Regional variations of care in home care and long-term care: a retrospective cohort study

Abstract

became an employee of Novartis after this article was submitted for publication but before revisions were undertaken. No other competing interests were declared. This article has been peer reviewed.

Outcomes of advance care directives after admission to a long-term care home: DNR the DNH?

“…We adjusted outcomes for age, sex, marital status, Activities of Daily Living Hierarchy Scale score, Cognitive Performance Scale score, diagnosis (binary variables for chronic obstructive pulmonary disease, pneumonia, diabetes, arthritis, renal failure, urinary tract infection, Alzheimer’s dementia and related dementias, heart failure, cancer and depression), day of stay, functional improvement potential, facility size, and province. We chose covariates on the basis of their expected associations with one or more of the outcomes states we modelled [ 3 , 28 , 29 ]. We only retained covariates that had significant associations with at least one outcome of interest in the models we used.…”

Assessments of Heart Failure and Frailty-Related Health Instability Provide Complementary and Useful Information for Home-Care Planning and Prognosis

“…We used multistate Markov models to examine the odds of transitions in health status over time and identify factors that influence these changes. We have previously used and described these methods elsewhere (10,23,29). Figure 2 is a state-space diagram for home care.…”

“…Health instability was measured with the CHESS (Changes in Health and End-stage disease Signs and Symptoms) scale, embedded in the RAI-HC and other interRAI instruments (see Box 1). The CHESS scale thus reflects the risk of adverse events related to acutely decompensated frailty, with higher scores shown to predict hospitalization and mortality among home care and long-term care clients, including those with HF (10,(22)(23)(24)(25). We ascertained the other outcomes, including death, using HCRS, DAD, and NACRS variables in respective care settings.…”

“…Using information from the first RAI-HC assessment, we recorded demographic data (age, sex, marital status), scores on Cognitive Performance Scale (CPS), Depression Rating Scale (DRS), Activities of Daily Living, day of stay when first assessed with the RAI-HC, functional improvement potential (self and clinician perceptions), physician visits, facility size, and advanced directives (i.e., Do Not Resuscitate, Do Not Hospitalize) (4,5,10,13,18,(26)(27)(28). We also recorded comorbidities (HF, pneumonia, Chronic Obstructive Pulmonary Disease, diabetes mellitus, renal failure, arthritis, Alzheimer's Disease and Related Dementias -ADRD, depression, cancer) from the RAI-HC, the reliability of each has been previously established (16).…”

“…Thus, among long-stay home care clients, a HF diagnosis is associated with a greater risk of poor health outcomes related to comorbidities, cognitive impairment, depressed mood, and other geriatric syndromes such as frailty. Admission to home care itself often reflects a transition to a state of increased frailty-related health instability that is also associated with greater odds of hospitalization and death (10). This raises questions about how best to organize the care of these clients, including how the role of cardiovascular specialists might evolve, and whether additional specialized services, such as geriatrics or palliative care, might also have a role.…”