Mortality and health services utilisation among older people with advanced cognitive impairment living in residential care homes

Luk, James Ka-Hay; Chan, Wenyaw; Ng, WC; Chiu, PW; Ho, Celina Kit Yee; Chan, Tuen-Ching; Chan, Felix Hon Wai

doi:10.12809/hkmj133951

Cited by 17 publications

(27 citation statements)

References 22 publications

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“…All but three [ 31 , 33 , 48 ] out of 38 studies (92.1%) found a positive association between UI and death in unadjusted analysis. However some studies considered the association between death and UI along with other geriatric symptoms [ 15 , 25 , 29 ] or together with faecal incontinence [ 41 , 44 ].…”

Section: Resultsmentioning

confidence: 99%

Urinary Incontinence as a Predictor of Death: A Systematic Review and Meta-Analysis

et al. 2016

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BackgroundThe association between urinary incontinence (UI) and increased mortality remains controversial. The objective of our study was to evaluate if this association exists.MethodsWe performed a systematic review and meta-analysis of observational studies comparing death rates among patients suffering from UI to those without incontinence. We searched in Medline, Embase and the Cochrane library using specific keywords. Studies exploring the post-stroke period were excluded. Hazard ratios (HR) were pooled using models with random effects. We stratified UI by gender and by UI severity and pooled all models with adjustment for confounding variables.ResultsThirty-eight studies were retrieved. When compared to non-urinary incontinent participants, UI was associated with an increase in mortality with pooled non adjusted HR of 2.22 (95%CI 1.77–2.78). The risk increased with UI severity: 1.24 (95%CI: 0.79–1.97) for light, 1.71 (95%CI: 1.26–2.31) for moderate, and 2.72 (95%CI: 1.90–3.87) for severe UI respectively. When pooling adjusted measures of association, the resulting HR was 1.27 (95%CI: 1.13–1.42) and increased progressively for light, moderate and severe UI: 1.07 (95%CI: 0.79–1.44), 1.25 (95%CI: 0.99–1.58), and 1.47 (95%CI: 1.03–2.10) respectively. There was no difference between genders.ConclusionUI is a predictor of higher mortality in the general and particularly in the geriatric population. The association increases with the severity of UI and persists when pooling models adjusted for confounders. It is unclear if this association is causative or just reflects an impaired general health condition. As in most meta-analyses of observational studies, methodological issues should be considered when interpreting results.

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Section: Resultsmentioning

confidence: 99%

Urinary Incontinence as a Predictor of Death: A Systematic Review and Meta-Analysis

et al. 2016

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“…Future studies may examine other aspects of the process, such as the dynamics in arriving a consensus within the families, adherence to the designated plan by medical staff outside the CGAT, and how psycho-social-spiritual care is provided in RCHEs in accordance with ACP. About 8.5% of those aged ≥65 years live in RCHEs in Hong Kong, 19 and 1-year mortality can be as high as 34% among RCHE residents with advanced dementia, 20 suggesting a tremendous demand for quality end-of-life care in RCHEs. Various authorities have recommended against a routinised, "tick-box" approach, and specified ACP as a process of communication between the care team and the family.…”

Section: Discussionmentioning

confidence: 99%

Facilitators and barriers to advance care planning programmes targeting older care home residents: a qualitative study

Lau

Luk²,

Fong

et al. 2020

Asian Journal of Gerontology and Geriatrics

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Background. Advance care planning (ACP) is considered to be an integral part of end-of-life care. This study explored the facilitators and barriers of ACP by consolidating the practice experiences of a group of healthcare professionals involved in an outreach end-of-life programme for older people living residential care homes for the elderly (RCHEs). Methods: Fourteen healthcare professionals participated in this qualitative study. They first completed a questionnaire to capture their views on ACP by describing a successful case. Then they took part in a focus group to discuss desired outcomes, facilitators, and barriers of ACP. Thematic analysis was applied to the questionnaire and focus group data. Results: Participants considered ACP a valuable opportunity for older people to express their care preferences. The resultant care plan provides families and care teams a useful reference for treatment decision-making. Facilitators included the collaborative ties among the community geriatric assessment team, RCHE staff, and the families of patients; dedicated and trained staff; and well-informed family members. Barriers included delayed referral, a lack of public acceptance and awareness, and overwhelming routines among healthcare professionals. Conclusions: Our findings underscore the multitude of individual, family, staff, and social factors affecting the dynamic process of ACP. An effective collaborative framework and professional training in communicating with distressed families are required. In addition, enhancing public awareness of comfort care and ACP is crucial.

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“…16 In a local study of 312 advanced cognitively impaired RCHE residents, 164 (53%) were being tube fed. 6 The 1-year mortality rate was 34% and enteral feeding was cited as an important risk factor for 1-year mortality (odds ratio=2.0; 95% confidence interval, 2.0-3.4; P=0.008). …”

Section: Pitfalls Of Tube Feedingmentioning

confidence: 95%

The feeding paradox in advanced dementia: a local perspective

Luk¹,

Chan²,

Hui

et al. 2017

Hong Kong Med J

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Mortality and health services utilisation among older people with advanced cognitive impairment living in residential care homes

Cited by 17 publications

References 22 publications

Urinary Incontinence as a Predictor of Death: A Systematic Review and Meta-Analysis

Urinary Incontinence as a Predictor of Death: A Systematic Review and Meta-Analysis

Facilitators and barriers to advance care planning programmes targeting older care home residents: a qualitative study

The feeding paradox in advanced dementia: a local perspective

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