Natural course of care dependency in residents of long-term care facilities: prospective follow-up study

Abstract

BackgroundInsight in the natural course of care dependency of vulnerable older persons in long-term care facilities (LTCF) is essential to organize and optimize individual tailored care. We examined changes in care dependency in LTCF residents over two 6-month periods, explored the possible predictive factors of change and the effect of care dependency on mortality.MethodsA prospective follow-up study in 21 Dutch long-term care facilities. 890 LTCF residents, median age 84 (Interquartile range 79–88) years participated. At baseline, 6 and 12 months, care dependency was assessed by the nursing staff with the Care Dependency Scale (CDS), range 15–75 points. Since the median CDS score differed between men and women (47.5 vs. 43.0, P = 0.013), CDS groups (low, middle and high) were based on gender-specific 33% of CDS scores at baseline and 6 months.ResultsAt baseline, the CDS groups differed in median length of stay on the ward, urine incontinence and dementia (all P < 0.001); participants in the low CDS group stayed longer, had more frequent urine incontinence and more dementia. They had also the highest mortality rate (log rank 32.2; df = 2; P for trend <0.001). Per point lower in CDS score, the mortality risk increased with 2% (95% CI 1%-3%). Adjustment for age, gender, cranberry use, LTCF, length of stay, comorbidity and dementia showed similar results. A one point decrease in CDS score between 0 and 6 months was related to an increased mortality risk of 4% (95% CI 3%-6%).At the 6-month follow-up, 10% improved to a higher CDS group, 65% were in the same, and 25% had deteriorated to a lower CDS group; a similar pattern emerged at 12-month follow-up. Gender, age, urine incontinence, dementia, cancer and baseline care dependency status, predicted an increase in care dependency over time.ConclusionThe majority of residents were stable in their care dependency status over two subsequent 6-month periods. Highly care dependent residents showed an increased mortality risk. Awareness of the natural course of care dependency is essential to residents and their formal and informal caregivers when considering therapeutic and end-of-life care options.

Characteristics Associated with Quality of Life in Long-Term Care Residents with Dementia: A Cross-Sectional Study

“…The average age and the proportion of males/females are comparable to other studies performed in LTCF [2,18]. Moreover, the QUALIDEM scores were also similar to those in other studies on persons with dementia [18,57,58].…”

“…With the decrease in functional independency in people with dementia and the need for specialized care, admission to a long-term care setting is often inevitable in later stages of the disease [1,2]. Because there is no cure for dementia, care, research and management in long-term care facilities (LTCFs) are primarily focused on improving or maintaining quality of life (QOL) in these vulnerable persons [3,4].…”

The effect of a daily application of a 0.05% chlorhexidine oral rinse solution on the incidence of aspiration pneumonia in nursing home residents: a multicenter study

“…The participants in this study were at greater risk of dying, because they suffered from multimorbidity and polypharmacy (respectively, mean number of diseases 4.5 ± 2.3, number of medication use 9.0 ± 3.7) and were in extremis care dependent (mean CDS-score 36.5 ± 15.8) [42]. The dropout rate in this study seems high, but this dropout rate and reasons for dropping out in the present study are comparable to other studies [23, 43].…”

Nursing care dependence in the experiences of advanced cancer inpatients

“…Care dependence is often related to patients with severe chronic conditions, such as advanced cancer (Caljouw et al, 2014). Cancer incidence and burden is growing in Europe while developments in cancer treatment and an ageing population are reducing overall mortality (Ferlay et al, 2013).…”

“…This implies that the length of cancer trajectory, the number of comorbidities and disabilities in cancer patients will probably increase in the near future (Sullivan et al, 2011). Therefore, patients with cancer will be more likely to face high levels of dependence (Caljouw et al, 2014). Patients with advanced cancer who are hospitalized often have a poor performance status and therefore are dependent on care for activities of daily life (Wheatley-Price et al, 2014).…”