Unexplained absence resulting in deaths of nursing home residents in Australia—A 13‐year retrospective study

Int J Older People Nursing

Weller

et al. 2019

Self Cite

Objectives Unexplained absences (UAs) contribute to the mortality and morbidity rates in the nursing home (NH) population. Valuing expert professional knowledge and skills is central to the achievement of improved care in NHs. This study developed and prioritised recommendations to prevent deaths of NH residents (NHRs) with UAs. Methods Two expert consultation forums using the modified nominal group technique to develop recommendations were conducted, followed by an online survey to prioritise the most important recommendations for implementation. A framework applying the temporal dimension (“pre‐event,” “event” and “post‐event”) of an internationally accepted injury prevention framework, Haddon's Matrix, was applied to the recommendations. Participants were purposively sampled and identified via aged care organisations; and were selected based on their experience in aged care practice, policy, research, elder rights, seniors' law, or missing persons search and rescue (SAR). Results Forum one comprised six, and forum two comprised nine experts from mixed disciplines. Seven participants completed the online survey. Twenty recommendations to prevent future injury and death were developed, five of which were prioritised for implementation in the aged care sector. In order of priority, these include: universal UA definition; mandated SAR plan, early assessment of NHRs; unmet needs behavioural assessments; and participation in decision‐making. Conclusions The recommendations cover the broad spectrum of complex issues raised in managing unexplained absences, and are a vital first step towards informing care providers, governments and SAR teams about how to prevent injury and death of NHRs in residents with UAs. Future research should explore how to translate and evaluate the recommendations into practice.

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Recommendations for the prevention of deaths among nursing home residents with unexplained absences

Woolford

Int J Older People Nursing

Weller

et al. 2019

Self Cite

“…For a wheelchair bound, person to smoke unsupervised is inher- Similar tensions also arise in situations involving unexplained absences (Woolford et al, 2018), residents who are at a high risk of falls and prefer to walk without gait aids and residents with dysphagia who wish to eat solid foods at the risk of choking. These situations all involve an element of risk which may result in harm.…”

Section: Ta B L E 2 Coroners' Recommendationsmentioning

confidence: 99%

Deaths due to thermal injury from cigarette smoking in a 13‐year national cohort of nursing home residents

Holmes

Int J Older People Nursing

Young

et al. 2019

Self Cite

Objectives To examine the nature and frequency of deaths due to thermal injuries from cigarette smoking reported to Australian coroners and to examine the decisions which surround these deaths. Design Retrospective cohort study. Setting and participants Residents dwelling in accredited nursing homes whose deaths were reported to coroners between 1 July 2000 and 30 June 2013 and attributed to thermal injuries from cigarette smoking. Measures A descriptive analysis was undertaken to report socio‐demographic characteristics of the deceased, medical history, mobility, level of observation, safety equipment provided/used, nursing home location, decision to smoke, timing of incident, time from incident to death, incident findings, mechanism of death, formal reports attached and coroners’ recommendations. Results Ten deaths of nursing home residents due to thermal injury from cigarette smoking were reported in Australia over a 13‐year period. The median age of residents was 78 years (IQR = 15.25); nine residents were female and one was male. Seven residents had impaired mobility with three residents being wheelchair bound and one resident bed bound. None of the residents were supervised by staff while they smoked, and none of the residents utilised any safety equipment to minimise harm. Burns/thermal injury was the mechanism of harm in most cases. Conclusions This national study confirms that thermal injuries caused by cigarette smoking in nursing homes result in fatalities, particularly in the absence of supervision. It also demonstrates the complex tension arising from balancing autonomy with safety. Implications for practice Nurses and aged care practitioners should endeavour to give effect to each resident’s wishes while mitigating the risk of harm. The supervision requirements for cigarette smoking residents should be tailored to the needs of individual residents and staff should try to ensure that residents who require supervision receive it.

“…We identified and extracted fourteen variables, potential risk-factors for death, based on a review of the published literature, 2,6,7,18,26,27 (Table 2). The primary outcome of this study was lost person found alive or found dead on SAR arrival.…”

Section: Data Extractionmentioning

confidence: 99%

Search and rescue incidents among persons 65 years and older in the USA: Examination of factors associated with death

Woolford

Int J Geriat Psychiatry

Weller

et al. 2022

Objectives Older people are vulnerable to becoming lost from home, especially if alone and in unfamiliar environments. Incidents of older persons becoming lost are frequently reported and often requiring a search and rescue (SAR) response. Becoming lost is distressing to the person concerned, their carer, and family and may result in physical injury and/or death. This study examined what factors are associated with death among older persons reported lost from home. Methods/Design A retrospective cross‐sectional study. Data were obtained from the International Search and Rescue Incident Database from 1985 to 2013. Participants comprised persons aged 65 years and older living in the United States. Individual, SAR incident, and environmental factors were analysed. The primary outcome of this study was lost person found alive or found dead on arrival. Relationships between categorical variables and outcome were summarised with contingency tables, chi‐squared test p‐values (or Fisher's‐exact‐test), and odds ratios (OR) with 95% confidence intervals (CI). Association between continuous variables and outcome were examined using multiple logistic regression. p‐value of <0.05 was considered significant. Results Among the 5242 SAR incidents, 1703 met the inclusion criteria, of which 87.8% (n = 1495) were found alive and 12.2% (n = 208) were found dead. Factors associated with death included: male gender (OR 1.46; CI 1.01–2.13; p = 0.048), cognitively intact (OR 0.32; CI 0.22–0.47; p < 0.001), prolonged SAR duration (OR: 1.028; CI: 1.021–1.035; p < 0.001), found in water/wetlands (OR 7.40; CI 3.37–16.24; p < 0.001), and extreme weather (OR: 2.06; 95% CI: 1.10–3.86; p = 0.024). Conclusions Older people have a fundamental human right to protection from preventable deaths. Findings indicate these rights are not being protected with deaths occurring frequently among older people who have become lost from home. To minimise fatalities, knowledge of factors associated with death could inform the development suitable assessment and intervention strategies for SAR teams and caregivers.