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Jorissen RN, Wesselingh SL, Whitehead C, Maddison J, Forward J, Bourke A, Harvey G, Crotty M, Inacio MC. Predictors of mortality shortly after entering a long-term care facility. Age Ageing 2024; 53:afae098. [PMID: 38773946 PMCID: PMC11109518 DOI: 10.1093/ageing/afae098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Indexed: 05/24/2024] Open
Abstract
OBJECTIVE Moving into a long-term care facility (LTCF) requires substantial personal, societal and financial investment. Identifying those at high risk of short-term mortality after LTCF entry can help with care planning and risk factor management. This study aimed to: (i) examine individual-, facility-, medication-, system- and healthcare-related predictors for 90-day mortality at entry into an LTCF and (ii) create risk profiles for this outcome. DESIGN Retrospective cohort study using data from the Registry of Senior Australians. SUBJECTS Individuals aged ≥ 65 years old with first-time permanent entry into an LTCF in three Australian states between 01 January 2013 and 31 December 2016. METHODS A prediction model for 90-day mortality was developed using Cox regression with the purposeful variable selection approach. Individual-, medication-, system- and healthcare-related factors known at entry into an LTCF were examined as predictors. Harrell's C-index assessed the predictive ability of our risk models. RESULTS 116,192 individuals who entered 1,967 facilities, of which 9.4% (N = 10,910) died within 90 days, were studied. We identified 51 predictors of mortality, five of which were effect modifiers. The strongest predictors included activities of daily living category (hazard ratio [HR] = 5.41, 95% confidence interval [CI] = 4.99-5.88 for high vs low), high level of complex health conditions (HR = 1.67, 95% CI = 1.58-1.77 for high vs low), several medication classes and male sex (HR = 1.59, 95% CI = 1.53-1.65). The model out-of-sample Harrell's C-index was 0.773. CONCLUSIONS Our mortality prediction model, which includes several strongly associated factors, can moderately well identify individuals at high risk of mortality upon LTCF entry.
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Affiliation(s)
- Robert N Jorissen
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Steve L Wesselingh
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia; and National Health and Medical Research Council, ACT, Australia
| | - Craig Whitehead
- Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - John Maddison
- Northern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - John Forward
- Northern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - Alice Bourke
- Central Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - Gillian Harvey
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Maria Crotty
- Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Maria C Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
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Savickas V, Stewart AJ, Short VJ, Mathie A, Bhamra SK, Veale EL, Corlett SA. Screening for atrial fibrillation in care homes using pulse palpation and the AliveCor Kardia Mobile® device: a comparative cross-sectional pilot study. Int J Clin Pharm 2024; 46:529-535. [PMID: 38151689 PMCID: PMC10960776 DOI: 10.1007/s11096-023-01672-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/14/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is a major cause of stroke in older people. Exacerbated by age and co-morbidities, residents of care homes are more likely to develop AF and less likely to receive oral anticoagulants. AIM To determine the prevalence of AF using the design and methodology of the Pharmacists Detecting Atrial Fibrillation (PDAF) study in a care home setting. METHOD A cross-sectional AF screening pilot study within four UK care homes, three residential and one residential/nursing. Screening followed the original PDAF protocol: a manual pulse check, followed by a single-Lead ECG (SLECG, AliveCor Kardia Mobile (KMD)) delivered by a pharmacist. All recorded SLECG were reviewed by a cardiologist and any residents requiring follow-up investigations were referred to their general practitioner. RESULTS Fifty-three of 112 care home residents participated. From 52 SLECGs recorded, the cardiologist interpreted 13.5% (7/52) as having possible AF of which 9.6% (5/52) were previously unknown. One resident with previously unknown AF received anticoagulation. CONCLUSION This study has shown a need for AF screening in care homes and that elements of the PDAF screening protocol are transferable in this setting. Early diagnosis and treatment of AF are essential to reduce the risk of stroke in this population.
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Affiliation(s)
- V Savickas
- Medway School of Pharmacy, University of Kent and University of Greenwich, Chatham Maritime, UK
| | - A J Stewart
- Medway NHS Foundation Trust, Medway Maritime Hospital, Gillingham, UK
| | | | - A Mathie
- Medway School of Pharmacy, University of Kent and University of Greenwich, Chatham Maritime, UK
- School of Allied Health Sciences, University of Suffolk, Ipswich, UK
| | - S K Bhamra
- Medway School of Pharmacy, University of Kent and University of Greenwich, Chatham Maritime, UK
| | - E L Veale
- Medway School of Pharmacy, University of Kent and University of Greenwich, Chatham Maritime, UK.
| | - S A Corlett
- Medway School of Pharmacy, University of Kent and University of Greenwich, Chatham Maritime, UK
- Medway NHS Foundation Trust, Medway Maritime Hospital, Gillingham, UK
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Jones RP. Addressing the Knowledge Deficit in Hospital Bed Planning and Defining an Optimum Region for the Number of Different Types of Hospital Beds in an Effective Health Care System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7171. [PMID: 38131722 PMCID: PMC11080941 DOI: 10.3390/ijerph20247171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
Based upon 30-years of research by the author, a new approach to hospital bed planning and international benchmarking is proposed. The number of hospital beds per 1000 people is commonly used to compare international bed numbers. This method is flawed because it does not consider population age structure or the effect of nearness-to-death on hospital utilization. Deaths are also serving as a proxy for wider bed demand arising from undetected outbreaks of 3000 species of human pathogens. To remedy this problem, a new approach to bed modeling has been developed that plots beds per 1000 deaths against deaths per 1000 population. Lines of equivalence can be drawn on the plot to delineate countries with a higher or lower bed supply. This method is extended to attempt to define the optimum region for bed supply in an effective health care system. England is used as an example of a health system descending into operational chaos due to too few beds and manpower. The former Soviet bloc countries represent a health system overly dependent on hospital beds. Several countries also show evidence of overutilization of hospital beds. The new method is used to define a potential range for bed supply and manpower where the most effective health systems currently reside. The method is applied to total curative beds, medical beds, psychiatric beds, critical care, geriatric care, etc., and can also be used to compare different types of healthcare staff, i.e., nurses, physicians, and surgeons. Issues surrounding the optimum hospital size and the optimum average occupancy will also be discussed. The role of poor policy in the English NHS is used to show how the NHS has been led into a bed crisis. The method is also extended beyond international benchmarking to illustrate how it can be applied at a local or regional level in the process of long-term bed planning. Issues regarding the volatility in hospital admissions are also addressed to explain the need for surge capacity and why an adequate average bed occupancy margin is required for an optimally functioning hospital.
