scholarly journals Impact of COVID-19 on Care-Home Mortality and Life Expectancy in Scotland

2021 ◽  
Author(s):  
Jennifer K Burton ◽  
Martin Reid ◽  
Ciara Gribben ◽  
David Caldwell ◽  
David N Clark ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Life Expectancy ◽  
Care Home ◽  
Mortality Data ◽  
Years Of Life Lost ◽  
Home Life ◽  
Mortality Burden ◽  
Scottish Population ◽  
Home Residency

Abstract Background COVID-19 deaths are commoner among care-home residents, but the mortality burden has not been quantified. Methods Care-home residency was identified via a national primary care registration database linked to mortality data. Life expectancy was estimated using Makeham-Gompertz models, to (i) describe yearly life expectancy from November 2015 to October 2020 (ii) compare life expectancy (during 2016–2018) between care-home residents and the wider population and (iii) apply care-home life expectancy estimates to COVID-19 death counts to estimate years of life lost (YLL). Results Among care-home residents, life expectancy in 2015/16 to 2019/20 ranged from 2.7 to 2.3 years for women and 2.3 to 1.8 years for men. Age-sex specific life expectancy in 2016–2018 in care-home residents was lower than in the Scottish population (10 and 2.5 years in those aged 70 and 90 respectively). Applying care-home specific life expectancies to COVID-19 deaths yields, mean YLLs for care-home residents of 2.6 and 2.2 for women and men respectively. In total YLL care-home residents have lost 3,560 years in women and 2,046 years in men. Approximately half of deaths and a quarter of YLL attributed to COVID-19 were accounted for by the 5% of over-70s who were care-home residents. Conclusion COVID-19 infection has led to the loss of substantial years of life in care-home residents aged 70 years and over in Scotland. Prioritising the 5% of older adults who are care-home residents for vaccination is justified not only in terms of total deaths, but also in terms of years of life lost.

scholarly journals Impact of COVID-19 on Care-Home Mortality and Life Expectancy in Scotland

2021 ◽  
Author(s):  
Jennifer K Burton ◽  
Martin Reid ◽  
Ciara Gribben ◽  
David Caldwell ◽  
David N Clark ◽  
...  
Keyword(s):  
Older Adults ◽  
Length Of Stay ◽  
Life Expectancy ◽  
Older People ◽  
Care Home ◽  
Care Homes ◽  
Years Of Life Lost ◽  
Home Life ◽  
Scottish Population ◽  
The Impact

AbstractIntroductionCOVID-19 deaths are commoner among care-home residents, but the mortality burden has not been quantified.MethodsCare-home residency was identified via a national primary care registration database linked to national mortality data. Life expectancy was estimated using Makeham-Gompertz models, to (i) describe yearly life expectancy from Nov 2015 to Oct 2020 (ii) compare life expectancy (during 2016-2018) between care-home residents and the wider Scottish population and (iii) apply care-home life expectancy estimates to COVID-19 death counts to estimate years of life lost (YLL).ResultsAmong care-home residents, life expectancy in 2015/16 to 2019/20 ranged from 2.7 to 2.3 years for women and 2.3 to 1.8 years for men. Life expectancy was lowest in 2019/20. Age-sex specific life expectancy in 2016-2018 in care-home residents was lower than in the Scottish population (10 and 2.5 years in those aged 70 and 90 respectively). Rather than using national life tables, applying care-home specific life expectancies to COVID-19 deaths yields, mean YLLs for care-home residents were 2.6 and 2.2 for women and men respectively, with total care-home resident YLLs of 3,560 years in women and 2,046 years in men. In people aged over-70, approximately half of deaths and a quarter of YLL attributed to COVID-19 were accounted for by the 5% of over-70s who were care-home residents.ConclusionPrioritising care-home residents for vaccination is justified not only in terms of total deaths, but also in terms of years of life lost.Research in contextEvidence before this studyWe searched PubMed to 1st December 2020, with the terms (“nursing home” OR “care-home” OR “long-term care” OR “residential care”) AND (“mortality” OR “life expectancy” OR “length of stay”). We also searched for studies specific to the impact of the COVID-19 pandemic on those living in care-homes. We restricted our search to publications in English. Usual care-home life expectancy, in a UK context, has not previously been defined. One systematic review of length of stay was identified, which found significant heterogeneity in factors and associations. The impact of COVID-19 on excess mortality among care-home residents was noted, but the impact on life expectancy was not reported. Studies evaluating life expectancy among older people in the COVID-19 pandemic have not taken account of residency in their estimates.Added value of this studyUsing Scottish national representative linked data we describe the usual life expectancy of older adults (aged ≥70 years) living in care-homes, compared to older people living elsewhere. Deaths among care-home residents account for a considerable proportion of all mortality in older adults, around 19% for men and 30% for women. Life expectancy in care-home residents during the pandemic fell by almost 6 months, from 2.7 to 2.3 years in men and 2.1 to 1.8 years in women. In total, over 5,600 Years of Life were Lost (YLL) by care-home residents in Scotland who died with COVID-19. Around half of COVID-19 deaths and a quarter of YLL in those aged 70 years and over occurred among care-home residents. During the COVID-19 pandemic a smaller proportion of deaths among care-home residents occurred in hospitals.Implications of all the available evidencePrioritising the 5% of older adults who are care-home residents for vaccination against COVID-19 is justified both in terms of total deaths and total years of life lost. Individual and societal planning for care needs in older age relies on understanding usual care-home life expectancy and patterns of mortality. Understanding life expectancy may help clinicians, residents and their families make decisions about their health care, facilitating more informed discussions around their priorities and wishes. Population-wide estimates of YLL and burden of disease should take account of residency status, given the significant differences between life expectancy of those living in care-homes from their peers in other settings.

