The vital prognosis of elderly adults living in a group home in their mid-eighties

Abstract

The purpose of the present study is to evaluate the vital prognoses of elderly people in their mid-eighties living in a group home (GH) compared to age- and sex-matched outpatient clinic (OPC) in an observational study conducted over 6 years. We investigated the association between mortality and general, cardiac, and nutritional parameters, including eicosapentaenoic acid (EPA) in 54 GH residents (83 ± 8 years old) and 57 OPC attendees (83 ± 5 years old). Kaplan-Meier curves and Cox proportional hazard ratio analyses were used to assess the association between EPA drug administration and mortality in the GH residents and OPC attendees, respectively. The 54 GH residents had higher mortality and poorer nutritional states, as indicated by lower EPA/arachidonic acid values (median 0.20 vs 0.55, p < 0.001), and BMI under the condition without EPA drug administration (1800 mg daily) than did the OPC group. The significant factors that differed between survivors and deceased in the GH residents and OPC attendees were nutritional and cardiac factors. Cox proportional hazard ratio analysis confirmed that a possible determinant of the prognosis was a lower incidence of EPA drug administration and lower hemoglobin in GH. Kaplan-Meier curves and Cox proportional hazard ratio analyses revealed that EPA drug administration significantly reduced the relative mortality by 82 % in the GH residents (p < 0.001) but not in the OPC attendees. The vital prognosis in individuals from GHs was potentially improved by EPA drug administration, which was not the case in the OPC group; however, further prospective studies are needed.

Prognostic Biomarkers of Mortality in Older Patients Without Cancer in Home Healthcare

“…In the present study, we observed that low levels of Hb or Alb were associated with a poor prognosis in patients in home healthcare, which is in line with previous studies [ 3 , 9 , 18 ]. Low Alb levels are associated with malnutrition [ 18 ], undernutrition [ 23 ], and inflammation in non-cancerous diseases [ 24 ].…”

“…This is the first description to indicate that AST, in addition to Hb and Alb, is an independent prognostic biomarker for older patients without cancer, who had a normal-to-mild increased level of AST, in the home healthcare settings. These findings suggest that the AST level could be measured at baseline and utilized in combination with the helpful biomarkers (Alb and Hb) as reported previously [ 3 , 9 - 10 ] for estimating prognosis in older patients. The time-dependent AUC of AST > 31 also increased by 360 days (Table 3 ).…”

“…The ability to predict a patient’s prognosis is useful for end-of-life planning for all patients, including those without cancer [ 6 , 8 ]. Almost all studies on prognostic prediction involve patients with cancer only or both with and without cancer [ 3 , 9 , 10 ]; thus, the studies on patients without cancer are necessary with some objective measures as patient prognosis is one of the main factors contributing to medical decisions in end-of-life planning [ 11 ]. Several generic biomarkers are commonly measured in clinical practice in Japan [ 12 ].…”

“…In community-dwelling older people, generic biomarkers such as hemoglobin (Hb) [ 13 ], aspartate aminotransferase (AST) [ 14 ], alanine aminotransferase (ALT) [ 15 ], estimated glomerular filtration rate (eGFR) [ 16 ], C-reactive protein (CRP) [ 17 ], and albumin (Alb) [ 18 ] were associated with the risk of all-course mortality. Although Hb [ 9 - 10 ] and Alb [ 3 , 10 ] have been previously studied as potential prognostic biomarkers in home healthcare, there is still a lack of research on other routinely employed generic biomarkers. Therefore, our study aimed to investigate the prediction of those generic biomarkers for all-cause mortality in older adults without cancer who received home healthcare.…”

An overview of innovative living arrangements within long-term care and their characteristics: a scoping review

“…Finally, 56 articles were selected to answer our research question. These articles described a total of seven distinctive innovative living arrangements: (1) small-scale living [ 15 , 16 , 18 , 29 – 39 ], (2) the green house model [ 40 – 47 ], (3) shared housing arrangements [ 48 – 54 ], (4) green care farms [ 20 , 55 – 61 ], (5) dementia villages [ 40 , 62 – 66 ], (6) group homes [ 67 – 69 ], and (7) intergenerational living [ 70 – 72 ]. Some articles, however, could not be grouped into one overarching living arrangement because they did not describe the same overarching elements (a household model of residential aged care [ 73 ], household model units [ 74 , 75 ], intensive service housing [ 76 ], a non-traditional residential care facility [ 77 ], the Woodside place model [ 78 ], a small-scale homelike unit [ 79 ], and a homelike dementia care facility [ 80 ]) and were described as an ‘other’ category.…”