Predicting mortality of residents at admission to nursing home: A longitudinal cohort study

Abstract

BackgroundAn increasing numbers of deaths occur in nursing homes. Knowledge of the course of development over the years in death rates and predictors of mortality is important for officials responsible for organizing care to be able to ensure that staff is knowledgeable in the areas of care needed. The aim of this study was to investigate the time from residents' admission to Icelandic nursing homes to death and the predictive power of demographic variables, health status (health stability, pain, depression and cognitive performance) and functional profile (ADL and social engagement) for 3-year mortality in yearly cohorts from 1996-2006.MethodsThe samples consisted of residents (N = 2206) admitted to nursing homes in Iceland in 1996-2006, who were assessed once at baseline with a Minimum Data Set (MDS) within 90 days of their admittance to the nursing home. The follow-up time for survival of each cohort was 36 months from admission. Based on Kaplan-Meier analysis (log rank test) and non-parametric correlation analyses (Spearman's rho), variables associated with survival time with a p-value < 0.05 were entered into a multivariate Cox regression model.ResultsThe median survival time was 31 months, and no significant difference was detected in the mortality rate between cohorts. Age, gender (HR 1.52), place admitted from (HR 1.27), ADL functioning (HR 1.33-1.80), health stability (HR 1.61-16.12) and ability to engage in social activities (HR 1.51-1.65) were significant predictors of mortality. A total of 28.8% of residents died within a year, 43.4% within two years and 53.1% of the residents died within 3 years.ConclusionIt is noteworthy that despite financial constraints, the mortality rate did not change over the study period. Health stability was a strong predictor of mortality, in addition to ADL performance. Considering these variables is thus valuable when deciding on the type of service an elderly person needs. The mortality rate showed that more than 50% died within 3 years, and almost a third of the residents may have needed palliative care within a year of admission. Considering the short survival time from admission, it seems relevant that staff is trained in providing palliative care as much as restorative care.

Longevity: Big Data Comparison of Mortality in Older Adults Receiving Care in Nursing Homes or Their Own Home in Andalusia (Spain)

“…We found an elevated mortality of institutionalized older adults [2], and the greater risk of death in the residential care setting compared to home-based care [8,9]. The results also confirm that ADL level is a very powerful predictive mortality factor [3].…”

“…Institutionalized dependent older adults represent a highly vulnerable group of the population, with high mortality as described in previous studies [1,2]. The Activities of Daily Living (ADL) level [3], cognitive impairment [4], hip fracture [5], cancer [6] and Chronic Obstructive Pulmonary Disease [7] are important risk factors of mortality in this population.…”

Factors Influencing Survival after Discharge from an Australian Palliative Care Unit to Residential Aged Care Facilities: A Retrospective Audit

“…10 Data investigating predictors of survival for anyone admitted into an aged care facility are limited. 17 A recent longitudinal study of 2206 admissions to Icelandic nursing homes reported significant predictors of survival included age, health stability, and activities of daily living (ADL) functioning. 17 Whereas many studies have analysed prognostic factors in palliative patients, 14,18-25 few have investigated predictors of shortened survival for those required to be discharged from a PCU to an RACF.…”

“…17 A recent longitudinal study of 2206 admissions to Icelandic nursing homes reported significant predictors of survival included age, health stability, and activities of daily living (ADL) functioning. 17 Whereas many studies have analysed prognostic factors in palliative patients, 14,18-25 few have investigated predictors of shortened survival for those required to be discharged from a PCU to an RACF. Lau et al, 25 in an unpublished retrospective audit of PCU separations over a 3-month period, investigated the addition of the Palliative Prognostic Score (PaP) to clinical predictive survival during discharge planning.…”

End-Stage Renal Disease in Nursing Homes: A Systematic Review

“…These survival rates are approximately 10–30% lower than those reported for more broadly defined populations of octogenarians and nonagenarians initiating dialysis 21 , and lower than overall rates reported for general NH populations 22,23 , although the lack of a relevant comparison group in most studies of ESRD residents makes it impossible to quantify the impact of ESRD on survival in a NH population. Survival does appear to be lower in patients newly started on dialysis, who may represent an important subgroup for future study or intervention.…”