Nursing Home Residents Hospitalization at the End of Life: Experience and Predictors in Portuguese Nursing Homes

Abstract

(1) Background: Nursing Home (NH) residents are a population with health and social vulnerabilities, for whom emergency department visits or hospitalization near the end of life can be considered a marker of healthcare aggressiveness. With the present study, we intend to identify and characterize acute care transitions in the last year of life in Portuguese NH residents, to characterize care integration between the different care levels, and identify predictors of death at hospital and potentially burdensome transitions; (2) Methods: a retrospective after-death study was performed, covering 18 months prior to the emergence of the COVID-19 pandemic, in a nationwide sample of Portuguese NH with 614 residents; (3) Results: 176 deceased patients were included. More than half of NH residents died at hospital. One-third experienced a potentially burdensome care transition in the last 3 days of life, and 48.3% in the last 90 days. Younger age and higher technical staff support were associated with death at hospital and a higher likelihood of burdensome transitions in the last year of life, and Palliative Care team support with less. Advanced Care planning was almost absent; (4) Conclusions: The studied population was frail and old without advance directives in place, and subject to frequent hospitalization and potentially burdensome transitions near the end of life. Unlike other studies, staff provisioning did not improve the outcomes. The results may be related to a low social and professional awareness of Palliative Care and warrant further study.

Anticipatory Prescribing of Injectable Controlled Drugs (ICDs) in Care Homes: a qualitative observational study of Staff Role, Uncertain Dying and Hospital Transfer at the End-of-Life

“…The few studies linking anticipatory prescribing to a reduction in care home residents' hospital transfers evaluate the outcome of single interventions 17,18 , failing to investigate the care home staff's common practices which may hinder or facilitate this reduction. This is a key gap in knowledge considering that care home senior staff are responsible for triggering residents' hospital transfers through emergency services 21 , residents' dying is extremely di cult to predict 22 , and most hospital admissions of care home residents are inappropriate at the endof-life, leading to traumatic transfers and poor symptom control 16,[23][24][25] .…”