Dying in hospital among nursing home residents with and without dementia in Germany

Hoffmann, Falk; Allers, Katharina

doi:10.1016/j.archger.2019.03.013

Cited by 16 publications

(20 citation statements)

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“…Häufig werden in der Literatur auch verschiedene Altersgruppen verwendet, was eine Interpretation erschwert [15]. Möglicherweise unterscheidet sich der Einfluss von Alter auch zwischen Bewohnern mit und ohne Demenz [17] sowie zwischen unterschiedlichen Perioden des Heimaufenthalts [16].…”

Section: Hospitalisierung Im Verlauf Des Letzten Jahres Vor Todunclassified

“…Die Mehrzahl der eingeschlossenen Studien kam aus den USA; aus Deutschland konnten wir lediglich eine ältere und eine eigene Studie einschließen. Diese legen nahe, dass in Deutschland ein vergleichsweise hoher Anteil der Pflegeheimbewohner unmittelbar vor dem Tod im Krankenhaus behandelt wird [2,17,35].…”

Section: Introductionunclassified

“…Ziel dieser Arbeit war es deshalb, in Ergänzung der bereits von uns publizierten Daten zum Versterben im Krankenhaus [2,17] vertiefende Analysen zur Häufigkeit von Krankenhausaufenthalten bei Pflegeheimbewohnern in verschiedenen Perioden innerhalb des letzten Lebensjahres durchzuführen. Dabei sollten auch Unterschiede nach Alter, Geschlecht, Pflegestufe, Demenz und Bundesländern untersucht werden.…”

Section: Introductionunclassified

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Krankenhausaufenthalte von Pflegeheimbewohnern in der letzten Lebensphase: eine Analyse von Krankenkassenroutinedaten

Hoffmann

Allers

2020

Z Gerontol Geriat

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Zusammenfassung Hintergrund Im internationalen Vergleich versterben Pflegeheimbewohner in Deutschland häufig im Krankenhaus. Daten zu längeren Zeiträumen vor dem Tod und zu regionalen Unterschieden fehlen. Ziel der Arbeit Es werden Häufigkeiten von Krankenhausaufenthalten bei Pflegeheimbewohnern in verschiedenen Perioden vor dem Tod analysiert. Zudem werden Unterschiede nach Alter, Geschlecht, Pflegestufe, Demenz und Bundesländern untersucht. Material und Methoden Wir verwendeten Daten einer großen Krankenkasse und schlossen Pflegeheimbewohner im Mindestalter von 65 Jahren ein, die zwischen dem 01.01.2010 und dem 31. 12.2014 verstarben. Outcome war mindestens ein Krankenhausaufenthalt nach Heimeintritt in verschiedenen Phasen des letzten Lebensjahres. Vertiefende Analysen wurden für die Zeiträume 0 (entspricht Versterben im Krankenhaus), 28 und 365 Tage vor Tod durchgeführt. Ergebnisse Von den insgesamt 67.328 verstorbenen Bewohnern (mittleres Alter: 85,3 Jahre; 69,8 % weiblich), verstarben 29,5 % im Krankenhaus. In den letzten 28 bzw. 365 Tagen vor Tod hatten 51,5 % bzw. 74,3 % mindestens einen Krankenhausaufenthalt. Diese Werte waren in ostdeutschen Bundesländern höher. In allen Zeiträumen wurden Männer häufiger hospitalisiert. Bewohner mit höherer Pflegestufe wurden seltener stationär behandelt, besonders unmittelbar vor dem Tod. Demenz hatte keinen nennenswerten Einfluss auf die Hospitalisierungshäufigkeiten. Diskussion Etwa die Hälfte der Pflegeheimbewohner wird im letzten Lebensmonat stationär behandelt, und ein Drittel verstirbt im Krankenhaus, was, international betrachtet, hoch ist. Dass wir keine Unterschiede bei Bewohnern mit und ohne Demenz fanden, widerspricht ebenso internationalen Befunden. Somit besteht erheblicher Handlungsbedarf, die palliative Versorgung von Pflegeheimbewohnern zu optimieren.

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Section: Hospitalisierung Im Verlauf Des Letzten Jahres Vor Todunclassified

Section: Introductionunclassified

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Krankenhausaufenthalte von Pflegeheimbewohnern in der letzten Lebensphase: eine Analyse von Krankenkassenroutinedaten

