Hospital diagnoses, Medicare charges, and nursing home admissions in the year when older persons become severely disabled

JAMA ◽  
1997 ◽  
Vol 277 (9) ◽  
pp. 728-734 ◽  
Author(s):  
L. Ferrucci
Keyword(s):  
Nursing Home ◽  
Older Persons

A Longitudinal Analysis of Functional Disability, Recovery, and Nursing Home Utilization After Hospitalization for Ambulatory Care Sensitive Conditions Among Community-Living Older Persons

2021 ◽  
Vol 16 (8) ◽  
Author(s):  
Cameron J Gettel ◽  
Arjun K Venkatesh ◽  
Linda S Leo-Summers ◽  
Terrence E Murphy ◽  
Evelyne A Gahbauer ◽  
...  
Keyword(s):  
Nursing Home ◽  
Ambulatory Care ◽  
Functional Recovery ◽  
Older Persons ◽  
Functional Disability ◽  
Ambulatory Care Sensitive Conditions ◽  
Disability Score ◽  
Patient Reported ◽  
The Mean ◽  
Monthly Probability

BACKGROUND/OBJECTIVE: Hospitalizations for ambulatory care sensitive conditions (ACSCs) are considered potentially preventable. With little known about the functional outcomes of older persons after ACSC-related hospitalizations, our objectives were to describe: (1) the 6-month course of postdischarge functional disability, (2) the cumulative monthly probability of functional recovery, and (3) the cumulative monthly probability of incident nursing home (NH) admission. METHODS: The analytic sample included 251 ACSC-related hospitalizations from a cohort of 754 nondisabled, community-living persons aged 70 years and older who were interviewed monthly for up to 19 years. Patient-reported disability scores in basic, instrumental, and mobility activities ranged from 0 to 13. Functional recovery was defined as returning within 6 months of discharge to a total disability score less than or equal to that immediately preceding hospitalization. RESULTS: The mean age was 85.1 years, and the mean disability score was 5.4 in the month prior to the ACSC-related hospitalization. After the ACSC-related hospitalization, total disability scores peaked at month 1 and improved modestly over the next 5 months, but remained greater than the pre-hospitalization score. Functional recovery was achieved by 70% of patients, and incident NH admission was experienced by 50% within 6 months after the 251 ACSC-related hospitalizations. CONCLUSIONS: During the 6 months after an ACSC-related hospitalization, older persons exhibited total disability scores that were higher than those immediately preceding hospitalization, with 3 of 10 not achieving functional recovery and half experiencing incident NH admission. These findings provide evidence that older persons experience clinically meaningful adverse patient-reported outcomes after ACSC-related hospitalizations.

scholarly journals Older persons’ thoughts about death and dying and their experiences of care in end-of-life: a qualitative study

BMC Nursing ◽  
2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Johanna Tjernberg ◽  
Christina Bökberg
Keyword(s):  
Quality Of Life ◽  
Nursing Home ◽  
Nursing Homes ◽  
End Of Life ◽  
Older Persons ◽  
Death And Dying ◽  
Living Condition ◽  
Care Needs ◽  
Healthy Persons

Abstract Background Few studies have focused on how older persons living in nursing homes perceive their last period of life. Furthermore, previous research on older persons’ perceptions of death and dying is limited. Hence, there is an urgent need to explore their experiences during their final period in life. Aim To explore thoughts about death and dying and experiences of care in end-of-life among older persons living in nursing homes. Methods This study employed a qualitative approach including individual interviews with 36 older persons living in Swedish nursing homes. Questions related to quality of life; physical health; thoughts about death, dying, and the future; and experiences related to the living condition and environment were asked. The interview transcripts were analysed through content analysis. The study was approved by the Regional Ethics Review Board (reference number: 2015/4). Results The analysis resulted in the identification of three main thematic categories: The unavoidable and unknown end of life, Thoughts on control and Living your last period of life at a nursing home. The older persons did not fear death itself but had some worries about dying. Spending the last stage of life at a nursing home contributed to different thoughts and feelings among the older persons. With a few exceptions, older persons characterized life at the nursing home as boring and felt they were surrounded by people who did not belong there. Conclusions This study indicates a need for older persons to talk about death, dying and end-life issues. Furthermore, this study highlighted that the co-residence of cognitively healthy persons and persons with dementia in the same ward adversely affected cognitively healthy persons. This situation resulted in there being not enough time to both handle the care needs of persons with dementia and have the conversations that cognitively healthy persons desired, such as conversations about thoughts about existence, that could have improved their quality of life. Trial registration NCT02708498 Date of registration 16 February 2016.