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Demonceau C, Buckinx F, Reginster JY, Bruyère O. Assessment of risk factors associated with long-term mortality in nursing homes: result from the SENIOR cohort. Aging Clin Exp Res 2023; 35:2997-3005. [PMID: 37917376 DOI: 10.1007/s40520-023-02579-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/24/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Previous studies on risk factors for death in nursing homes have focused on short-term observation and limited number risk factors. AIMS This study aims to identify factors predictive of 8-year survival in nursing homes. METHODS The study used the baseline measurements from the SENIOR cohort collected in 2013-2014. Data included clinical assessments (i.e., body composition, nutritional status, physical performance, level of dependence and cognition, frailty phenotype) as well as demographic information, number of medications and medical history. Mortality data were collected annually for 8 years. Univariate analyses were initially performed to assess potential predictive factors, followed by a Cox regression model using stepwise selection. RESULTS Of the 662 participants enrolled in the cohort, 58 (8.8%) were not further assessed due to the withdrawal of 2 nursing homes and 71 (10.7%) had no mortality data available (i.e., relocation, refusal to continue the study). Among the 533 patients included, 111 (20.8%) were still alive in 2022. Median survival time was 4 years (1.93-6.94). Multivariate regression showed that younger age (HR = 1.04 (1.03-1.06)), higher body mass index (HR = 0.96 (0.94-0.98)), higher score on the Mini-Mental State-Examination (HR = 0.97 (0.94-0.99)) and higher score on the Short Physical Performance Battery (HR = 0.93 (0.90-0.97)) were protective factors against mortality. CONCLUSIONS This study highlights that certain modifiable factors related to physical or mental health contribute to increased survival in nursing homes. Because of its ability to improve physical performance and partly cognitive function, promoting physical activity in nursing homes appears to be a public health priority.
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Affiliation(s)
- Céline Demonceau
- WHO Collaborating Center for Epidemiologic Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Avenue Hippocrate 13, CHU Bât B23, 4000, Liège, Belgium.
| | - Fanny Buckinx
- WHO Collaborating Center for Epidemiologic Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Avenue Hippocrate 13, CHU Bât B23, 4000, Liège, Belgium
| | - Jean-Yves Reginster
- WHO Collaborating Center for Epidemiologic Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Avenue Hippocrate 13, CHU Bât B23, 4000, Liège, Belgium
| | - Olivier Bruyère
- WHO Collaborating Center for Epidemiologic Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Avenue Hippocrate 13, CHU Bât B23, 4000, Liège, Belgium
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5
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Boucaud-Maitre D, Letenneur L, Dramé M, Taubé-Teguo N, Dartigues JF, Amieva H, Tabué-Teguo M. Comparison of mortality and hospitalizations of older adults living in residential care facilities versus nursing homes or the community. A systematic review. PLoS One 2023; 18:e0286527. [PMID: 37256888 DOI: 10.1371/journal.pone.0286527] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/17/2023] [Indexed: 06/02/2023] Open
Abstract
Residential care facility may provide a transition between living at home and a nursing home for dependent older people or an alternative to nursing homes. The objective of this review was to compare mortality and hospitalizations of older adults living in residential care facilities with those living in nursing homes or in the community. We searched Medline, Scopus and Web of Science from inception to December 2022. Fifteen cohort studies with 6 months to 10 years of follow-up were included. The unadjusted relative risk (RR) of mortality was superior in nursing homes than in residential care facilities in 6 of 7 studies (from 1.3 to 1.68). Conversely, the unadjusted relative risk of hospitalizations was higher in residential care facilities in 6 studies (from 1.3 to 3.37). Studies conducted on persons with dementia found mixed results, the only study adjusted for co-morbidities observing no difference on these two endpoints. Compared with home, unadjusted relative risks were higher in residential care facilities for mortality in 4 studies (from 1.34 à 10.1) and hospitalizations in 3 studies (from 1.12 to 1.62). Conversely, the only study that followed older adults initially living at home over a 10-year period found a reduced risk of heavy hospital use (RR = 0.68) for those who temporarily resided in a residential care facilities. There is insufficient evidence to determine whether residential care facilities might be an alternative to nursing homes for older people with similar clinical characteristics (co-morbidities and dementia). Nevertheless, given the high rate of hospitalizations observed in residential care facilities, the medical needs of residents should be better explored.
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Affiliation(s)
- Denis Boucaud-Maitre
- Centre Hospitalier Le Vinatier, Bron, France
- Equipe EPICLIV, Université des Antilles, Fort-de-France, Martinique
| | - Luc Letenneur
- Inserm, U1219 Bordeaux Population Health Center, University of Bordeaux, Bordeaux, France
| | - Moustapha Dramé
- Equipe EPICLIV, Université des Antilles, Fort-de-France, Martinique
- Centre Hospitalo-Universitaire de Martinique, Fort-de-France, Martinique
| | - Nadine Taubé-Teguo
- Equipe EPICLIV, Université des Antilles, Fort-de-France, Martinique
- Centre Hospitalo-Universitaire de Martinique, Fort-de-France, Martinique
| | | | - Hélène Amieva
- Inserm, U1219 Bordeaux Population Health Center, University of Bordeaux, Bordeaux, France
| | - Maturin Tabué-Teguo
- Equipe EPICLIV, Université des Antilles, Fort-de-France, Martinique
- Centre Hospitalo-Universitaire de Martinique, Fort-de-France, Martinique
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6
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Ritchie LA, Harrison SL, Penson PE, Akbari A, Torabi F, Hollinghurst J, Harris D, Oke OB, Akpan A, Halcox JP, Rodgers SE, Lip GYH, Lane DA. Prevalence and outcomes of atrial fibrillation in older people living in care homes in Wales: a routine data linkage study 2003-2018. Age Ageing 2022; 51:6872693. [PMID: 36469091 PMCID: PMC9721338 DOI: 10.1093/ageing/afac252] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/24/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To determine atrial fibrillation (AF) prevalence and temporal trends, and examine associations between AF and risk of adverse health outcomes in older care home residents. METHODS Retrospective cohort study using anonymised linked data from the Secure Anonymised Information Linkage Databank on CARE home residents in Wales with AF (SAIL CARE-AF) between 2003 and 2018. Fine-Gray competing risk models were used to estimate the risk of health outcomes with mortality as a competing risk. Cox regression analyses were used to estimate the risk of mortality. RESULTS There were 86,602 older care home residents (median age 86.0 years [interquartile range 80.8-90.6]) who entered a care home between 2003 and 2018. When the pre-care home entry data extraction was standardised, the overall prevalence of AF was 17.4% (95% confidence interval 17.1-17.8) between 2010 and 2018. There was no significant change in the age- and sex-standardised prevalence of AF from 16.8% (15.9-17.9) in 2010 to 17.0% (16.1-18.0) in 2018. Residents with AF had a significantly higher risk of cardiovascular mortality (adjusted hazard ratio [HR] 1.27 [1.17-1.37], P < 0.001), all-cause mortality (adjusted HR 1.14 [1.11-1.17], P < 0.001), ischaemic stroke (adjusted sub-distribution HR 1.55 [1.36-1.76], P < 0.001) and cardiovascular hospitalisation (adjusted sub-distribution HR 1.28 [1.22-1.34], P < 0.001). CONCLUSIONS Older care home residents with AF have an increased risk of adverse health outcomes, even when higher mortality rates and other confounders are accounted for. This re-iterates the need for appropriate oral anticoagulant prescription and optimal management of cardiovascular co-morbidities, irrespective of frailty status and predicted life expectancy.
