Predicting admission to long‐term care and mortality among community‐based, dependent older people in Ireland

Aspell, Niamh; O’Sullivan, Maria; O’Shea, Eamon; Irving, Kate; Duffy, Chloe; Gorman, Rebecca; Warters, Austin

doi:10.1002/gps.5101

Cited by 31 publications

(57 citation statements)

References 38 publications

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“…The importance of cancellations stems from the potential consequences of healthcare deprivation, while the number of weekly care hours has been shown to predict admission to long-term care facilities especially in the older population. 4 …”

Section: Introductionmentioning

confidence: 99%

Evaluating access to health and care services during lockdown by the COVID-19 survey in five UK national longitudinal studies

et al. 2021

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ObjectiveAccess to health services and adequate care is influenced by sex, ethnicity, socioeconomic position (SEP) and the burden of comorbidities. Our study aimed to assess whether the COVID-19 pandemic further deepened these already existing health inequalities.DesignCross-sectional study.SettingData were collected from five longitudinal age-homogenous British cohorts (born in 2000-2002, 1989-1990, 1970, 1958 and 1946).ParticipantsA web survey was sent to the cohorts. Anybody who responded to the survey was included, resulting in 14 891 eligible participants.Main outcomes measuredThe survey provided data on cancelled surgical or medical appointments, and the number of care hours received in a week during the first UK COVID-19 national lockdown.InterventionsUsing binary or ordered logistic regression, we evaluated whether these outcomes differed by sex, ethnicity, SEP and having a chronic illness. Adjustment was made for study design, non-response weights, psychological distress, presence of children or adolescents in the household, COVID-19 infection, key worker status, and whether participants had received a shielding letter. Meta-analyses were performed across the cohorts, and meta-regression was used to evaluate the effect of age as a moderator.ResultsWomen (OR 1.40, 95% CI 1.27 to 1.55) and those with a chronic illness (OR 1.84, 95% CI 1.65 to 2.05) experienced significantly more cancellations during lockdown (all p<0.0001). Ethnic minorities and those with a chronic illness required a higher number of care hours during the lockdown (both OR≈2.00, all p<0.002). SEP was not associated with cancellation or care hours. Age was not independently associated with either outcome in the meta-regression.ConclusionThe UK government’s lockdown approach during the COVID-19 pandemic appears to have deepened existing health inequalities, impacting predominantly women, ethnic minorities and those with chronic illnesses. Public health authorities need to implement urgent policies to ensure equitable access to health and care for all in preparation for a fourthwave.

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Section: Introductionmentioning

confidence: 99%

Evaluating access to health and care services during lockdown by the COVID-19 survey in five UK national longitudinal studies

et al. 2021

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“…Dementia disorders are typically progressive, leading to dependency and death [1][2][3], and progression of dementia is associated with numerous factors [4][5][6]. Prognosis is of key importance for newly diagnosed persons with dementia and their families, especially in regard to the amount of time to dependency and the need for around-the-clock assistance.…”

Section: Introductionmentioning

confidence: 99%

“…Both time to dependency and time to mortality in persons with dementia are associated with older age, poorer cognition and reduced functioning in activities of daily living (ADL) at the time of diagnosis [1,[4][5][6][23][24][25]. As functional and cognitive impairment progress during the course of dementia, support at home provided by formal carers or family members may delay NH admission [5,10,26]. Studies have indicated that married persons or persons with adult children are less likely to be admitted to NHs, probably because of the support they receive at home [10,[27][28][29][30][31].…”

Section: Introductionmentioning

confidence: 99%

“…Increased impairment in both cognition and personal activities of daily living are associated with a greater risk of NH admission [ 5 , 6 , 23 , 25 , 27 , 32 ]. Compared to persons with dementia due to Alzheimer’s disease (AD), persons with non-AD dementia, particularly Lewy body dementia, have been found to experience earlier admission to NH [ 21 , 22 , 33 ] as well as a shorter life expectancy [ 1 , 24 , 33 ].…”