scholarly journals Predictors of drug prescription in nursing home residents: results from the INCUR study

2021 ◽  
Author(s):  
Laura Calcaterra ◽  
Marco Proietti ◽  
Edoardo Saporiti ◽  
Vanessa Nunziata ◽  
Yves Rolland ◽  
...  
Keyword(s):  
Nursing Home ◽  
Older Persons ◽  
Drug Prescription ◽  
Frailty Index ◽  
Nursing Home Residents ◽  
Public Health Issue ◽  
Linear Regression Models ◽  
The Mean ◽  
Independent Association ◽  
Post Hoc

AbstractPolypharmacy represents a major clinical and public health issue in older persons. We aimed to measure the prevalence of polypharmacy, and the main predictors of drug prescription in nursing home residents. Post hoc analyses of the “Incidence of pNeumonia and related ConseqUences in nursing home Residents” (INCUR) study were conducted. Polypharmacy was defined as the prescription of 5 or more drugs. A frailty index (FI) was computed according to the model proposed by Rockwood and Mitnitski using 36 health deficits, including diseases, signs, symptoms, and disabilities. Linear regression models were performed to identify the main predictors of the number of prescribed drugs. The INCUR study enrolled 800 patients (mean [SD] age 86.2 [4.1] years, 74.1% women). The mean number of medications prescribed at the baseline was 8.5 (SD 4.1). Prevalence of polypharmacy was found 86.4%. The mean FI was 0.38 (SD 0.10). A fully adjusted linear multivariate regression model found an inverse and independent association between age and number of prescribed drugs (beta − 0.07, 95% CI − 0.13, − 0.02; p = 0.005). Conversely, the FI was independently and positively associated with the number of medications (beta 4.73, 95% CI 1.17, 8.29; p = 0.009). The prevalence of polypharmacy is high among older persons living in nursing home. Age and FI are significantly associated with the number of drugs. The number of prescribed drugs tends to decrease with age, whereas a direct association with frailty is reported.

scholarly journals What Keeps Older People out of Nursing Homes? A Meta-Analysis

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 510-510
Author(s):  
Joseph Gaugler ◽  
Rachel Zmora ◽  
Colleen Peterson ◽  
Lauren Mitchell ◽  
Robyn Birkeland ◽  
...  
Keyword(s):  
Nursing Home ◽  
Older People ◽  
Randomized Controlled Trials ◽  
Older Persons ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Nursing Home Admission ◽  
Controlled Trials ◽  
Fee For Service ◽  
Randomized Controlled

Abstract Perhaps one of the most examined, and costly, health transitions older people experience is nursing home admission. In addition to the financial costs nursing home admission poses to older people, their families, and other payers (e.g., the public), institutionalization is linked with a range of negative outcomes and represents a loss of independence and quality of life to many older persons. The current meta-analysis attempted to synthesize all available randomized controlled trials available to ascertain which intervention approaches appeared to prevent nursing home entry for older adults. The MEDLINE, PsycInfo, CINAHL, Cochrane, and EMBASE databases were searched to August, 2020. Abstracts were screened (N = 28,120) to identify randomized controlled trials of interventions to prevent or delay nursing home admission as well as systematic reviews. Identified studies were cross-referenced until the point of saturation, resulting in 1,786 studies for additional inclusion/exclusion screening. Following a consensus-based review among the authors that included risk of bias, 323 randomized controlled trials were included in the meta analysis. Although several intervention modalities appeared protective against nursing home admission and approached statistical significance, preliminary results suggest that comprehensive geriatrics assessment (pooled OR = .69, 95% CI: .50, .95) and specialized, inpatient geriatrics care (pooled OR: .77, 95% CI: .59, .99) were most consistent in helping to prevent institutionalization among older persons. The findings emphasize the importance of geriatrics when delivering optimal care to older persons. Integrating such approaches more effectively into a largely fee-for-service healthcare paradigm remain a critical challenge.