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Affiliation(s)
- Leona A Ritchie
- Address correspondence to: Leona A. Ritchie, Liverpool Centre for Cardiovascular Science, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool L7 8TX, UK. Tel: 0151 794 2000;
| | - Stephanie L Harrison
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool L7 8TX, UK,Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK
| | - Peter E Penson
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool L7 8TX, UK,Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK,School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK
| | - Ashley Akbari
- Population Data Science, Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, Wales SA2 8PP, UK,Population Data Science, Administrative Data Research Wales, Swansea University Medical School, Swansea University, Swansea, Wales SA2 8PP, UK
| | - Fatemeh Torabi
- Population Data Science, Administrative Data Research Wales, Swansea University Medical School, Swansea University, Swansea, Wales SA2 8PP, UK
| | - Joe Hollinghurst
- Population Data Science, Administrative Data Research Wales, Swansea University Medical School, Swansea University, Swansea, Wales SA2 8PP, UK
| | - Daniel Harris
- Population Data Science, Administrative Data Research Wales, Swansea University Medical School, Swansea University, Swansea, Wales SA2 8PP, UK
| | - Oluwakayode B Oke
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool L7 8TX, UK,Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK
| | - Asangaedem Akpan
- Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK,Liverpool University Hospitals NHS Foundation Trust, Liverpool L9 7AL, UK
| | - Julian P Halcox
- Population Data Science, Administrative Data Research Wales, Swansea University Medical School, Swansea University, Swansea, Wales SA2 8PP, UK
| | - Sarah E Rodgers
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool L69 3GF, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool L7 8TX, UK,Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg DK-9220, Denmark,Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool L7 8TX, UK,Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg DK-9220, Denmark,Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
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7
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Mortality differences in disabled older adults by place of care in Japan: nationwide 10-year results. J Public Health Policy 2022; 43:542-559. [DOI: 10.1057/s41271-022-00369-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2022] [Indexed: 11/21/2022]
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8
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Grimm F, Johansen A, Knight H, Brine R, Deeny SR. Indirect effect of the COVID-19 pandemic on hospital mortality in patients with hip fracture: a competing risk survival analysis using linked administrative data. BMJ Qual Saf 2022; 32:264-273. [PMID: 35914925 PMCID: PMC10176403 DOI: 10.1136/bmjqs-2022-014896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/20/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Hip fracture is a leading cause of disability and mortality among older people. During the COVID-19 pandemic, orthopaedic care pathways in the National Health Service in England were restructured to manage pressures on hospital capacity. We examined the indirect consequences of the pandemic for hospital mortality among older patients with hip fracture, admitted from care homes or the community. METHODS Retrospective analysis of linked care home and hospital inpatient data for patients with hip fracture aged 65 years and over admitted to hospitals in England during the first year of the pandemic (1 March 2020 to 28 February 2021) or during the previous year. We performed survival analysis, adjusting for case mix and COVID-19 infection, and considered live discharge as a competing risk. We present cause-specific hazard ratios (HRCS) for the effect of admission year on hospital mortality risk. RESULTS During the first year of the pandemic, there were 55 648 hip fracture admissions: a 5.2% decrease on the previous year. 9.5% of patients had confirmed or suspected COVID-19. Hospital stays were substantially shorter (p<0.05), and there was a higher daily chance of discharge (HRCS 1.40, 95% CI 1.38 to 1.41). Overall hip fracture inpatient mortality increased (7.2% in 2020/2021 vs 6.4% in 2019/2020), but patients without concomitant COVID-19 infection had lower mortality rates compared with the year before (5.3%). Admission during the pandemic was associated with a 11% increase in the daily risk of hospital death for patients with hip fracture (HRCS 1.11, 95% CI 1.05 to 1.16). CONCLUSIONS Although COVID-19 infections led to increases in hospital mortality, overall hospital mortality risk for older patients with hip fracture remained largely stable during the first year of the pandemic.
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Affiliation(s)
| | - Antony Johansen
- University Hospital of Wales and Cardiff University School of Medicine, Cardiff, UK.,National Hip Fracture Database, Royal College of Physicians, London, UK
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Li Y, Zhang X, Yang L, Yang Y, Qiao G, Lu C, Liu K. Association between polypharmacy and mortality in the older adults: A systematic review and meta-analysis. Arch Gerontol Geriatr 2022; 100:104630. [DOI: 10.1016/j.archger.2022.104630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/18/2022] [Accepted: 01/21/2022] [Indexed: 01/10/2023]
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10
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Li Y, Zhang X, Yang L, Yang Y, Qiao G, Lu C, Liu K. Association between polypharmacy and mortality in the older adults: A systematic review and meta-analysis. Arch Gerontol Geriatr 2022. [DOI: https://doi.org/10.1016/j.archger.2022.104630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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11
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Gulliford MC, Prevost AT, Clegg A, Rezel-Potts E. Mortality of care home residents and community-dwelling controls during the covid-19 pandemic in 2020: matched cohort study. J Am Med Dir Assoc 2022; 23:923-929.e2. [PMID: 35561757 PMCID: PMC9005362 DOI: 10.1016/j.jamda.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/23/2022] [Accepted: 04/05/2022] [Indexed: 12/02/2022]
Abstract
Objective This study aimed to estimate and compare mortality of care home residents, and matched community-dwelling controls, during the COVID-19 pandemic from primary care electronic health records in England. Design Matched cohort study. Setting and Participants Family practices in England in the Clinical Practice Research Datalink Aurum database. There were 83,627 care home residents in 2020, with 26,923 deaths; 80,730 (97%) were matched on age, sex, and family practice with 300,445 community-dwelling adults. Methods All-cause mortality was evaluated and adjusted rate ratios by negative binomial regression were adjusted for age, sex, number of long-term conditions, frailty category, region, calendar month or week, and clustering by family practice. Results Underlying mortality of care home residents was higher than community controls (adjusted rate ratio 5.59, 95% confidence interval 5.23‒5.99, P < .001). During April 2020, there was a net increase in mortality of care home residents over that of controls. The mortality rate of care home residents was 27.2 deaths per 1000 patients per week, compared with 2.31 per 1000 for controls. Excess deaths for care home residents, above that predicted from pre-pandemic years, peaked between April 13 and 19 (men, 27.7, 95% confidence interval 25.1‒30.3; women, 17.4, 15.9‒18.8 per 1000 per week). Compared with care home residents, long-term conditions and frailty were differentially associated with greater mortality in community-dwelling controls. Conclusions and Implications Individual-patient data from primary care electronic health records may be used to estimate mortality in care home residents. Mortality is substantially higher than for community-dwelling comparators and showed a disproportionate increase in the first wave of the COVID-19 pandemic. Care home residents require particular protection during periods of high infectious disease transmission.