Section: Introductionmentioning

confidence: 99%

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Time from dementia diagnosis to nursing-home admission and death among persons with dementia: A multistate survival analysis

et al. 2020

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Objectives To estimate transition times from dementia diagnosis to nursing-home (NH) admission or death and to examine whether sex, education, marital status, level of cognitive impairment and dementia aetiology are associated with transition times. Design Markov multistate survival analysis and flexible parametric models. Setting Participants were recruited from the Norwegian Registry of Persons Assessed for Cognitive Symptoms (NorCog) in specialist healthcare between 2008 and 2017 and followed until August 2019, a maximum of 10.6 years follow-up time (mean 4.4 years, SD 2.2). Participants’ address histories, emigration and vital status were retrieved from the National Population Registry from time of diagnosis and linked to NorCog clinical data. Participants 2,938 home-dwelling persons with dementia, ages 40–97 years at time of diagnosis (mean 76.1, SD 8.5). Results During follow-up, 992 persons (34%) were admitted to nursing-homes (NHs) and 1,556 (53%) died. Approximately four years after diagnosis, the probability of living in a NH peaked at 19%; thereafter, the probability decreased due to mortality. Median elapsed time from dementia diagnosis to NH admission among those admitted to NHs was 2.28 years (IQR 2.32). The probability of NH admission was greater for women than men due to women´s lower mortality rate. Persons living alone, particularly men, had a higher probability of NH admission than cohabitants. Age, dementia aetiology and severity of cognitive impairment at time of diagnosis did not influence the probability of NH admission. Those with fewer than 10 years of education had a lower probability of NH admission than those with 10 years or more, and this was independent of the excess mortality in the less-educated group. Conclusion Four years after diagnosis, half of the participants still lived at home, while NH residency peaked at 19%. Those with fewer than 10 years of education were less often admitted to NH.

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“…We analyzed how these outcomes varied by already established factors contributing to health inequalities. The importance of cancellations stems from the potential consequences of healthcare deprivation, while the number of weekly care hours has been shown to predict admission to long-term care facilities especially in the older population 4 .…”

Section: Introductionmentioning

confidence: 99%

Inequality in access to health and care services during lockdown – Findings from the COVID-19 survey in five UK national longitudinal studies

Topriceanu

Wong

et al. 2020

Preprint

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Background: Access to health services and adequate care is influenced by sex, ethnicity, socio-economic position (SEP) and burden of co-morbidities. However, it is unknown whether the COVID-19 pandemic further deepened these already existing health inequalities. Methods: Participants were from five longitudinal age-homogenous British cohorts (born in 2001, 1990, 1970, 1958 and 1946). A web and telephone-based survey provided data on cancelled surgical or medical appointments, and the number of care hours received during the UK COVID-19 national lockdown. Using binary or ordered logistic regression, we evaluated whether these outcomes differed by sex, ethnicity, SEP and having a chronic illness. Adjustment was made for study-design, non-response weights, psychological distress, presence of children or adolescents in the household, keyworker status, and whether participants had received a shielding letter. Meta-analyses were performed across the cohorts and meta-regression evaluated the effect of age as a moderator. Findings: 14891 participants were included. Females (OR 1.40, 95% confidence interval [1.27,1.55]) and those with a chronic illness (OR 1.84 [1.65-2.05]) experienced significantly more cancellations during lockdown (all p<0.0001). Ethnic minorities and those with a chronic illness required a higher number of care hours during the lockdown (both OR approx. 2.00, all p<0.002). Age was not independently associated with either outcome in meta-regression. SEP was not associated with cancellation or care hours. Interpretation: The UK government's lockdown approach during the COVID-19 pandemic appears to have deepened existing health inequalities, impacting predominantly females, ethnic-minorities and those with chronic illnesses. Public health authorities need to implement urgent policies to ensure equitable access to health and care for all in preparation for a second wave.

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Predicting admission to long‐term care and mortality among community‐based, dependent older people in Ireland

Cited by 31 publications

References 38 publications

Evaluating access to health and care services during lockdown by the COVID-19 survey in five UK national longitudinal studies

Evaluating access to health and care services during lockdown by the COVID-19 survey in five UK national longitudinal studies

Time from dementia diagnosis to nursing-home admission and death among persons with dementia: A multistate survival analysis

Inequality in access to health and care services during lockdown – Findings from the COVID-19 survey in five UK national longitudinal studies

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