scholarly journals Association of Injurious Falls With Disability Outcomes and Nursing Home Admissions in Community-Living Older Persons

2013 ◽  
Vol 178 (3) ◽  
pp. 418-425 ◽  
Author(s):  
T. M. Gill ◽  
T. E. Murphy ◽  
E. A. Gahbauer ◽  
H. G. Allore
Keyword(s):  
Nursing Home ◽  
Older Persons ◽  
Community Living ◽  
Injurious Falls

Transforming the hospital-style nursing home to a centre for living

2021 ◽  
pp. 084047042110450
Author(s):  
Dan Levitt
Keyword(s):  
Nursing Home ◽  
Literature Review ◽  
Capital Investment ◽  
Older Persons ◽  
Long Term Care ◽  
Transformational Change ◽  
Term Care ◽  
Institutional Model ◽  
Systems Transformation

COVID-19 has put a spotlight on the senior living sector. Transformational change is needed to address the challenges of an institutional model of long-term care. This article makes recommendations applying the Systems Transformation domain of the LEADS leadership capabilities framework to change the way older persons experience the ageing journey by creating a small home model of living. A literature review reinforces the spotlight on the capital investment needed to reinvent the nursing home into a centre for living.

scholarly journals A System of Integrated Care for Older Persons With Disabilities in Canada: Results From a Randomized Controlled Trial

2006 ◽  
Vol 61 (4) ◽  
pp. 367-373 ◽  
Author(s):  
François Béland ◽  
Howard Bergman ◽  
Paule Lebel ◽  
A. Mark Clarfield ◽  
Pierre Tousignant ◽  
...  
Keyword(s):  
Nursing Home ◽  
Integrated Care ◽  
Social Services ◽  
Caregiver Burden ◽  
Older Persons ◽  
Controlled Trial ◽  
Full Range ◽  
Community Dwelling ◽  
Elderly Persons ◽  
Persons With Disabilities

Abstract Background. Care for elderly persons with disabilities is usually characterized by fragmentation, often leading to more intrusive and expensive forms of care such as hospitalization and institutionalization. There has been increasing interest in the ability of integrated models to improve health, satisfaction, and service utilization outcomes. Methods. A program of integrated care for vulnerable community-dwelling elderly persons (SIPA [French acronym for System of Integrated Care for Older Persons]) was compared to usual care with a randomized control trial. SIPA offered community-based care with local agencies responsible for the full range and coordination of community and institutional (acute and long-term) health and social services. Primary outcomes were utilization and public costs of institutional and community care. Secondary outcomes included health status, satisfaction with care, caregiver burden, and out-of-pocket expenses. Results. Accessibility was increased for health and social home care with increased intensification of home health care. There was a 50% reduction in hospital alternate level inpatient stays (“bed blockers”) but no significant differences in utilization and costs of emergency department, hospital acute inpatient, and nursing home stays. For all study participants, average community costs per person were C$3390 higher in the SIPA group but institutional costs were C$3770 lower with, as hypothesized, no difference in total overall costs per person in the two groups. Satisfaction was increased for SIPA caregivers with no increase in caregiver burden or out-of-pocket costs. As expected, there was no difference in health outcomes. Conclusions. Integrated systems appear to be feasible and have the potential to reduce hospital and nursing home utilization without increasing costs.

Sign in / Sign up

Export Citation Format

Share Document