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Affiliation(s)
- Martin C Gulliford
- School of Population and Life Course Sciences, King's College London, Guy's Campus, London, United Kingdom; NIHR Biomedical Research Centre at Guy's and St Thomas' Hospitals London, Great Maze Pond, London, United Kingdom.
| | - A Toby Prevost
- Nightingale-Saunders Clinical Trials and Epidemiology Unit, Cicely Saunders Institute, King's College London, London, United Kingdom
| | - Andrew Clegg
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom; Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, United Kingdom
| | - Emma Rezel-Potts
- School of Population and Life Course Sciences, King's College London, Guy's Campus, London, United Kingdom; NIHR Biomedical Research Centre at Guy's and St Thomas' Hospitals London, Great Maze Pond, London, United Kingdom
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12
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Garden G, Usman A, Readman D, Storey L, Wilkinson L, Wilson G, Dening T, Gordon AL, Gladman JRF. Advance care plans in UK care home residents: a service evaluation using a stepped wedge design. Age Ageing 2022; 51:6555262. [PMID: 35348604 PMCID: PMC8963445 DOI: 10.1093/ageing/afac069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Indexed: 11/14/2022] Open
Abstract
Introduction advance care planning (ACP) in care homes has high acceptance, increases the proportion of residents dying in place and reduces hospital admissions in research. We investigated whether ACP had similar outcomes when introduced during real-world service implementation. Methods a service undertaking ACP in Lincoln, UK care homes was evaluated using routine data. Outcomes were proportion of care homes and residents participating in ACP; characteristics of residents choosing/declining ACP and place of death for those with/without ACP. Hospital admissions were analysed using mixed-effects Poisson regression for number of admissions, and a mixed-effects negative binomial model for number of occupied hospital bed days. Results About 15/24 (63%) eligible homes supported the service, in which 404/508 (79.5%) participants chose ACP. Residents choosing ACP were older, frailer, more cognitively impaired and malnourished; 384/404 (95%) residents choosing ACP recorded their care home as their preferred place of death: 380/404 (94%) declined cardiopulmonary resuscitation. Among deceased residents, 219/248 (88%) and 33/49 (67%) with and without advance care plan respectively died in their care home (relative risk 1.35, 95% confidence interval [CI] 1.1–1.6, P < 0.001). Hospital admission rates and bed occupancy did not differ after implementation. Discussion About 79.5% participants chose ACP. Those doing so were more likely to die at home. Many homes were unwilling or unable to support the service. Hospital admissions were not reduced. Further research should consider how to enlist the support of all homes and to explore why hospital admissions were not reduced.
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Affiliation(s)
- Gill Garden
- Lincoln Medical School, University of Lincoln, Lincoln, UK.,United Lincolnshire Hospitals Trust, Lincoln, UK
| | - Adeela Usman
- School of Medicine, University of Nottingham, Nottingham, UK
| | | | | | | | - Graham Wilson
- Lincolnshire Community Health Services Trust, Lincoln, UK
| | - Tom Dening
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Adam L Gordon
- School of Medicine, University of Nottingham, Nottingham, UK.,NIHR Applied Research Centre-East Midlands (ARC-EM), Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, Nottingham, UK.,University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - John R F Gladman
- School of Medicine, University of Nottingham, Nottingham, UK.,NIHR Applied Research Centre-East Midlands (ARC-EM), Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, Nottingham, UK.,Nottingham University Hospitals NHS Trust, Nottingham, UK
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13
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Schultze A, Nightingale E, Evans D, Hulme W, Rosello A, Bates C, Cockburn J, MacKenna B, Curtis HJ, Morton CE, Croker R, Bacon S, McDonald HI, Rentsch CT, Bhaskaran K, Mathur R, Tomlinson LA, Williamson EJ, Forbes H, Tazare J, Grint D, Walker AJ, Inglesby P, DeVito NJ, Mehrkar A, Hickman G, Davy S, Ward T, Fisher L, Green ACA, Wing K, Wong AYS, McManus R, Parry J, Hester F, Harper S, Evans SJW, Douglas IJ, Smeeth L, Eggo RM, Goldacre B, Leon DA. Mortality among Care Home Residents in England during the first and second waves of the COVID-19 pandemic: an observational study of 4.3 million adults over the age of 65. THE LANCET REGIONAL HEALTH. EUROPE 2022; 14:100295. [PMID: 35036983 PMCID: PMC8743167 DOI: 10.1016/j.lanepe.2021.100295] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Residents in care homes have been severely impacted by COVID-19. We describe trends in the mortality risk among residents of care homes compared to private homes. METHODS On behalf of NHS England we used OpenSAFELY-TPP to calculate monthly age-standardised risks of death due to all causes and COVID-19 among adults aged >=65 years between 1/2/2019 and 31/03/2021. Care home residents were identified using linkage to Care and Quality Commission data. FINDINGS We included 4,340,648 people aged 65 years or older on the 1st of February 2019, 2.2% of whom were classified as residing in a care or nursing home. Age-standardised mortality risks were approximately 10 times higher among care home residents compared to those in private housing in February 2019: comparative mortality figure (CMF) = 10.59 (95%CI = 9.51, 11.81) among women, and 10.87 (9.93, 11.90) among men. By April 2020 these relative differences had increased to more than 17 times with CMFs of 17.57 (16.43, 18.79) among women and 18.17 (17.22, 19.17) among men. CMFs did not increase during the second wave, despite a rise in the absolute age-standardised COVID-19 mortality risks. INTERPRETATION COVID-19 has had a disproportionate impact on the mortality of care home residents in England compared to older residents of private homes, but only in the first wave. This may be explained by a degree of acquired immunity, improved protective measures or changes in the underlying frailty of the populations. The care home population should be prioritised for measures aimed at controlling COVID-19. FUNDING Medical Research Council MR/V015737/1.
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Affiliation(s)
- Anna Schultze
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT
| | - Emily Nightingale
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT
| | - David Evans
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG
| | - William Hulme
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG
| | - Alicia Rosello
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT
| | - Chris Bates
- TPP, TPP House, 129 Low Lane, Horsforth, Leeds, LS18 5PX
| | | | - Brian MacKenna
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG
| | - Helen J Curtis
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG
| | - Caroline E Morton
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG
| | - Richard Croker
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG
| | - Seb Bacon
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG
| | - Helen I McDonald
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT
| | | | - Krishnan Bhaskaran
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT
| | - Rohini Mathur
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT
| | - Laurie A Tomlinson
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT
| | | | - Harriet Forbes
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT
| | - John Tazare
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT
| | - Daniel Grint
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT
| | - Alex J Walker
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG
| | - Peter Inglesby
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG
| | - Nicholas J DeVito
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG
| | - Amir Mehrkar
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG
| | - George Hickman
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG
| | - Simon Davy
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG
| | - Tom Ward
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG
| | - Louis Fisher
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG
| | - Amelia CA Green
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG
| | - Kevin Wing
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT
| | - Angel YS Wong
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT
| | - Robert McManus
- TPP, TPP House, 129 Low Lane, Horsforth, Leeds, LS18 5PX
| | - John Parry
- TPP, TPP House, 129 Low Lane, Horsforth, Leeds, LS18 5PX
| | - Frank Hester
- TPP, TPP House, 129 Low Lane, Horsforth, Leeds, LS18 5PX
| | - Sam Harper
- TPP, TPP House, 129 Low Lane, Horsforth, Leeds, LS18 5PX
| | - Stephen JW Evans
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT
| | - Ian J Douglas
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT
| | - Liam Smeeth
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT
| | - Rosalind M Eggo
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT
| | - Ben Goldacre
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG
| | - David A Leon
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- International Laboratory For Population and Health, National Research University Higher School of Economics, Moscow, Russia
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14
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Davies LE, Kingston A, Todd A, Hanratty B. Is polypharmacy associated with mortality in the very old: findings from the Newcastle 85+ Study. Br J Clin Pharmacol 2022; 88:2988-2995. [PMID: 34981552 PMCID: PMC9302636 DOI: 10.1111/bcp.15211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 11/28/2022] Open
Abstract
Polypharmacy is common in the very old (≥85 years), where little is known about its association with mortality. We aimed to investigate the association between polypharmacy and all-cause mortality in the very old, over an 11-year time period. Data were drawn from the Newcastle 85+ Study (741), a cohort of people who were born in 1921 and turned 85 in 2006. Survival analysis was performed using Cox proportional hazards models with time-varying covariates, wherein polypharmacy was operationalised continuously. Each additional medication prescribed was associated with a 3% increased risk of mortality (HR: 1.03, 95% CI: 1.00-1.06). Amongst the very old, the risks and benefits of each additional medication prescribed should be carefully considered.