Hoffmann

Allers

2020

Z Gerontol Geriat

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Section: Introductionmentioning

confidence: 99%

Perspectives of general practitioners and nursing staff on acute hospital transfers of nursing home residents in Germany: results of two cross-sectional studies

et al. 2020

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Background: Visits in emergency departments and hospital admissions are common among nursing home (NH) residents and they are associated with significant complications. Many of these transfers are considered inappropriate. This study aimed to compare the perceptions of general practitioners (GPs) and NH staff on hospital transfers among residents and to illustrate measures for improvement. Methods: Two cross-sectional studies were conducted as surveys among 1121 GPs in the German federal states Bremen and Lower Saxony and staff from 1069 NHs (preferably nursing staff managers) from all over Germany, each randomly selected. Questionnaires were sent in August 2018 and January 2019, respectively. The answers were compared between GPs and NH staff using descriptive statistics, Mann-Whitney U tests and χ2-tests. Results: We received 375 GP questionnaires (response: 34%) and 486 NH questionnaires (response: 45%). GPs estimated the proportion of inappropriate transfers higher than NH staff (hospital admissions: 35.0% vs. 25.6%, p < 0.0001; emergency department visits: 39.9% vs. 20.9%, p < 0.0001). The majority of NH staff and nearly half of the GPs agreed that NH residents do often not benefit from hospital admissions (NHs: 61.4% vs. GPs: 48.8%; p = 0.0009). Both groups rated almost all potential measures for improvement differently (p < 0.0001), however, GPs and NH staff considered most areas to reduce hospital transfers importantly. The two most important measures for GPs were more nursing staff (91.6%) and better communication between nursing staff and GP (90.9%). NH staff considered better care / availability of GP (82.8%) and medical specialists (81.3%) as most important. Both groups rated similarly the importance of explicit advance directives (GPs: 77.2%, NHs: 72.4%; p = 0.1492). Conclusions: A substantial proportion of hospital transfers from NHs were considered inappropriate. Partly, the ratings of possible areas for improvement differed between GPs and NH staff indicating that both groups seem to pass the responsibility to each other. These findings, however, support the need for interprofessional collaboration.

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“…These visits in emergency departments (EDs) with subsequent discharge to the NH (in the following named ED visits) and hospital admissions are even more common in Germany than in other Western countries [12,13] with 0.5 ED visits and 1.2 hospital admissions per resident and year [14]. Furthermore, a comparably high proportion (30%) of German NH residents die in hospital [15,16].The major reasons for acute hospital transfers of NH residents are falls and injuries, cardiovascular diseases, respiratory diseases and infections [8,10,13,17,18]. In general, hospital transfers of older persons are associated with significant complications, e.g.…”

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Perspectives of General Practitioners and Nursing Staff on Acute Hospital Transfers of Nursing Home Residents in Germany: Results of two cross-sectional Studies

Fassmer

Pulst

Spreckelsen

et al. 2020

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Background: Visits in emergency departments and hospital admissions are common among nursing home (NH) residents and they are associated with significant complications. Many of these transfers are considered inappropriate. This study aimed to compare the perceptions of general practitioners (GPs) and NH staff on hospital transfers among residents and to illustrate measures for improvement.Methods: Two cross-sectional studies were conducted as surveys among 1,121 GPs in the German federal states Bremen and Lower Saxony and staff from 1,069 NHs (preferably nursing staff managers) from all over Germany, each randomly selected. Questionnaires were sent in August 2018 and January 2019, respectively. The answers were compared between GPs and NH staff using descriptive statistics, Mann-Whitney U tests and χ2-tests.Results : We received 375 GP questionnaires (response: 34%) and 486 NH questionnaires (response: 45%). GPs estimated the proportion of inappropriate transfers higher than NH staff (hospital admissions: 35.0% vs. 25.6%, p<0.0001; emergency department visits: 39.9% vs. 20.9%, p<0.0001). The majority of NH staff and nearly half of the GPs agreed that NH residents do often not benefit from hospital admissions (NHs: 61.4% vs. GPs: 48.8%; p=0.0009). Both groups rated almost all potential measures for improvement differently (p<0.0001), however, GPs and NH staff considered most areas to reduce hospital transfers importantly. The two most important measures for GPs were more nursing staff (91.6%) and better communication between nursing staff and GP (90.9%). NH staff considered better care / availability of GP (82.8%) and medical specialists (81.3%) as most important. Both groups rated similarly the importance of explicit advance directives (GPs: 77.2%, NHs: 72.4%; p=0.1492).Conclusions : A substantial proportion of hospital transfers from NHs were considered inappropriate. Partly, the ratings of possible areas for improvement differed between GPs and NH staff indicating that both groups seem to pass the responsibility to each other. These findings, however, support the need for interprofessional collaboration.

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Dying in hospital among nursing home residents with and without dementia in Germany

Cited by 16 publications

References 40 publications

Krankenhausaufenthalte von Pflegeheimbewohnern in der letzten Lebensphase: eine Analyse von Krankenkassenroutinedaten

Krankenhausaufenthalte von Pflegeheimbewohnern in der letzten Lebensphase: eine Analyse von Krankenkassenroutinedaten

Perspectives of general practitioners and nursing staff on acute hospital transfers of nursing home residents in Germany: results of two cross-sectional studies

Perspectives of General Practitioners and Nursing Staff on Acute Hospital Transfers of Nursing Home Residents in Germany: Results of two cross-sectional Studies

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