Physical performance trajectories and mortality among nursing home residents: results of the SENIOR cohort

Abstract Background Previous studies have shown that older people can experience a considerable change in their physical performance (PP) over time. Objectives To identify PP trajectories and their association with mortality among nursing home residents who were followed up for 3 years. Design Three-year longitudinal observational study. Setting Subjects of the SENIOR cohort. Subjects Six hundred and four nursing home residents with a mean age of 82.9 ± 9.1 years. Methods Baseline characteristics and the date of death were collected from the medical records. PP was assessed annually by the short physical performance battery (SPPB) test. Multiple imputations were performed to manage the missing data. PP trajectory groups were estimated using latent growth curve analysis. Cox proportional hazard regression models were applied to examine the risk of mortality according to the PP trajectory groups. Results Three PP trajectory groups were identified: slow decline (N = 96), moderate decline (N = 234) and fast decline (N = 274). After adjustments for potential confounding variables and the baseline SPPB scores, the residents in the fast decline and moderate decline trajectory groups had an increased risk of mortality compared to those in the slow decline trajectory group, with hazard ratio values of 1.78 (95% confidence interval [CI] = 1.34–2.26) and 1.37 (95% CI = 1.10–1.66), respectively. Conclusions PP trajectories provide value-added information to baseline geriatric assessments and could be used for predicting 3-year mortality among nursing home residents. It may be important to regularly monitor the SPPB score and signal an alert when a fast decline in PP is detected in older people.

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299 A Retrospective Review of Unscheduled Hospital Admissions of Nursing Home Residents Over a Two Year Period

Age and Ageing ◽

10.1093/ageing/afz103.191 ◽

2019 ◽

Vol 48 (Supplement_3) ◽

pp. iii17-iii65

Author(s):

Aoife McFeely ◽

Cliona Small ◽

Susie Hyland ◽

Jonathan O'Keeffe ◽

Graham Hughes ◽

...

Keyword(s):

Nursing Home ◽

Older People ◽

Hospital Admissions ◽

Nursing Home Residents ◽

Integrated Approach ◽

Care Team ◽

Similar Data ◽

Readmission Rates ◽

Increased Risk ◽

One Year

Abstract Background Older people living in Nursing Homes (NHs) represent a frail and vulnerable group. With multiple co-morbidities they are at increased risk of acute health deterioration prompting urgent hospital transfer. Our aim was to examine the outcomes for nursing home residents following unscheduled hospital attendances. Methods A prospective database was collected between 1 January 2016 and 31 December 2017. This recorded all emergency admissions of older people from NHs. The data was retrospectively analysed. Outcomes assessed included: length of stay (LOS), 30-day readmission rates, number of readmissions within one year and mortality. We compared these results to similar data collected in 2012-13. Results Over a two-year period, there were 1435 hospital admissions; a 7% increase from 1015 in 2012. 60% were female and 40% male with a mean age of 84.7 years. The average LOS was 9.58 days (vs 11.2 days in 2012-13). The 30-day readmission rate was 9.8% (vs 14% in 2012-13). 30.45% of all patients went on to have 2 or more readmissions within one year, an increase from 21.1% in 2012-13. The total in-hospital mortality was 14%. Conclusion An increase in the number of NH residents presenting to an acute hospital over the past 5 years was observed. Despite this, we have seen reductions in average LOS and 30 day readmission rates. There is, however, an increasing number of recurrent admissions (≥ 2) to the hospital within one year. These results highlight the importance of an integrated approach to patient care; from the primary care team, hospital team, palliative and community care services. We believe the continued development of Nursing Home Outreach Programmes and community liaison services, combined with the evolving role of the in-hospital Geriatric ANP and liaison palliative care team, will help reduce inappropriate ED referrals and encourage advanced care planning.

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The Role of Nursing Homes Architectural Design in Mitigating the Risk of COVID-19 Pandemics: The Case of Slovenia

Athens Journal of Architecture ◽

10.30958/aja.8-1-3 ◽

2022 ◽

Vol 8 (1) ◽

pp. 51-66

Author(s):

