates of adverse events such as Emergency Department (ED) presentation or hospitalisation or death. This task is difficult as advanced age, multiple morbidity and frailty cause atypical or non-specific presentations of ill health. This study aimed to quantify the association between clinical indicators of acute deterioration reported in the literature and adverse events in his population. Method: A retrospective cohort study using routinely collected health data. The cohort (n=5238) were aged 65 years or older in their last year of life and had an interRAI-LTCF assessment completed (I January to 31 December 2015). InterRAI-LTCF variables were matched with clinical indicators of acute deterioration reported in the literature. Univariate and multivariate logistic regression tested the association between those variables and ED presentation, hospitalisation or death 7 days or less from last completed interRAI-LTCF assessment. Results: Nine clinical indicators, from four health domains were independently associated with acute deterioration. Cognitive indicators were being ‘largely asleep or unresponsive’odds ratio (OR) 7.95 95% CI 4.72-13.39, p<.001 and being ‘easily distracted; different to usual’ (OR 1.78 95% CI 1.28-2.49, p<.001). In the behavioural domain, eating ‘one or fewer meals a day’ (OR 2.13 95% CI 1.67-2.73, p<.001) and functional domain, a decline in activities of daily living status (OR 2.06 95% CI 1.11-3.82, p = .02) and not transferring to the toilet in the last three days (OR 1.95 95% CI 1.24-3.03, p = .004) were significant. Physical domain indicators were ‘dyspnoea; at rest’ (OR 1.81 5% CI 1.32-2.49, p<.001), ‘two or more falls in last 30 days’ (OR 1.53 95% CI 1.15-2.03, p = .003), daily peripheral oedema (OR 1.37 95 CI 1.07-1.77, p = .014) and daily pain (OR 1.37 95% CI 1.05-1.77, p = .019). Conclusion and implication: Clinical indicators of acute deterioration reported in the literature are significantly associated with adverse events. This evidence is a first step towards the future development of tools to support residential aged care staff with the identification of acute deterioration.

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Using residential aged care data to understand natural deaths

Potter¹,

Etherton‐Beer

2023

J. Prim. Health Care

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Everybody dies. This truth is unbreakable. Until we learn to thwart death, humans will continue to exit life unexpectedly or predictably.As clinicians, we try to delay mortality for as long as possible. Our success in this endeavour is evidenced by the number of people who now survive into their 9th and 10th decades. However, every patient eventually reaches a point where extending life is no longer a rational treatment goal. At this point our obligation as clinicians is simple. We should do all we can to support a good death. Recognising when a patient has reached this point is difficult and, for many patients, the shift to a palliative approach comes far too late. 1 The decision to cease active treatment is particularly difficult in people experiencing age-related terminal decline. How long is it reasonable to continue offering interventions that might prolong survival but provide no symptomatic relief? How do we decide which treatments are appropriate or inappropriate when patients can no longer discuss their preferences? And when patients do understand their prognosis, why are we so uncomfortable discussing their imminent death? 2,3 To improve the quality of end-of-life care we offer frail older people, we need better knowledge of the trajectory of natural death, particularly in people with dementia as their primary diagnosis. Knowing with confidence the signs of an irreversible terminal decline in these patients would reassure us when ceasing active treatment that we are practising compassionate acceptance of reality rather than creating a self-fulfilling prophecy.Aged residential care (ARC) is the optimal setting to study death in older people. ARC facilities in Aotearoa New Zealand and Australia house a rapidly expanding cohort of people who have reached the natural end of their lives. In September 2021, in Aotearoa New Zealand, 35 254 people were occupying an aged residential care bed. 4 This total comprised approximately 5% of the 75-to 84-year-old population and >25% of the over-84-year-old population. 5 Australia reports similar rates of ARC occupancy. 6 The median age of entry to residential care is 86 years, and the median survival time from admission is 18 months. 7,8 International data on place of death indicate that one in three of us will enter ARC shortly before we die. 9 Research requiring the active participation of people living in ARC can be challenging. People with cognitive impairment severe enough to require residential care often do not have the capacity to provide informed consent to participate in research. However, large volumes of clinical data consented for research use are collected regularly from every person who receives government-funded age-care services in Aotearoa New Zealand. 10 In addition, many large residential aged care providers in Aotearoa New Zealand and Australia maintain a fully digital patient record comprised of regular comprehensive nursing assessments and, in most cases, a complete electronic record of all medicines charted and administered. These records contai...

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Detecting Acute Deterioration in Older Adults Living in Residential Aged Care: A Scoping Review

Cited by 3 publications

References 70 publications

Ambulance use and emergency department visits among people with dementia: A cross‐sectional survey

Ambulance use and emergency department visits among people with dementia: A cross‐sectional survey

Association of clinical indicators of acute deterioration and morbidity and mortality in the residential aged care population: a retrospective cohort study of routinely collected health data (interRAI-LTCF New Zealand)

Using residential aged care data to understand natural deaths

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