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Affiliation(s)
- Laurie E Davies
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Andrew Kingston
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Adam Todd
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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15
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Macgregor A, McCormack B, Spilsbury K, Hockley J, Rutherford A, Ogden M, Soulsby I, McKenzie M, Hanratty B, Forbat L. Supporting care home residents in the last year of life through 'Needs Rounds': Development of a pre-implementation programme theory through a rapid collaborative online approach. FRONTIERS IN HEALTH SERVICES 2022; 2:1019602. [PMID: 36925884 PMCID: PMC10012649 DOI: 10.3389/frhs.2022.1019602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/12/2022] [Indexed: 01/12/2023]
Abstract
Background Realist evaluation aims to address the knowledge to practice gap by explaining how an intervention is expected to work, as well as what is likely to impact upon the success of its implementation, by developing programme theories that link contexts, mechanisms and outcomes. Co-production approaches to the development of programme theories offer substantial benefits in addressing power relations, including and valuing different types of knowledge, and promoting buy-in from stakeholders while navigating the complex social systems in which innovations are embedded. This paper describes the co-production of an initial programme theory of how an evidence based intervention developed in Australia - called 'Palliative Care Needs Rounds' - might work in England and Scotland to support care home residents approaching their end of life. Methods Using realist evaluation and iPARIHS (integrated Promoting Action on Research Implementation in Health Services) we sought to determine how contexts and mechanisms of change might shape implementation outcomes. Pre-intervention online interviews (n = 28) were conducted (February-April 2021), followed by four co-design online workshops with 43 participants (April-June 2021). The online interviews and workshops included a range of stakeholders, including care home staff, specialist palliative care staff, paramedics, general practitioners, and relatives of people living in care homes. Results This methodology paper reports developments in realist evaluation and co-production methodologies, and how they were used to develop context, mechanisms, outcomes (CMOs) configurations, and chains of inference. The initial (pre-intervention) programme theory is used to illustrate this process. Two developments to iPARIHS are described. First, involving stakeholders in the collaborative co-design workshops created opportunities to commence facilitation. Second, we describe developing iPARIHS' innovation component, to include novel stakeholder interpretations, perceptions and anticipated use of the intervention as they participated in workshop discussions. Conclusions This rapid and robust co-production methodology draws on interactive collaborative research practices (interviews, workshop discussions of data, illustrative vignettes and visual methods). These innovative and engaging methods can be packaged for online processes to develop, describe and interrogate the CMOs in order to co-produce a programme theory. These approaches also commence facilitation and innovation, and can be adopted in other implementation science and realist studies.
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Affiliation(s)
- Aisha Macgregor
- Faculty of Social Sciences, University of Stirling, Stirling, Scotland
| | - Brendan McCormack
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW, Australia
| | | | - Jo Hockley
- College of Medicine and Veterinary Science, University of Edinburgh, Scotland
| | | | | | | | | | | | - Liz Forbat
- Faculty of Social Sciences, University of Stirling, Stirling, Scotland
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16
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Huang YT, Steptoe A, Wei L, Zaninotto P. The impact of high-risk medications on mortality risk among older adults with polypharmacy: evidence from the English Longitudinal Study of Ageing. BMC Med 2021; 19:321. [PMID: 34911547 PMCID: PMC8675465 DOI: 10.1186/s12916-021-02192-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 11/18/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Polypharmacy is common among older people and is associated with an increased mortality risk. However, little is known about whether the mortality risk is related to specific medications among older adults with polypharmacy. This study therefore aimed to investigate associations between high-risk medications and all-cause and cause-specific mortality among older adults with polypharmacy. METHODS This study included 1356 older adults with polypharmacy (5+ long-term medications a day for conditions or symptoms) from Wave 6 (2012/2013) of the English Longitudinal Study of Ageing. First, using the agglomerative hierarchical clustering method, participants were grouped according to the use of 14 high-risk medication categories. Next, the relationship between the high-risk medication patterns and all-cause and cause-specific mortality (followed up to April 2018) was examined. All-cause mortality was assessed by Cox proportional hazards model and competing-risk regression was employed for cause-specific mortality. RESULTS Five high-risk medication patterns-a renin-angiotensin-aldosterone system (RAAS) inhibitors cluster, a mental health drugs cluster, a central nervous system (CNS) drugs cluster, a RAAS inhibitors and antithrombotics cluster, and an antithrombotics cluster-were identified. The mental health drugs cluster showed increased risks of all-cause (HR = 1.55, 95%CI = 1.05, 2.28) and cardiovascular disease (CVD) (SHR = 2.11, 95%CI = 1.10, 4.05) mortality compared with the CNS drug cluster over 6 years, while others showed no differences in mortality. Among these patterns, the mental health drugs cluster showed the highest prevalence of antidepressants (64.1%), benzodiazepines (10.4%), antipsychotics (2.4%), antimanic agents (0.7%), opioids (33.2%), and muscle relaxants (21.5%). The findings suggested that older adults with polypharmacy who took mental health drugs (primarily antidepressants), opioids, and muscle relaxants were at higher risk of all-cause and CVD mortality, compared with those who did not take these types of medications. CONCLUSIONS This study supports the inclusion of opioids in the current guidance on structured medication reviews, but it also suggests that older adults with polypharmacy who take psychotropic medications and muscle relaxants are prone to adverse outcomes and therefore may need more attention. The reinforcement of structured medication reviews would contribute to early intervention in medication use which may consequently reduce medication-related problems and bring clinical benefits to older adults with polypharmacy.