scholarly journals OPTIMAL STAFFING MODELS TO CARE FOR FRAIL ELDERLY ADULTS IN PRIMARY CARE AND GERIATRIC PRACTICES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S66-S66
Author(s):  
David I Auerbach ◽  
Carie Michael ◽  
Douglas Levy ◽  
Peter Maramaldi ◽  
Robert Dittus ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Frail Elderly ◽  
Elderly Population ◽  
Care Home ◽  
Care Practice ◽  
Clinical Practices ◽  
Frail Elders ◽  
The Us ◽  
Health Care Home

Abstract As the US population ages, primary care is expected to be the health care “home” for older adults, and several initiatives are aimed at helping to transform primary care practice to care for this population. Wide variation in staffing has been observed. Meyers et al proposed ideal models of primary care staffing for a general population and for a frail elderly population (2018). We developed the 2018 Survey of Primary Care and Geriatric Clinicians to measure optimal team configuration in clinical practices caring for older adults. A majority employed NPs, MDs and PAs, with [r = -.53] between % of clinician labor of NPs and physicians). High-NP practices are more likely located in states with full scope of practice, perform well for frail elders and are less expensive. Meyers' models, with fewer physicians, more SW and CHWs, more RNs, perform better for frail elders, and are less expensive.

scholarly journals The burden of disease among Brazilian older adults and the challenge for health policies. Results of the Global Burden of Disease Study 2017

2020 ◽  
Author(s):  
VALÉRIA MARIA DE AZEREDO PASSOS ◽  
Ana Paula Silva Champs ◽  
Renato Teixeira ◽  
Maria Fernanda Furtado Lima-Costa ◽  
Renata Kirkwood ◽  
...  
Keyword(s):  
Older Adults ◽  
Information System ◽  
Life Expectancy ◽  
Burden Of Disease ◽  
Health Policies ◽  
Global Burden Of Disease ◽  
Global Burden ◽  
Years Of Life Lost ◽  
Life Expectancy At Birth ◽  
Life Years

Abstract Background Brazil is the world’s fifth most populous nation, and is currently experimenting a fast demographic ageing process in a context of scarce resources and social inequalities. To understand the health profile of older adults in Brazil is fundamental for planning public policies. Methods The estimates were derived from data obtained through the collaboration between Brazilian Ministry of Health with the Institute of Health Metrics and Evaluation of the University of Washington. The Brazilian Institute of Geography and Statistics provided the population estimates. Data on causes of death came from the Mortality Information System. To calculate morbidity, population-based studies on the prevalence of diseases in Brazil were comprehensively searched, in addition to information obtained from national databases such as the Hospital Information System, the Outpatient Information System, and the Injury Information System. We presented the Global Burden of Disease (GBD) 2017 estimates among Brazilian older adults (60 + years old) for life expectancy at birth (LE), healthy life expectancy (HALE), cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs), from 2000 to 2017. Results LE at birth significantly increased from 71.3 years (95%UI to 70.9–71.8) to 75.2 years (95%UI 74.7–75.7). There was a trend of increasing HALE, from 62.2 years (95%UI 59.54–64.5) to 65.5 years (95%UI 62.6–68.0). The proportion of DALYs among older adults increased from 7.3–10.3%. Chronic noncommunicable diseases are the leading cause of death among middle-aged and older adults, while Alzheimer's disease is a leading cause only among older adults. Mood disorders, musculoskeletal pain and hearing or vision losses are among the leading causes of disability. Conclusions The increase in LE and the decrease of the DALYs rates are probably results of the improvement of social conditions and health policies. However, the smaller increase of HALE than LE means that despite living more, people spend a substantial time of their old age with disability and illness. Preventable or potentially controllable diseases are responsible for most of the burden of disease among Brazilian older adults. Health investments are necessary to obtain longevity with quality of life in Brazil.

