Nursing Home Admission in Elderly Subjects With Dementia: Predictive Factors and Future Challenges (original) (raw)
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Predicting nursing home admission in the U.S: a meta-analysis
BMC Geriatrics, 2007
Background: While existing reviews have identified significant predictors of nursing home admission, this meta-analysis attempted to provide more integrated empirical findings to identify predictors. The present study aimed to generate pooled empirical associations for sociodemographic, functional, cognitive, service use, and informal support indicators that predict nursing home admission among older adults in the U.S.
Contemporary Clinical Trials Communications
Background: Each year, around one out of two nursing home (NH) residents are hospitalized in France, and about half to the emergency department (ED). These transfers are frequently inappropriate. This paper describes the protocol of the FINE study. The first aim of this study is to identify the factors associated with inappropriate transfers to ED. Methods/design: FINE is a case-control observational study. Sixteen hospitals participate. Inclusion period lasts 7 days per season in each center for a total period of inclusion of one year. All the NH residents admitted in ED during these periods are included. Data are collected in 4 times: before transfer in the NH, at the ED, in hospital wards in case of patient's hospitalization and at the patient's return to NH. The appropriateness of ED transfers (i.e. case versus control NH residents) is determined by a multidisciplinary team of experts. Results: Our primary objective is to determine the factors predisposing NH residents to inappropriate transfer to ED. Our secondary objectives are to assess the cost of the transfers to ED; study the evolution of NH residents' functional status and the psychotropic and inappropriate drugs prescription between before and after the transfer; calculate the prevalence of potentially avoidable transfers to ED; and identify the factors predisposing NH residents to potentially avoidable transfer to ED. Discussion: A better understanding of the determinant factors of inappropriate transfers to ED of NH residents may lead to proposals of recommendations of better practice in NH and would allow implementing quality improvement programs in the health organization.
Predictors of institution admission in the year following acute hospitalisation of elderly people
Journal of Nutrition, Health and Aging, 2011
Objectives: The aim of the study was to identify factors related to institutionalisation within one-year follow up of subjects aged 75 or over, hospitalised via the emergency department (ED). Design: Prospective multicentre cohort. Setting: Nine French university teaching hospitals. Participants: One thousand and forty seven (1 047) non institutionalised subjects aged 75 or over, hospitalised via ED. A sub-group analysis was performed on the 894 subjects with a caregiver. Measurements: Patients were assessed using Comprehensive Geriatric Assessment (CGA) tools. Cox survival analysis was performed to identify predictors of institutionalisation at one year. Results: Within one year after hospital admission, 210 (20.1%) subjects were institutionalised. For the overall study population, age >85 years (HR 1.6; 95%CI 1.1-2.1; p=0.005), inability to use the toilet (HR 1.6; 95%CI 1.1-2.4; p=0.007), balance disorders (HR 1.6; 95%CI 1.1-2.1; p=0.005) and presence of dementia syndrome (HR 1.9; 95%CI 1.4-2.6; p<0.001) proved to be independent predictors of institutionalisation; while a greater number of children was inversely linked to institutionalisation (HR 0.8; 95%CI 0.7-0.9; p<0.001). Bathing was of borderline significance (p=.09). For subjects with a caregiver, initial caregiver burden was significantly linked to institutionalisation within one year, in addition to the predictors observed in the overall study population. Conclusions: CGA performed at the beginning of hospitalisation in acute medical wards is useful to predict institutionalisation. Most of the predictors identified can lead to targeted therapeutic options with a view to preventing or delaying institution admission.
Risk Factors for Nursing Home Placement in Older Adults With and Without Dementia
Journal of Aging and Health, 2007
The authors explored the effect of predisposing, enabling, and need characteristics on risk of nursing home placement (NHP) in participants with and without dementia. Method: Participants were 1,943 newly enrolled Medicare/Medicaid beneficiaries in Florida who were evaluated for health services by the Department of Elder Affairs. They were at least 65 years of age during fiscal year 1998-1999 and were followed for up to 4 years. Results: Cox proportional hazard regressions indicated that baseline characteristics including older age, White race, diabetes, incontinence, stroke, and difficulties with instrumental activities increased risk of NHP in those without dementia. Caregiver, widowed status, arthritis, and heart disease reduced the risk. Only age, race, and marital status were predictive among participants with dementia. Discussion: Dementia plays a central role in risk of NHP. Understanding risk factors for NHP in this relatively vulnerable population has important policy implications.