Vesna Žegarac Leskovar ◽

Vanja Skalicky Klemenčič

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Older People ◽

Architectural Design ◽

Nursing Home Residents ◽

The Elderly ◽

Evaluation Tool ◽

Negative Effect ◽

Disproportionate Number ◽

Role Of Nursing

Currently, many older people live in institutions for various social and health reasons. In Slovenia, this proportion is almost 5% of the population aged 65 and over. In the COVID-19 pandemic, the elderly proved to be the most vulnerable social group, as they are exposed to a number of comorbidities that increase the risk of mortality. At that time, nursing homes represented one of the most critical types of housing, as seen from a disproportionate number of infections and deaths among nursing home residents worldwide, including Slovenia. During the emergency, a number of safety protocols had to be followed to prevent the spread of infection. Unfortunately, it turned out that while the safety measures protected the nursing home residents, they also had a negative effect on their mental health, mainly due to isolation and social distancing. It follows that especially in times of epidemics of infectious respiratory diseases, the quality of life in nursing homes requires special attention. In this context, it is also necessary to consider whether and how an appropriate architectural design can help mitigating the spread of infections, while at the same time enable older people to live in dignity and with a minimum of social exclusion. To this end, the present study examined 97 nursing homes in Slovenia, analysing the number of infections in nursing homes and their correlation with the degree of infection in the corresponding region in Slovenia. Additionally, 2 nursing homes were studied in more detail with the use of newly developed “Safe and Connected” evaluation tool, analysing the architectural features of each building. The advantages identified so far include living in smaller units, single rooms with balconies, the possibility of using green open spaces and the use of an adequate ventilation. Conclusions of this study are useful for further consideration of design of new nursing homes and the refurbishment of existing ones.

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Claims data analysis of medical specialist utilization among nursing home residents and community-dwelling older people

BMC Health Services Research ◽

10.1186/s12913-020-05548-0 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Maike Schulz ◽

Chrysanthi Tsiasioti ◽

Jonas Czwikla ◽

Antje Schwinger ◽

Daniel Gand ◽

...

Keyword(s):

Nursing Home ◽

Data Analysis ◽

Older People ◽

Claims Data ◽

Nursing Home Residents ◽

Community Dwelling ◽

Medical Specialist ◽

Community Dwelling Older People ◽

Claims Data Analysis

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Impact of morbidity on care need increase and mortality in nursing homes: a retrospective longitudinal study using administrative claims data

BMC Geriatrics ◽

10.1186/s12877-020-01847-7 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Katrin C. Reber ◽

Ivonne Lindlbauer ◽

Claudia Schulz ◽

Kilian Rapp ◽

Hans-Helmut König

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Claims Data ◽

Nursing Home Residents ◽

Medical Conditions ◽

Term Care ◽

Care Level ◽

Level Change ◽

Risk Of Mortality

Abstract Background A growing number of older people are care dependent and live in nursing homes, which accounts for the majority of long-term-care spending. Specific medical conditions and resident characteristics may serve as risk factors predicting negative health outcomes. We investigated the association between the risk of increasing care need and chronic medical conditions among nursing home residents, allowing for the competing risk of mortality. Methods In this retrospective longitudinal study based on health insurance claims data, we investigated 20,485 older adults (≥65 years) admitted to German nursing homes between April 2007 and March 2014 with care need level 1 or 2 (according to the three level classification of the German long-term care insurance). This classification is based on required daily time needed for assistance. The outcome was care level change. Medical conditions were determined according to 31 Charlson and Elixhauser conditions. Competing risks analyses were applied to identify chronic medical conditions associated with risk of care level change and mortality. Results The probability for care level change and mortality acted in opposite directions. Dementia was associated with increased probability of care level change compared to other conditions. Patients who had cancer, myocardial infarction, congestive heart failure, cardiac arrhythmias, renal failure, chronic pulmonary disease, weight loss, or recent hospitalization were more likely to die, as well as residents with paralysis and obesity when admitted with care level 2. Conclusion This paper identified risk groups of nursing home residents which are particularly prone to increasing care need or mortality. This enables focusing on these risk group to offer prevention or special treatment. Moreover, residents seemed to follow specific trajectories depending on their medical conditions. Some were more prone to increased care need while others had a high risk of mortality instead. Several conditions were neither related to increased care need nor mortality, e.g., valvular, cerebrovascular or liver disease, peripheral vascular disorder, blood loss anemia, depression, drug abuse and psychosis. Knowledge of functional status trajectories of residents over time after nursing home admission can help decision-makers when planning and preparing future care provision strategies (e.g., planning of staffing, physical equipment and financial resources).

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Reliability of Physical Performance Measures in Nursing Home Residents With Alzheimer's Disease

The Journals of Gerontology Series A ◽

10.1093/gerona/52a.1.m52 ◽

1997 ◽

Vol 52A (1) ◽

pp. M52-M55 ◽

Cited By ~ 52

Author(s):

R. M. Tappen ◽

K. E. Roach ◽

D. Buchner ◽

C. Barry ◽

J. Edelstein

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Nursing Home ◽

Physical Performance ◽

Performance Measures ◽

Nursing Home Residents

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Choosing to live in a nursing home: a culturally and linguistically diverse perspective

Australian Journal of Primary Health ◽

10.1071/py13164 ◽

2015 ◽

Vol 21 (2) ◽

pp. 239

Author(s):

