Nursing Home Residents at Risk of Hospitalization and the Characteristics of Their Hospital Stays

Murtaugh, Christopher M.; Freiman, Marc P.

doi:10.1093/geront/35.1.35

Cited by 95 publications

(81 citation statements)

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“…One possibility is that patients admitted with dementia have fewer comorbid conditions requiring expensive medical interventions compared to individuals with no dementia. This interpretation is consistent with research conducted by Murtaugh and Freiman (1995) and Fried and Mor (1997); both studies found that nursing home residents with dementia were significantly less likely to be hospitalized compared to those with no dementia. Another possible reason for lower utilization rates among nursing home residents with dementia is they are treated less aggressively for other medical conditions, possibly as a result of advance directives.…”

supporting

confidence: 90%

Medicare Cost Differences Between Nursing Home Patients Admitted With and Without Dementia

Stuart¹,

Gruber‐Baldini²,

Fahlman³

et al. 2005

The Gerontologist

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Purpose: Our objective in this study was to compare Medicare costs of treating older adults with and without dementia in nursing home settings. Design and Methods: An expert panel established the dementia status of a stratified random sample of newly admitted residents in 59 Maryland nursing homes between 1992 and 1995. Medicare expenditures per-person month (PPM) were compared for 640 residents diagnosed with dementia and 636 with no dementia for 1 year preadmission and 2 years postadmission. Multivariate analysis with generalized estimating equations was used to identify the source of Medicare cost differentials between the two groups. Results: Medicare expenditures peaked in the month immediately preceding admission and dropped to preadmission levels by the third month in a nursing home. Adjusted PPM costs postadmission for the dementia group as a whole were 79% (p , .001) of the Medicare costs of treating residents without dementia. For the subgroup of residents admitted without a Medicare qualified stay (MQS), those with dementia had Medicare costs of just 63% (p , .001) of those without dementia. Overall Medicare costs PPM were insignificantly different between the two groups admitted with a MQS. Implications: Whether nursing home residents are admitted with a MQS is the single most important factor in assessing treatment cost differentials between residents admitted with and without dementia. Failure to consider this factor may lead researchers and policy makers to misdirect their attention from the true source of the differentialdementia patients admitted without a qualifying stay.

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supporting

confidence: 90%

Medicare Cost Differences Between Nursing Home Patients Admitted With and Without Dementia

Stuart¹,

Gruber‐Baldini²,

Fahlman³

et al. 2005

The Gerontologist

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“…N ursing home residents frequently develop lower respiratory tract infections, mostly pneumonia and bronchitis, [1][2][3][4][5] with estimated 30-day mortality from pneumonia or lower respiratory tract infection varying between 10% and 30%. 3,[6][7][8][9] Because meaningful cultures from specimens are rarely obtained in practice, 10,11 antibiotic treatment is usually empiric.…”

Section: Introductionmentioning

confidence: 99%

Antibiotic Treatment and Survival of Nursing Home Patients With Lower Respiratory Tract Infection: A Cross-National Analysis

Kruse

Mehr²,

Steen³

et al. 2005

The Annals of Family Medicine

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PURPOSE Although lower respiratory tract infections are a leading cause of death in frail elderly patients, few studies have compared treatments and outcomes. We assessed the effects of different antibiotic treatment strategies on survival of elderly nursing home residents with lower respiratory tract infections in the United States and the Netherlands, where treatment approaches are quite different. METHODSWe combined data from 2 prospective cohort studies of lower respiratory tract infections conducted in 36 nursing homes in the United States and 61 in the Netherlands. We included residents whose infections were treated with antibiotics: 806 in the United States and 415 in the Netherlands. Outcome measures were 1-month and 3-month mortality. We used logistic regression to adjust for differing illness severity.RESULTS Dutch residents had higher mortality than US residents (28.1% vs 15.1% at 1 month, respectively; P <.001). After adjusting for illness severity with logistic regression, the differences between the Dutch and US populations were not significant (odds ratio 1.34; 95% confi dence interval, 0.94-1.90). Predicted mortality was overestimated for more severely ill US residents at 1 month but not at 3 months. No antibiotic regimen was consistently associated with increased or decreased mortality. CONCLUSION Despite differences in illness severity and treatment, adjusted mortality did not differ between the 2 countries. Although we cannot exclude a short-term survival benefi t from more aggressive treatment in the United States, differences in baseline health appear prognostically more important than the type of antibiotic treatment.

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“…There is evidence to support the treatment of certain conditions-such as incontinence [108], pressure sores [109], infections [10,14,18,29,[110][111][112][113], diabetes mellitus [6,114], minor trauma [12, 25,54] and falls [14,17,54,[115][116][117][118][119][120]-in nursing homes. We need research to compare nursinghome care with hospital treatment to ensure that any changes improve the management of these patients and does not exclude them from the best possible care.…”

Section: Resultsmentioning

confidence: 99%

“…The prognosis for some older people after hospitalization, particularly emergency admission, is poor [12,14,16,17,20,22,24,25,27,30,32,41,57,73,74], given the attendant risk of further complications [12,18,30,38,40,42,44]. Hence, the need to review how best to manage acutely ill nursing-home residents [75] (especially those over 85).…”

Section: Introductionmentioning

confidence: 99%

Improving the emergency medical treatment of older nursing-home residents

Turrell

Castleden²

1999

Age and Ageing

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Nursing Home Residents at Risk of Hospitalization and the Characteristics of Their Hospital Stays

Cited by 95 publications

References 0 publications

Medicare Cost Differences Between Nursing Home Patients Admitted With and Without Dementia

Medicare Cost Differences Between Nursing Home Patients Admitted With and Without Dementia

Antibiotic Treatment and Survival of Nursing Home Patients With Lower Respiratory Tract Infection: A Cross-National Analysis

Improving the emergency medical treatment of older nursing-home residents

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