BMC Geriatrics, 2022
Background: This study examines predictors of nursing home admission (NHA) in Belgium in order to contribute to a better planning of the future demand for nursing home (NH) services and health care resources. Methods: Data derived from the Belgian 2013 health interview survey were linked at individual level with health insurance data (2012 tot 2018). Only community dwelling participants, aged ≥65 years at the time of the survey were included in this study (n = 1930). Participants were followed until NHA, death or end of study period, i.e., December 31, 2018. The risk of NHA was calculated using a competing risk analysis. Results: Over the follow-up period (median 5.29 years), 226 individuals were admitted to a NH and 268 died without admission to a NH. The overall cumulative risk of NHA was 1.4, 5.7 and 13.1% at respectively 1 year, 3 years and end of follow-up period. After multivariable adjustment, higher age, low educational attainment, living alone and use of home care services were significantly associated with a higher risk of NHA. A number of need factors (e.g., history of falls, suffering from urinary incontinence, depression or Alzheimer's disease) were also significantly associated with a higher risk of NHA. On the contrary, being female, having multimorbidity and increased contacts with health care providers were significantly associated with a decreased risk of NHA. Perceived health and limitations were both significant determinants of NHA, but perceived health was an effect modifier on limitations and vice versa. Conclusions: Our findings pinpoint important predictors of NHA in older adults, and offer possibilities of prevention to avoid or delay NHA for this population. Practical implications include prevention of falls, management of urinary incontinence at home and appropriate and timely management of limitations, depression and Alzheimer's disease. Focus should also be on people living alone to provide more timely contacts with health care providers. Further investigation of predictors of NHA should include contextual factors such as the availability of nursing-home beds, hospital beds, physicians and waiting lists for NHA.
International Journal of Environmental Research and Public Health
Nursing home (NH) residents are often transferred to hospital (emergency department (ED) visits or hospital admissions) and this occurs more frequently in males. However, respective reasons are rather unclear. We conducted a multicenter prospective study in 14 northwest German NHs with 802 residents in which NH staff recorded anonymized data between March 2018 and July 2019 for each hospital transfer. Measures were analyzed using descriptive statistics and compared between sexes via univariate logistic regression analyses using mixed models with random effects. Eighty-eight planned transfers (53.5% hospital admissions, 46.5% ED visits) occurred as well as 535 unplanned transfers (63.1% hospital admissions, 36.9% ED visits). The two most common causes for unplanned transfers were deteriorations of health status (35.1%) and falls/accidents/injuries (33.5%). Male transferred residents were younger, more often married; their advance directives were more commonly not considered correctly...
Journal of The American Geriatrics Society, 2009
OBJECTIVES: To study the feasibility and effectiveness of a discharge planning intervention.DESIGN: Quasi-experimental pre–post study design.SETTING: General medicine wards at three hospitals: an academic medical center, a community teaching hospital, and a community-based nonteaching hospital.PARTICIPANTS: All patients aged 65 and older admitted to the hospitalist services.INTERVENTION: The intervention toolkit had five core elements: admission form with geriatric cues, facsimile to the primary care provider, interdisciplinary worksheet to identify barriers to discharge, pharmacist–physician collaborative medication reconciliation, and predischarge planning appointments.MEASUREMENTS: Thirty-day readmission and return to emergency department rates and patient satisfaction with discharge. Odds ratios were determined, and site effects were examined accordig to interaction terms and Breslow Day statistics.RESULTS: Two hundred thirty-seven patients were followed during the preintervention period, and 185 were exposed to the intervention. Patients characteristics were similar across the two time periods. The proportion of patients with high-quality transitions home, measured according to Coleman's Care Transition Measures, increased from 68% to 89% (odds ratio (OR)=3.49, 95% confidence interval (CI)=2.06–5.92). Return to the emergency department within 3 days of discharge was lower in the intervention period (10% vs 3%, OR=0.25, 95% CI=0.10–0.62). At 30 days, there was a lower rate of readmission (22% vs 14%, OR=0.59, 95% CI=0.34–0.97) and fewer visits to the emergency department (21% vs 14%, OR=0.61, 95% CI=0.36–1.03) (P=.06).CONCLUSION: When hospitalized elderly patients are treated with consideration of their specific needs, healthcare outcomes can be improved.