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Affiliation(s)
- Yun-Ting Huang
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, London, UK
| | - Li Wei
- School of Pharmacy, University College London, London, UK
| | - Paola Zaninotto
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
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17
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Clery A, Martin FC, Redmond P, Marshall I, McKevitt C, Sackley C, Manthorpe J, Wolfe C, Wang Y. Survival and outcomes for stroke survivors living in care homes: a prospective cohort study. Age Ageing 2021; 50:2079-2087. [PMID: 34240106 PMCID: PMC8581388 DOI: 10.1093/ageing/afab140] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Indexed: 11/14/2022] Open
Abstract
Background Stroke survivors living in care homes require high levels of support with everyday living. The aims of this study were to describe the survival, health status and care received by stroke survivors living in care homes at 1-year post-stroke, compared with those in their own homes. Methods A total of 3,548 stroke survivors with a first ever stroke between 1998 and 2017 in the South London Stroke Register were identified for survival analysis. A total of 2,272 were included in the 1-year follow-up analysis. Cox regression and Kaplan–Meier plots were used to describe survival, stratified into four 5-year cohorts. Health status, medications and rehabilitation received at 1-year post-stroke were compared using descriptive statistics. Results Over the 20-year period, survival improved for stroke survivors discharged to their own home (P < 0.001) but not for those discharged to care homes (P = 0.75). Care home residents were highly disabled (median Barthel index: 6/20, interquartile range: 2–10). Rates of secondary stroke prevention medications at 1-year follow-up increased over time for care home residents, including antiplatelets from 12.3 to 38.1%, although still lower than for those in their own homes (56.3%). Speech and language problems were common in the care home population (40.0%), but only 16% had received speech and language therapy. Conclusions Rates of secondary stroke prevention prescribing increased over 20 years but remained lower in care home residents. The lower levels of rehabilitation received by stroke survivors in care homes, despite their higher levels of disability, suggest a gap in care and urgent need for restorative and/or preventative rehabilitation.
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Affiliation(s)
- Amanda Clery
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - Finbarr C Martin
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - Patrick Redmond
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - Iain Marshall
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - Christopher McKevitt
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - Catherine Sackley
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - Jill Manthorpe
- National Institute for Health Research Policy Research Unit in Health and Social Care Workforce, King’s College London, London, UK
| | - Charles Wolfe
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, London, UK
- National Institute for Health Research Biomedical Research Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South London, London, UK
| | - Yanzhong Wang
- Address correspondence to: Yanzhong Wang, School of Population Health and Environmental Sciences, King’s College London, 4th Floor, Addison House, Guy’s Campus, London SE1 1UL, UK. Tel: (+44) 20 7848 8223. Email
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18
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Todd S, Bernal J, Worth R, Shearn J, Brearley S, McCarron M, Hunt K. Hidden lives and deaths: the last months of life of people with intellectual disabilities living in long-term, generic care settings in the UK. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 34:1489-1498. [PMID: 34031949 DOI: 10.1111/jar.12891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 02/15/2021] [Accepted: 03/12/2021] [Indexed: 11/27/2022]
Abstract
RATIONALE This paper concerns mortality and needs for end-of-life care in a population of adults with ID living in generic care homes. METHODS Various sampling strategies were used to identify a difficult to find a population of people with ID in generic care homes. Demographic and health data were obtained for 132 people with ID. This included the Surprise Question. At T2, 12 months later, data were obtained on the survival of this sample. FINDINGS The average age was 68.6 years, and the majority were women (55.3%). Their health was typically rated as good or better. Responses to the Surprise Question indicated that 23.3% respondents might need EoLC. At T2, 18.0% of this population had died. The average of death was 72.2 years. The majority died within the care setting (62.9%). IMPLICATIONS The implications for end-of-life care and mortality research are discussed.
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19
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Survival and community care use by care home residents in England: does mental health matter? AGEING & SOCIETY 2021. [DOI: 10.1017/s0144686x21001148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
The aim was to provide evidence of mortality and community care costs of people living in care homes and to investigate its association with mental health based on the Mental Health Clustering Tool (MHCT). In an observational study, 5,782 residents living in 104 care homes were followed from 2014 to 2016. Residents were categorised into four groups using the MCHT: three with mental health conditions, ‘non-psychotic’, ‘psychotic’ or ‘organic’; and one without mental health conditions, ‘non-clustered’. Generalised estimating equations were used to explore associations between mean community care costs over 6 months per patient and the clustering of residents into the four groups. Differences in survival rates of residents were plotted using Kaplan–Meier curves and tested with the log-rank test and Cox regression analysis. Community care costs were similar among residents with dementia (£431) and without mental health conditions (£407), while costs were higher among residents with non-psychotic (£762) and psychotic (£1,724) mental health conditions. After adjusting for patient and care home characteristics, residents with dementia were 30 per cent less likely to die compared with residents without mental health conditions. Similarly, residents with psychotic conditions and residents with non-psychotic conditions were 25 and 20 per cent less likely to die, respectively, than residents without mental health conditions. The MHCT seems to provide an informative stratification of care home residents with regards to survival and community care use.
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20
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Grimm F, Hodgson K, Brine R, Deeny SR. Hospital admissions from care homes in England during the COVID-19 pandemic: a retrospective, cross-sectional analysis using linked administrative data. Int J Popul Data Sci 2021; 5:1663. [PMID: 34286106 PMCID: PMC8267611 DOI: 10.23889/ijpds.v5i4.1663] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Care home residents have complex healthcare needs but may have faced barriers to accessing hospital treatment during the first wave of the COVID-19 pandemic. OBJECTIVES To examine trends in the number of hospital admissions for care home residents during the first months of the COVID-19 outbreak. METHODS Retrospective analysis of a national linked dataset on hospital admissions for residential and nursing home residents in England (257,843 residents, 45% in nursing homes) between 20 January 2020 and 28 June 2020, compared to admissions during the corresponding period in 2019 (252,432 residents, 45% in nursing homes). Elective and emergency admission rates, normalised to the time spent in care homes across all residents, were derived across the first three months of the pandemic between 1 March and 31 May 2020 and primary admission reasons for this period were compared across years. RESULTS Hospital admission rates rapidly declined during early March 2020 and remained substantially lower than in 2019 until the end of June. Between March and May, 2,960 admissions from residential homes (16.2%) and 3,295 admissions from nursing homes (23.7%) were for suspected or confirmed COVID-19. Rates of other emergency admissions decreased by 36% for residential and by 38% for nursing home residents (13,191 fewer admissions in total). Emergency admissions for acute coronary syndromes fell by 43% and 29% (105 fewer admission) and emergency admissions for stroke fell by 17% and 25% (128 fewer admissions) for residential and nursing home residents, respectively. Elective admission rates declined by 64% for residential and by 61% for nursing home residents (3,762 fewer admissions). CONCLUSIONS This is the first study showing that care home residents' hospital use declined during the first wave of COVID-19, potentially resulting in substantial unmet health need that will need to be addressed alongside ongoing pressures from COVID-19.
