Morbidity and mortality among older people admitted to nursing home

Reilev, Mette; Lundby, Carina; Jensen, John; Larsen, Søren Post; Hoffmann, H.; Pottegård, Anton

doi:10.1093/ageing/afz136

Cited by 50 publications

(49 citation statements)

References 20 publications

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“…The Danish study by Reilev and colleagues found that men in NHs have a higher prevalence of comorbidities [15] and shorter survival compared to women, a finding that aligns with our results. As both sexes receive the same type and amount of care in the NH, it is difficult to understand why men have shorter survival in a NH.…”

Section: Survival In Nhssupporting

confidence: 92%

“…More than 80% of persons living in Norwegian NHs today have dementia [12], and the average length of stay for this group is reported to be 2.4 years [13], similar to figures from the Netherlands [14], where the median length of NH stay for persons with dementia was found to be 2.5 years. Figures on the general NH population in European countries show a mean length of stay of approximately 2 years [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

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Time from dementia diagnosis to nursing-home admission and death among persons with dementia: A multistate survival analysis

et al. 2020

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Objectives To estimate transition times from dementia diagnosis to nursing-home (NH) admission or death and to examine whether sex, education, marital status, level of cognitive impairment and dementia aetiology are associated with transition times. Design Markov multistate survival analysis and flexible parametric models. Setting Participants were recruited from the Norwegian Registry of Persons Assessed for Cognitive Symptoms (NorCog) in specialist healthcare between 2008 and 2017 and followed until August 2019, a maximum of 10.6 years follow-up time (mean 4.4 years, SD 2.2). Participants’ address histories, emigration and vital status were retrieved from the National Population Registry from time of diagnosis and linked to NorCog clinical data. Participants 2,938 home-dwelling persons with dementia, ages 40–97 years at time of diagnosis (mean 76.1, SD 8.5). Results During follow-up, 992 persons (34%) were admitted to nursing-homes (NHs) and 1,556 (53%) died. Approximately four years after diagnosis, the probability of living in a NH peaked at 19%; thereafter, the probability decreased due to mortality. Median elapsed time from dementia diagnosis to NH admission among those admitted to NHs was 2.28 years (IQR 2.32). The probability of NH admission was greater for women than men due to women´s lower mortality rate. Persons living alone, particularly men, had a higher probability of NH admission than cohabitants. Age, dementia aetiology and severity of cognitive impairment at time of diagnosis did not influence the probability of NH admission. Those with fewer than 10 years of education had a lower probability of NH admission than those with 10 years or more, and this was independent of the excess mortality in the less-educated group. Conclusion Four years after diagnosis, half of the participants still lived at home, while NH residency peaked at 19%. Those with fewer than 10 years of education were less often admitted to NH.

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Section: Survival In Nhssupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Time from dementia diagnosis to nursing-home admission and death among persons with dementia: A multistate survival analysis

et al. 2020

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“…Furthermore, the older adults had to be able to sign an informed consent before the interview. The latter excluded older adults with dementia, which is very common in Danish nursing homes 13 . As such, a limitation to this study is inclusion of residents less frail than expected for older adults with limited life expectancy.…”

Section: Discussionmentioning

confidence: 99%

“…The latter excluded older adults with dementia, which is very common in Danish nursing homes. 13 As such, a limitation to this study is inclusion of residents less frail than expected for older adults with limited life expectancy. For these reasons, we believe that in regard to medication, the residents were representative of older adults with a life expectancy of 1-2 years outside nursing home as well.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“I simply don't know, because I don't know which drugs I get”: Perspectives on deprescribing among older adults with limited life expectancy and their relatives

