Dependency in older people recently admitted to care homes

Abstract

Objective: to investigate dependency and general health status of a cohort of older people admitted to residential or nursing homes for long-term care. Method: we assessed 308 people aged over 65 years within 2 weeks of admission for long-term care to one of 30 nursing or residential homes in north-west England. Dependency was assessed using the Barthel activities of daily living index and the Crichton Royal Behaviour Rating Scale. We collected information from the homes' records on diagnosed conditions and current medication. Results: 50% of the cohort were in a 'low dependency' band (Barthel score 13-20): 31% of those in nursing homes and 71% of those in residential homes. In nursing homes, low-dependency residents were more likely to be selffunding than those with higher dependency. Of a number of broad diagnostic groupings, only a diagnosis of dementia was associated with nursing-rather than residential-home admission. Of 47 residents who scored 9 or less on the Mini-Mental State Examination (indicating severe cognitive impairment), 85% had no diagnosis of dementia, neurological disorder or other psychiatric disorder. Discussion: the high proportion of new admissions of subjects with low dependency needs raises questions about the effective targeting of resources and about management of the boundary between home-based and institutional care. The existence of an important group of self-funded, low-dependency new admissions to nursing homes suggests a need to provide better assessment and placement services for those who are financially independent of local authorities. Many new admissions had conditions which might benefit from rehabilitation but there were almost no therapy staff in the studied homes. In some cases where severe cognitive impairment was evident, there was no evidence that the result of any formal pre-admission psychiatric evaluation had been communicated to nursing or care staff.

Functional disability of older persons in long-term care facilities in Korea

“…001. al., 1999;Challis et al, 2000). The majority of nursing home residents, as well as those in residential care facilities, had limitations in basic activities that required long-term assistance and care.…”

“…The current state, in which a large number of residents without any functional impairment are being cared in institutions, needs to be dealt with. Reports of inappropriate levels of institutionalization among older people have raised serious policy concerns in other countries, as well (Spector et al, 1996;Noro and Aro, 1997;Crawford et al, 1999;Challis et al, 2000).…”

“…Variations in the degree of functional impairment of the institutionalized elderly, however, make the provision of long-term care especially challenging (Hawes, 1999). Moreover, older residents' changing dependency needs create problems in effective and appropriate targeting of limited care resources (Challis et al, 2000).…”

When should older people go into care?

“…Many residents in non-specialist care homes have significant cognitive problems, [4][5][6] with or without a formal diagnosis of dementia. 7 All care homes require that staff have skills to manage residents with dementia but, importantly, not all patients with dementia need care in a specialist home. 8 …”

“…12 Physical disability, cognitive problems and chronic diseases are the major risk factors (Table 1). [4][5][6][7]13 Medical morbidity (in particular, dementia and stroke disease) and the associated physical dependence, rather than general frailty or social needs, are the main reasons for nursing home admission.…”