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Affiliation(s)
- Fiona Grimm
- The Health Foundation, 8 Salisbury Square, London EC4Y 8AP, UK
| | - Karen Hodgson
- The Health Foundation, 8 Salisbury Square, London EC4Y 8AP, UK
| | - Richard Brine
- The Health Foundation, 8 Salisbury Square, London EC4Y 8AP, UK
| | - Sarah R Deeny
- The Health Foundation, 8 Salisbury Square, London EC4Y 8AP, UK
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21
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Burton JK, Reid M, Gribben C, Caldwell D, Clark DN, Hanlon P, Quinn TJ, Fischbacher C, Knight P, Guthrie B, McAllister DA. Impact of COVID-19 on care-home mortality and life expectancy in Scotland. Age Ageing 2021; 50:1029-1037. [PMID: 33914870 PMCID: PMC8135527 DOI: 10.1093/ageing/afab080] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND COVID-19 deaths are commoner among care-home residents, but the mortality burden has not been quantified. METHODS Care-home residency was identified via a national primary care registration database linked to mortality data. Life expectancy was estimated using Makeham-Gompertz models to (i) describe yearly life expectancy from November 2015 to October 2020 (ii) compare life expectancy (during 2016-18) between care-home residents and the wider population and (iii) apply care-home life expectancy estimates to COVID-19 death counts to estimate years of life lost (YLL). RESULTS Among care-home residents, life expectancy in 2015/16 to 2019/20 ranged from 2.7 to 2.3 years for women and 2.3 to 1.8 years for men. Age-sex-specific life expectancy in 2016-18 in care-home residents was lower than in the Scottish population (10 and 2.5 years in those aged 70 and 90, respectively). Applying care home-specific life expectancies to COVID-19 deaths yield mean YLLs for care-home residents of 2.6 and 2.2 for women and men, respectively. In total YLL care-home residents have lost 3,560 years in women and 2,046 years in men. Approximately half of deaths and a quarter of YLL attributed to COVID-19 were accounted for by the 5% of over-70s who were care-home residents. CONCLUSION COVID-19 infection has led to the loss of substantial years of life in care-home residents aged 70 years and over in Scotland. Prioritising the 5% of older adults who are care-home residents for vaccination is justified not only in terms of total deaths, but also in terms of YLL.
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Affiliation(s)
- Jennifer K Burton
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G31 2ER, UK
| | - Martin Reid
- Public Health Scotland, Meridian Court, Glasgow G2 6QE, UK
| | - Ciara Gribben
- Public Health Scotland, Gyle Square , Edinburgh EH12 9EB, UK
| | - David Caldwell
- Public Health Scotland, Gyle Square , Edinburgh EH12 9EB, UK
| | - David N Clark
- Public Health Scotland, Gyle Square , Edinburgh EH12 9EB, UK
| | - Peter Hanlon
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK
| | - Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G31 2ER, UK
| | | | - Peter Knight
- Public Health Scotland, Gyle Square , Edinburgh EH12 9EB, UK
| | - Bruce Guthrie
- Advanced Care Research Centre, University of Edinburgh, Old Medical School, Edinburgh EG8 9AG, UK
| | - David A McAllister
- Public Health Scotland, Meridian Court, Glasgow G2 6QE, UK
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK
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22
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Huang YT, Steptoe A, Wei L, Zaninotto P. Dose-response relationships between polypharmacy and all-cause and cause-specific mortality among older people. J Gerontol A Biol Sci Med Sci 2021; 77:1002-1008. [PMID: 34079992 PMCID: PMC9071388 DOI: 10.1093/gerona/glab155] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Indexed: 12/16/2022] Open
Abstract
Background Although medicines are prescribed based on clinical guidelines and expected to benefit patients, both positive and negative health outcomes have been reported associated with polypharmacy. Mortality is the main outcome, and information on cause-specific mortality is scarce. Hence, we investigated the association between different levels of polypharmacy and all-cause and cause-specific mortality among older adults. Method The English Longitudinal Study of Ageing is a nationally representative study of people aged 50+. From 2012/2013, 6 295 individuals were followed up to April 2018 for all-cause and cause-specific mortality. Polypharmacy was defined as taking 5–9 long-term medications daily and heightened polypharmacy as 10+ medications. Cox proportional hazards regression and competing-risks regression were used to examine associations between polypharmacy and all-cause and cause-specific mortality, respectively. Results Over a 6-year follow-up period, both polypharmacy (19.3%) and heightened polypharmacy (2.4%) were related to all-cause mortality, with hazard ratios of 1.51 (95% CI: 1.05–2.16) and 2.29 (95% CI: 1.40–3.75) respectively, compared with no medications, independently of demographic factors, serious illnesses and long-term conditions, cognitive function, and depression. Polypharmacy and heightened polypharmacy also showed 2.45 (95% CI: 1.13–5.29) and 3.67 (95% CI: 1.43–9.46) times higher risk of cardiovascular disease deaths, respectively. Cancer mortality was only related to heightened polypharmacy. Conclusion Structured medication reviews are currently advised for heightened polypharmacy, but our results suggest that greater attention to polypharmacy in general for older people may reduce adverse effects and improve older adults’ health.
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Affiliation(s)
- Yun-Ting Huang
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, London, UK
| | - Li Wei
- School of Pharmacy, University College London, London, UK
| | - Paola Zaninotto
- Department of Epidemiology and Public Health, University College London, London, UK
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23
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Aicken C, Hodgson L, de Vries K, Wilkinson I, Aldridge Z, Galvin K. 'This Adds Another Perspective': Qualitative Descriptive Study Evaluating Simulation-Based Training for Health Care Assistants, to Enhance the Quality of Care in Nursing Homes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18083995. [PMID: 33920207 PMCID: PMC8069740 DOI: 10.3390/ijerph18083995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 12/23/2022]
Abstract
Much of the UK's ageing population lives in care homes, often with complex care needs including dementia. Optimal care requires strong clinical leadership, but opportunities for staff development in these settings are limited. Training using simulation can enable experiential learning in situ. In two nursing homes, Health Care Assistants (HCAs) received training in clinical communication skills (Situation-Background-Assessment-Recommendation Education through Technology and Simulation, SETS: group training with an actor simulating scenarios); and dementia (A Walk Through Dementia, AWTD: digital simulation, delivered one-to-one). In this qualitative descriptive study, we evaluated the potential of this training to enhance HCAs' clinical leadership skills, through thematic analysis of 24 semi-structured interviews with HCAs (before/after training) and their managers and mentors. Themes were checked by both interviewers. HCAs benefitted from watching colleagues respond to SETS scenarios and reported greater confidence in communicating with registered healthcare professionals. Some found role-play participation challenging. AWTD sensitised HCAs to the experiences of residents with dementia, and those with limited dementia experience gained a fuller understanding of the disease's effects. Staffing constraints affected participation in group training. Training using simulation is valuable in this setting, particularly when delivered flexibly. Further work is needed to explore its potential on a larger scale.
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Affiliation(s)
- Catherine Aicken
- School of Health Sciences, University of Brighton, Falmer BN1 9PH, UK;
- Correspondence: (C.A.); (K.G.)
| | - Lisa Hodgson
- School of Health Sciences, University of Brighton, Falmer BN1 9PH, UK;
| | - Kay de Vries
- School of Nursing and Midwifery, De Montfort University, Leicester LE1 9BH, UK; (K.d.V.); (Z.A.)
| | - Iain Wilkinson
- Surrey and Sussex Healthcare NHS Trust, Redhill RH2 5RH, UK;
- Brighton and Sussex Medical School, Falmer BN1 9PH, UK
| | - Zena Aldridge
- School of Nursing and Midwifery, De Montfort University, Leicester LE1 9BH, UK; (K.d.V.); (Z.A.)