scholarly journals The burden of disease among Brazilian older adults and the challenge for health policies: results of the Global Burden of Disease Study 2017

2020 ◽  
Vol 18 (S1) ◽  
Author(s):  
Valéria Maria de Azeredo Passos ◽  
Ana Paula Silva Champs ◽  
Renato Teixeira ◽  
Maria Fernanda Furtado Lima-Costa ◽  
Renata Kirkwood ◽  
...  
Keyword(s):  
Older Adults ◽  
Information System ◽  
Life Expectancy ◽  
Burden Of Disease ◽  
Health Policies ◽  
Global Burden Of Disease ◽  
Global Burden ◽  
Years Of Life Lost ◽  
Life Expectancy At Birth ◽  
Life Years

Abstract Background Brazil is the world’s fifth most populous nation, and is currently experimenting a fast demographic aging process in a context of scarce resources and social inequalities. To understand the health profile of older adults in Brazil is fundamental for planning public policies. Methods The estimates were derived from data obtained through the collaboration between the Brazilian Ministry of Health and the Institute of Health Metrics and Evaluation of the University of Washington. The Brazilian Institute of Geography and Statistics provided the population estimates. Data on causes of death came from the Mortality Information System. To calculate morbidity, population-based studies on the prevalence of diseases in Brazil were comprehensively searched, in addition to information obtained from national databases such as the Hospital Information System, the Outpatient Information System, and the Injury Information System. We presented the Global Burden of Disease (GBD) 2017 estimates among Brazilian older adults (60+ years old) for life expectancy at birth (LE), healthy life expectancy (HALE), cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs), from 2000 to 2017. Results LE at birth significantly increased from 71.3 years (95% UI to 70.9-71.8) to 75.2 years (95% UI 74.7-75.7). There was a trend of increasing HALE, from 62.2 years (95% UI 59.54-64.5) to 65.5 years (95% UI 62.6-68.0). The proportion of DALYs among older adults increased from 7.3 to 10.3%. Chronic noncommunicable diseases are the leading cause of death among middle aged and older adults, while Alzheimer’s disease is a leading cause only among older adults. Mood disorders, musculoskeletal pain, and hearing or vision losses are among the leading causes of disability. Conclusions The increase in LE and the decrease of the DALYs rates are probably results of the improvement of social conditions and health policies. However, the smaller increase of HALE than LE means that despite living more, people spend a substantial time of their old age with disability and illness. Preventable or potentially controllable diseases are responsible for most of the burden of disease among Brazilian older adults. Health investments are necessary to obtain longevity with quality of life in Brazil.

scholarly journals Effects of covid-19 pandemic on life expectancy and premature mortality in 2020: time series analysis in 37 countries

BMJ ◽  
2021 ◽  
pp. e066768
Author(s):  
Nazrul Islam ◽  
Dmitri A Jdanov ◽  
Vladimir M Shkolnikov ◽  
Kamlesh Khunti ◽  
Ichiro Kawachi ◽  
...  
Keyword(s):  
Time Series ◽  
New Zealand ◽  
Life Expectancy ◽  
Confidence Interval ◽  
Time Series Analysis ◽  
South Korea ◽  
Mortality Data ◽  
Years Of Life Lost ◽  
The Us ◽  
The Difference

Abstract Objective To estimate the changes in life expectancy and years of life lost in 2020 associated with the covid-19 pandemic. Design Time series analysis. Setting 37 upper-middle and high income countries or regions with reliable and complete mortality data. Participants Annual all cause mortality data from the Human Mortality Database for 2005-20, harmonised and disaggregated by age and sex. Main outcome measures Reduction in life expectancy was estimated as the difference between observed and expected life expectancy in 2020 using the Lee-Carter model. Excess years of life lost were estimated as the difference between the observed and expected years of life lost in 2020 using the World Health Organization standard life table. Results Reduction in life expectancy in men and women was observed in all the countries studied except New Zealand, Taiwan, and Norway, where there was a gain in life expectancy in 2020. No evidence was found of a change in life expectancy in Denmark, Iceland, and South Korea. The highest reduction in life expectancy was observed in Russia (men: −2.33, 95% confidence interval −2.50 to −2.17; women: −2.14, −2.25 to −2.03), the United States (men: −2.27, −2.39 to −2.15; women: −1.61, −1.70 to −1.51), Bulgaria (men: −1.96, −2.11 to −1.81; women: −1.37, −1.74 to −1.01), Lithuania (men: −1.83, −2.07 to −1.59; women: −1.21, −1.36 to −1.05), Chile (men: −1.64, −1.97 to −1.32; women: −0.88, −1.28 to −0.50), and Spain (men: −1.35, −1.53 to −1.18; women: −1.13, −1.37 to −0.90). Years of life lost in 2020 were higher than expected in all countries except Taiwan, New Zealand, Norway, Iceland, Denmark, and South Korea. In the remaining 31 countries, more than 222 million years of life were lost in 2020, which is 28.1 million (95% confidence interval 26.8m to 29.5m) years of life lost more than expected (17.3 million (16.8m to 17.8m) in men and 10.8 million (10.4m to 11.3m) in women). The highest excess years of life lost per 100 000 population were observed in Bulgaria (men: 7260, 95% confidence interval 6820 to 7710; women: 3730, 2740 to 4730), Russia (men: 7020, 6550 to 7480; women: 4760, 4530 to 4990), Lithuania (men: 5430, 4750 to 6070; women: 2640, 2310 to 2980), the US (men: 4350, 4170 to 4530; women: 2430, 2320 to 2550), Poland (men: 3830, 3540 to 4120; women: 1830, 1630 to 2040), and Hungary (men: 2770, 2490 to 3040; women: 1920, 1590 to 2240). The excess years of life lost were relatively low in people younger than 65 years, except in Russia, Bulgaria, Lithuania, and the US where the excess years of life lost was >2000 per 100 000. Conclusion More than 28 million excess years of life were lost in 2020 in 31 countries, with a higher rate in men than women. Excess years of life lost associated with the covid-19 pandemic in 2020 were more than five times higher than those associated with the seasonal influenza epidemic in 2015.

Appendix for The COVID-19 Pandemic, Years of Life Lost, and Life Expectancy: Decomposition Using Individual-Level Mortality Data

2022 ◽  
Author(s):  
Paula Natalia Barreto Parra ◽  
Vladimir A. Atanasov ◽  
Jeffrey Whittle ◽  
John Meurer ◽  
Qian Luo ◽  
...  
Keyword(s):  
Life Expectancy ◽  
Mortality Data ◽  
Years Of Life Lost ◽  
Individual Level

scholarly journals USE OF PRIMARY CARE HOME VISITS FOR OLDER ADULTS IN MONGOLIA

2017 ◽  
Vol 1 (suppl_1) ◽  
pp. 1202-1202
Author(s):  
A. Bagaajav ◽  
A. Ghesquiere ◽  
E. Tumenjargal ◽  
D. Gardner
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Care Home ◽  
Home Visits

scholarly journals Older Adults’ Preferences for When and How to Discuss Life Expectancy in Primary Care

2017 ◽  
Vol 30 (6) ◽  
pp. 813-815 ◽  
Author(s):  
Nancy L. Schoenborn ◽  
Kimberley Lee ◽  
Craig E. Pollack ◽  
Karen Armacost ◽  
Sydney M. Dy ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Life Expectancy

scholarly journals Development of an information leaflet and diagnostic flow chart to improve the management of urinary tract infections in older adults: a qualitative study using the Theoretical Domains Framework

BJGP Open ◽  
2020 ◽  
Vol 4 (3) ◽  
pp. bjgpopen20X101044 ◽  
Author(s):  
Leah Ffion Jones ◽  
Emily Cooper ◽  
Amelia Joseph ◽  
Rosalie Allison ◽  
Natalie Gold ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Urinary Tract ◽  
Care Home ◽  
Theoretical Domains Framework ◽  
Antibiotic Use ◽  
Flow Chart ◽  
Information Leaflet ◽  
Care Home Staff ◽  
Tract Infections

BackgroundUrinary tract infections (UTIs), older age, lack of access to health care, and recent antibiotic use are risk factors for Escherichia coli (E. coli) bloodstream infections.AimTo explore the diagnosis and management of UTIs in primary care to inform the development of an information leaflet, a diagnostic flow chart, and recommendations for other resources.Design & settingThe study had a qualitative design and was undertaken in primary care settings and care homes.MethodInterviews and focus groups were informed by the Theoretical Domains Framework (TDF) with 31 care home staff, three residents, six relatives, 57 GP staff, and 19 members of the public. An inductive thematic analysis was used and themes were placed in the Behaviour Change Wheel (BCW) to recommend interventions.ResultsCare home staff were pivotal for identifying suspected UTI, alerted clinicians to symptoms that influenced prescribing decisions, and reported confusion or behavioural changes as the most common diagnostic sign. Care home staff lacked knowledge about asymptomatic bacteriuria (ASB) and sepsis, and incorrectly diagnosed UTI using urine dipsticks. GP staff used urine dipsticks to rule out UTI and reported that stopping dipsticks would require a culture change, clear protocols, and education about ASB. Many prescribers believed that stopping urine dipstick use should help to reduce antibiotic use.ConclusionA consistent message about ASB and UTI diagnosis and management in older adults should be communicated across the care pathway. Resource development should increase capability, motivation, and opportunity to improve management of suspected UTIs. An educational leaflet for older adults and a diagnostic flow chart for clinicians have been developed, and recommendations for interventions are discussed.

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