Graabæk

Lundby

Ryg

et al. 2020

Basic Clin Pharma Tox

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Use of medications of questionable benefit is common in end of life care. In order to effectively carry out deprescribing, it is important to gain insight into the perspectives of patients and their relatives. Thus, our objective was to explore perspectives on deprescribing among older adults with limited life expectancy and their relatives. We conducted semi-structured interviews with ten nursing home residents and nine relatives. Interviews were analysed using systematic text condensation. Four main themes were identified: "Medication as a necessity and to feel well," "Frailty as a barrier for taking responsibility," "Patient autonomy and faith in authority" and "A wish for being involved." Most participants had not considered the possibility of deprescribing but were open towards medication change if proposed by a healthcare professional. Most participants did not have in-depth knowledge about medication but would like to be informed or involved in decisions. The participants generally had faith in healthcare professionals despite limited contact. Our study implies that older adults with limited life expectancy and their relatives are generally interested in deprescribing activities; however, the initiative of deprescribing lies with the healthcare professionals.

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“…International epidemiological research on the health and health care needs of LTCF residents is gaining more attention [48][49][50], allowing for heterogeneity in the care residents' experience to be explored further. Despite the emphasis on ageing in place [51], and a common preference for older adults to remain living in the community until death [52], there is little evidence to suggest that cohorts on admission are in poorer health or have shorter lengths of stay than those in previous years [53].…”

Section: Implications For Future Research Policy and Practicementioning

confidence: 99%

Associations between Length of Stay in Long Term Care Facilities and End of Life Care. Analysis of the PACE Cross-Sectional Study

Moore

Payne

Keegan

et al. 2020

IJERPH

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Long term care facilities (LTCFs) are increasingly a place of care at end of life in Europe. Longer residence in an LTCF prior to death has been associated with higher indicators of end of life care; however, the relationship has not been fully explored. The purpose of this analysis is to explore associations between length of stay and end of life care. The analysis used data collected in the Palliative Care for Older People in care and nursing homes in Europe (PACE) study, a cross-sectional mortality follow-back survey of LTCF residents who died within a retrospective 3-month period, conducted in Belgium, England, Finland, Italy, the Netherlands and Poland. Primary outcomes were quality of care in the last month of life, comfort in the last week of life, contact with health services in the last month of life, presence of advance directives and consensus in care. Longer lengths of stay were associated with higher scores of quality of care in the last month of life and comfort in the last week of life. Longer stay residents were more likely to have advance directives in place and have a lasting power of attorney for personal welfare. Further research is needed to explore the underlying reasons for this trend, and how good quality end of life care can be provided to all LTCF residents.Ensuring LTCF residents approaching end of life receive appropriate care is challenging; residents may be frail, with multiple, complex care needs, and may be unable to either establish or communicate their preferences at end of life. Long term care facilities are often staffed by a combination of registered, qualified nurses and care assistants, who may have limited knowledge of end of life care for older adults and limited access to specialist services to support end of life care [7]. In addition, LTCF managers and their staff may lack clarity in defining and identifying end of life, or their role or responsibility in providing subsequent care within the facility [8]. In many European countries, end of life care in LTCFs in not well supported at a national level; in a review of 29 countries only eight had national policies which specifically addressed end of life care in LTCFs [9].Palliative care is defined as "an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual" [10]. The term "end of life care" is often used synonymously with palliative care in the UK, and refers to "an extended period of 1 to 2 years during which the patient/family and health professionals become aware of the life-limiting nature of their illness" [11]. Previous studies have found that the adoption of a palliative care approach in LTCFs led to a reduction in deaths outside the LTCF [12], an increase in the numbers of completed advance directives [13], improvements in end-of-life communication betw...

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Morbidity and mortality among older people admitted to nursing home

Cited by 50 publications

References 20 publications

Time from dementia diagnosis to nursing-home admission and death among persons with dementia: A multistate survival analysis

Time from dementia diagnosis to nursing-home admission and death among persons with dementia: A multistate survival analysis

“I simply don't know, because I don't know which drugs I get”: Perspectives on deprescribing among older adults with limited life expectancy and their relatives

Associations between Length of Stay in Long Term Care Facilities and End of Life Care. Analysis of the PACE Cross-Sectional Study

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