Cecilia A. Yeboah

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Older People ◽

Cultural History ◽

Nursing Home Residents ◽

Linguistically Diverse ◽

Culturally And Linguistically Diverse ◽

Individual Interviews ◽

Cultural Origins ◽

Diverse Perspective

As part of the findings of a study on culturally and linguistically diverse older people relocating to a nursing home, this paper contributes to our understanding of how older people draw on their cultural history to explain their decisions to relocate. Family reciprocity was identified by most participants as central to their decisions, regardless of their specific cultural origins. Using the grounded theory methodology, data were collected through progressive, semi-structured, repeated, in-person, individual interviews with 20 residents of four nursing homes in the northern suburbs of Melbourne, Australia. Culturally and linguistically diverse (CALD) older people, regardless of specific cultural origin, make relocation decisions based on the importance and meaning of reciprocity within families. Understanding their decisions as reflecting a culturally valued reciprocity offered a sense of cultural continuity to the relocation and was comforting to the older adults involved in the study. This study also suggests that culturally and linguistically diverse older people are much more active participants in the decision to relocate to a nursing home than is commonly recognised. The four nursing homes in the northern suburbs of Melbourne and the 20 participants studied constitute only a small proportion of all culturally and linguistically diverse older nursing home residents in Australia. Therefore, the findings may not be pertinent to other culturally and linguistically diverse elderly. Nonetheless, this study makes an important contribution to future discussions regarding cultural diversity in the nursing home relocation of culturally and linguistically diverse older Australians. The study findings provide some insight into the conditions and contexts that impact nursing home relocation.

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Acetaminophen Safety: Risk of Mortality and Cardiovascular Events in Nursing Home Residents, a Prospective Study

Journal of the American Geriatrics Society ◽

10.1111/jgs.15861 ◽

2019 ◽

Cited By ~ 6

Author(s):

Philippe Girard ◽

Sandrine Sourdet ◽

Christelle Cantet ◽

Philipe Souto Barreto ◽

Yves Rolland

Keyword(s):

Nursing Home ◽

Prospective Study ◽

Cardiovascular Events ◽

Nursing Home Residents ◽

Safety Risk ◽

Risk Of Mortality ◽

A Prospective Study

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Odds of Venous Thromboembolims (VTE) Associated with Hospitalization, Surgery, and Cancer Among Nursing Home Residents: A Population-Based Study.

Blood ◽

10.1182/blood.v114.22.2984.2984 ◽

2009 ◽

Vol 114 (22) ◽

pp. 2984-2984

Author(s):

Cynthia L. Leibson ◽

John A. Heit ◽

Kent R. Bailey ◽

Tanya M. Petterson ◽

Aneel Ashrani

Keyword(s):

Nursing Home ◽

Symptom Onset ◽

Odds Ratio ◽

Conflicts Of Interest ◽

Conditional Logistic Regression ◽

Nursing Home Residents ◽

Population Based ◽

Olmsted County ◽

Increased Risk ◽

Active Cancer

Abstract Abstract 2984 Poster Board II-960 In previous studies of venous thromboembolism (VTE) among all residents of Olmsted County, MN, the odds of VTE associated with surgery, medical hospitalization, or active cancer were extremely high (Univariate odds ratio [OR] =14.6; 4.6, and 8.4 respectively). We also showed that nursing home (NH) residency was an independent risk factor for VTE (OR =5.6). From a clinical practice perspective, it is important to identify which NH residents are at risk of VTE. While it might be assumed that, similar to estimates for the population generally, surgery, medical hospitalization, and cancer are associated with increased risk of VTE within the NH population, the answer remains unclear. We took advantage of the previous identification of all Olmsted County, MN residents who met research criteria for incident VTE 1998-2005 (N=1168). We then determined which individuals were resident of a local NH at time of symptom onset, regardless of location of symptom onset (i.e., for purposes of this study, individuals whose VTE occurred in-hospital having been admitted from a NH were considered NH residents). For each such NH VTE case (N=96), we identified 2 same sex Olmsted County residents of similar age and duration-of-medical-history who were resident of a local NH at the time of the case's VTE event (i.e., index date) (N=192). The detailed provider-linked medical records of NH VTE cases and NH non-VTE controls were reviewed for 3 months before index for surgery or medical hospitalization and for 6 months surrounding index for active cancer. Using conditional logistic regression, we tested and estimated the odds ratio associated with each of these potential risk factors. The proportions of NH VTE cases and NH non-VTE controls with surgery (33%, 28%), medical hospitalization (44%, 46%), and active cancer (12%, 9%) were similar. Univariate odds ratios (95% confidence intervals) and p values for surgery, medical hospitalization, and active cancer were 1.5 (0.7-3.1), p=0.30; 1.1 (0.6-2.1), p=0.74; and 1.4 (0.6-3.2), p=0.46 respectively. Compared to the entire Olmsted County population, the odds of VTE associated with surgery, hospitalization, and cancer are surprisingly much lower for NH residents. Additional investigation is needed to characterize the subset of NH residents at increased risk of VTE. Disclosures: No relevant conflicts of interest to declare.

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