- Dementia UK, London EC3N 1RE, UK
| | - Kathleen Galvin
- School of Health Sciences, University of Brighton, Falmer BN1 9PH, UK;
- Correspondence: (C.A.); (K.G.)
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24
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Espuny Pujol F, Hancock R, Morciano M. Trends in survival of older care home residents in England: A 10-year multi-cohort study. Soc Sci Med 2021; 282:113883. [PMID: 34154839 DOI: 10.1016/j.socscimed.2021.113883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/20/2021] [Accepted: 03/24/2021] [Indexed: 01/18/2023]
Abstract
Increases in longevity combined with a policy emphasis on caring for older people in their own homes could have widened or narrowed the survival gap between care home and community-dwelling resident older people. Knowledge of pre-COVID-19 trends in this gap is needed to assess the longer-term impacts of the pandemic. We provide evidence for England on recent trends in 1, 2 and 3-year mortality amongst care home residents aged 65+ compared with similar community-dwelling residents. We use the Clinical Practice Research Datalink, a nationally representative primary care database. For each of the ten years from 2006 to 2015, care home and community-dwelling residents aged 65+ were identified and matched in the ratio 1:3, according to age, gender, area deprivation and region. Cox survival analyses were used to estimate mortality risks for care home residents in comparison with similar community-dwelling people, adjusting for age, gender, area deprivation and region. The study sample consisted of ten overlapping cohorts averaging 5495 care home residents per cohort. Adjusted mortality risks increased over the study period for care home residents while decreasing slightly for matched community-dwelling residents. The relative risks (RRs) of mortality associated with care home residence were higher for younger ages and shorter follow-up periods, in all years. Over the decade, the RRs increased, most at younger ages and for shorter follow-up periods (e.g. for the age group 65-74 years, 1-year average RR increased by 61% from 5.4 to 8.8, while for those aged 85-94 years and over, 3-year RR increased by 22% from 1.3 to 1.6). Thus the survival gap between older care home and community-dwelling residents has been widening, especially at younger ages. In due course, it will be possible to establish to what extent the COVID-19 pandemic has resulted in further growth in this gap.
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Affiliation(s)
- Ferran Espuny Pujol
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK; Clinical Operational Research Unit, Department of Mathematics, University College London, London, UK.
| | - Ruth Hancock
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK; Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Marcello Morciano
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK; Health Organisation, Policy and Economics (HOPE) Research Group, University of Manchester, Manchester, UK
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25
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Manson J, Gardiner C, Taylor P, Ghasemi L, Westerdale-Shaw E, Sutton L, Cawley H. 'Palliative care education in nursing homes: a qualitative evaluation of telementoring. BMJ Support Palliat Care 2021:bmjspcare-2020-002727. [PMID: 33627368 DOI: 10.1136/bmjspcare-2020-002727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/14/2021] [Accepted: 01/17/2021] [Indexed: 01/08/2023]
Abstract
There is an increasing need to support nursing homes in palliative care to reduce suffering and avoid unnecessary hospital admissions at the end of life. Providing education to nursing homes faces many barriers including structural systems and cultural issues. In order to overcome some of these barriers, education using Project Extension for Community Health Outcomes (ECHO) methodology has been delivered to nursing homes throughout a large city in England. This paper aims to explore participant experience in Project ECHO for nursing homes. METHODOLOGY Qualitative semistructured interviews with a purposive sample of nursing home staff. Interviews were conducted by one researcher and transcribed verbatim. Line-by-line coding and categorisation were used to form themes. RESULTS Eleven interviews were completed with data saturation reached by interview eight. The following themes were revealed: Barriers and facilitators to accessing Project ECHO, Community of Practice and Communication with nursing homes and data extraction. CONCLUSION Project ECHO is an accessible, acceptable and engaging way of delivering palliative care education to nursing homes combatting some of the traditional barriers that nursing homes face in accessing training.
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Affiliation(s)
- Jane Manson
- Project ECHO Team, St Luke's Hospice, Sheffield, UK
| | - Clare Gardiner
- School of Nursing, University of Sheffield, Sheffield, UK
| | - Paul Taylor
- Project ECHO Team, St Luke's Hospice, Sheffield, UK
| | | | | | - Lucy Sutton
- Therapy Services, Ashgate Hospice, Chesterfield, Derbyshire, UK
| | - Helen Cawley
- Project ECHO Team, St Luke's Hospice, Sheffield, UK
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26
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Macgregor A, Rutherford A, McCormack B, Hockley J, Ogden M, Soulsby I, McKenzie M, Spilsbury K, Hanratty B, Forbat L. Palliative and end-of-life care in care homes: protocol for codesigning and implementing an appropriate scalable model of Needs Rounds in the UK. BMJ Open 2021; 11:e049486. [PMID: 33619205 PMCID: PMC7903098 DOI: 10.1136/bmjopen-2021-049486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Palliative and end-of-life care in care homes is often inadequate, despite high morbidity and mortality. Residents can experience uncontrolled symptoms, poor quality deaths and avoidable hospitalisations. Care home staff can feel unsupported to look after residents at the end of life. Approaches for improving end-of-life care are often education-focused, do not triage residents and rarely integrate clinical care. This study will adapt an evidence-based approach from Australia for the UK context called 'Palliative Care Needs Rounds' (Needs Rounds). Needs Rounds combine triaging, anticipatory person-centred planning, case-based education and case-conferencing; the Australian studies found that Needs Rounds reduce length of stay in hospital, and improve dying in preferred place of care, and symptoms at the end of life. METHODS AND ANALYSIS This implementation science study will codesign and implement a scalable UK model of Needs Rounds. The Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework will be used to identify contextual barriers and use facilitation to enable successful implementation. Six palliative care teams, working with 4-6 care homes each, will engage in two phases. In phase 1 (February 2021), stakeholder interviews (n=40) will be used to develop a programme theory to meet the primary outcome of identifying what works, for whom in what circumstances for UK Needs Rounds. Subsequently a workshop to codesign UK Needs Rounds will be run. Phase 2 (July 2021) will implement the UK model for a year. Prospective data collection will focus on secondary outcomes regarding hospitalisations, residents' quality of death and care home staff capability of adopting a palliative approach. ETHICS AND DISSEMINATION Frenchay Research Ethics Committee (287447) approved the study. Findings will be disseminated to policy-makers, care home/palliative care practitioners, residents/relatives and academic audiences. An implementation package will be developed for practitioners to provide the tools and resources required to adopt UK Needs Rounds. REGISTRATION DETAILS Registration details: ISRCTN15863801.
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Affiliation(s)
- Aisha Macgregor
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | | | - Brendan McCormack
- Divisions of Nursing, Occupational Therapy & Arts Therapies, Queen Margaret University, Edinburgh, UK
| | - Jo Hockley
- Usher Institute, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Margaret Ogden
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Irene Soulsby
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Maisie McKenzie
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | | | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Liz Forbat
- Faculty of Social Sciences, University of Stirling, Stirling, UK
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27
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Werbrouck A, Schmidt M, