P3534Infective endocarditis is associated with an increased risk of nursing home admission and initiation of domiciliary care

Background Patients with chronic diseases are at higher risk of requiring domiciliary and nursing home care, but how different chronic diseases compare in terms of risk is not known. We examined initiation of domiciliary care and nursing home admission among patients with heart failure (HF), stroke, COPD and cancer. Methods Patients with a first-time hospitalization for HF, stroke, COPD or cancer from 2008–2016 were identified. Patients were matched on age and sex and followed for five years. Results 111,144 patients, 27,786 with each disease, were identified. The median age was 69 years and two thirds of the patients were men. The 5-year risk of receiving domiciliary care was; HF 20.9%, stroke 25.2%, COPD 24.6% and cancer 19.3%. The corresponding adjusted hazard ratios (HRs), with HF patients used as reference, were: stroke 1.35[1.30–1.40]; COPD 1.29[1.25–1.34]; and cancer 1.19[1.14–1.23]. The five-year incidence of nursing home admission was 6.6% for stroke, and substantially lower in patients with HF(2.6%), COPD(2.6%) and cancer (1.5%). The adjusted HRs were (HF reference): stroke, 2.44 [2.23–2.68]; COPD 1.01 [0.91–1.13] and cancer 0.76 [0.67–0.86]. Living alone, older age, diabetes, chronic kidney disease, depression and dementia predicted a higher likelihood of both types of care. Conclusions In patients with HF, stroke, COPD or cancer 5-year risk of domiciliary care and nursing home admission, ranged from 19–25% and 1–7%, respectively. Patients with stroke had the highest rate of domiciliary care and were more than twice as likely to be admitted to a nursing home, compared to patients with the other conditions.

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1428Factors leading to institutionalization among the oldest old. Longitudinal findings from the AgeCoDe-AgeQualiDe study

International Journal of Epidemiology ◽

10.1093/ije/dyab168.102 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Elzbieta Buczak-Stec ◽

André Hajek ◽

Michael Wagner ◽

Martin Scherer ◽

Wolfgang Maier ◽

...

Keyword(s):

Nursing Home ◽

Cognitive Decline ◽

Service Use ◽

Oldest Old ◽

Strong Association ◽

Functional Decline ◽

Nursing Home Admission ◽

Term Care ◽

Increased Risk ◽

Health Related

Abstract Background Due to the strong association between old age and the need for long-term care, the number of individuals in need for care is projected to increase noticeably. The aim of this study is to examine determinants of institutionalization nursing home admission among the oldest old longitudinally. Methods Longitudinal data were gathered from a multicenter prospective cohort study (“Study on Needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (85+)”; AgeQualiDe). At baseline (2014), complete measures were available for 684 individuals. The average age was 88.9ys (85-100), 68% were female. Sociodemographic and health-related variables (e.g., depressive symptoms, functioning) were included in the regression model. Institutionalization was defined as a date of admission to a nursing home. Competing risk survival analysis was performed using death as a competing event (Fine and Gray model). Results During the follow-up of the study, altogether 104 individuals were institutionalized, 81 died. Based on the estimated subhazard ratios, the risk of institutionalization increased with functional decline sHR=0.62, 95% CI [0.56-0.69] in total sample. Moreover, cognitive decline was associated with an increased risk of institutionalization only in men (sHR=1.73, 95%CI [1.05-2.87]). Conclusions Our findings stress the importance of functional decline (for both sexes) and cognitive decline (only for men) for institutionalization among the oldest old. Key messages Preventing or at least postponing functional decline might help to delay as far as possible institutionalization.

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Predictors for Nursing Home Admission and Death among Community-Dwelling People 70 Years and Older Who Receive Domiciliary Care

Dementia and Geriatric Cognitive Disorders Extra ◽

10.1159/000437382 ◽

2015 ◽

Vol 5 (3) ◽

pp. 320-329 ◽

Cited By ~ 30

Author(s):

Jon N. Wergeland ◽

Geir Selbæk ◽

Sverre Bergh ◽

Ulrika Soederhamn ◽

Øyvind Kirkevold

Keyword(s):

Nursing Home ◽

Functional Impairment ◽

Proportional Hazards ◽

Depressive Mood ◽

Cox Proportional Hazards ◽

Community Dwelling ◽

Nursing Home Admission ◽

Life Changes ◽

Domiciliary Care ◽

The Family

Aim: The aim of this study was to analyze which variables predicted nursing home admission (NHA) and death. Methods: 1,001 recipients of domiciliary care were assessed three times in a 3-year period. Through bivariate and multivariate Cox proportional hazards regression models, associations between a covariate and the outcomes were analyzed. Results: Participants with dementia had a higher risk of NHA (odds ratio 3.88, 95% confidence interval 2.92-5.16) compared to participants without dementia. The Neuropsychiatric Inventory sub-syndrome psychosis, poorer functional impairment and age were associated with NHA. Female sex, age, worse medical health and functional impairment were associated with death. Conclusion: Support to the caregiver and education on how to meet and cope with behavioral disturbance, depressive mood and sub-syndrome psychosis will probably enable the family to better adapt to late life changes.

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CO-PRESENCE OF MULTIMORBIDITY AND DISABILITY WITH FRAILTY: AN EXAMINATION OF HETEROGENEITY IN THE FRAIL OLDER POPULATION

Journal of Frailty & Aging ◽

10.14283/jfa.2015.45 ◽

2015 ◽

pp. 1-8

Author(s):

S. AARTS ◽

K.V. PATEL ◽

M.E. GARCIA ◽

M. VAN DEN AKKER ◽

F.R.J. VERHEY ◽

...

Keyword(s):

Nursing Home ◽

Reference Group ◽

Adult Population ◽

Energy Levels ◽

White Matter Lesions ◽

Population Based ◽

Nursing Home Admission ◽

Older Population ◽

Distribution Width ◽

Increased Risk

Background: Frailty is often associated with multimorbidity and disability. Objectives: We investigated heterogeneity in the frail older population by characterizing five subpopulations according to quantitative biological markers, multimorbidity and disability, and examined their association with mortality and nursing home admission. Design: Observational study. Participants: Participants (n=4,414) were from the population-based Age Gene/Environment Susceptibility Reykjavik Study. Measurements: Frailty was defined by ≥ 3 of five characteristics: weight loss, weakness, reduced energy levels, slowness and physical inactivity. Multimorbidity was assessed using a simple disease count, based on 13 prevalent conditions. Disability was assessed by five activities of daily living; participants who had difficulty with one or more tasks were considered disabled. Differences among frail subpopulations were based on the co-presence of multimorbidity and disability. Differences among the following subpopulations were examined: 1) Non-frail (reference group); 2) Frail only; 3) Frail with disability; 4) Frailty with multimorbidity; 5) Frail with disability and multimorbidity. Results: Frailty was present in 10.7% (n=473). Frailty was associated with increased risk for mortality (OR 1.40; 95% CI 1.15-1.69) and nursing home admission (OR 1.50; 95% CI 1.16-1.93); risks differed by subpopulations. Compared to the non-frail, the frail only group had poorer cognition and increased inflammation levels but did not have increased risk for mortality (OR 1.40; 95% CI 0.84-2.33) or nursing home admission (OR 1.01; 95% CI 0.46-2.21). Compared to the non-frail, the other frail subpopulations had significantly poorer cognition, increased inflammation levels, more white matter lesions, higher levels of calcium, glucose and red cell distribution width and increased risk for mortality and nursing home admission. Conclusions: The adverse health risks associated with frailty in the general older adult population may primarily be driven by increased disease burden and disability.

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Causes of nursing home placement for older people with dementia: a systematic review and meta-analysis

International Psychogeriatrics ◽

10.1017/s1041610216001654 ◽

2016 ◽

Vol 29 (2) ◽

pp. 195-208 ◽

Cited By ~ 87

Author(s):

Sandeep Toot ◽

Tom Swinson ◽

Mike Devine ◽

David Challis ◽

Martin Orrell

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Older People ◽

Meta Analysis ◽

Community Support ◽

Nursing Home Placement ◽

Nursing Home Admission ◽

People With Dementia ◽

Increased Risk ◽

Home Placement

ABSTRACTBackground:Up to half of people with dementia in high income countries live in nursing homes and more than two-thirds of care home residents have dementia. Fewer than half of these residents report good quality of life and most older people are anxious about the prospect of moving into a nursing home. Robust evidence is needed as to the causes of admission to nursing homes, particularly where these risk factors are modifiable.Methods:We conducted a systematic literature search to identify controlled comparison studies in which the primary outcome was admission to nursing home of older adults with dementia. Identified studies were assessed for validity and 26 (17 cohort and 9 case-control) were included. Qualitative and quantitative analyses were conducted, including meta-analysis of 15 studies.Results:Poorer cognition and behavioral and psychological symptoms of dementia (BPSD) were consistently associated with an increased risk of nursing home admission and most of our meta-analyses demonstrated impairments in activities of daily living as a significant risk. The effects of community support services were unclear, with both high and low levels of service use leading to nursing home placement. There was an association between caregiver burden and risk of institutionalization, but findings with regard to caregiver depression varied, as did physical health associations, with some studies showing an increased risk of nursing home placement following hip fracture, reduced mobility, and multiple comorbidities.Conclusion:We recommend focusing on cognitive enhancement strategies, assessment and management of BPSD, and carer education and support to delay nursing home placement.

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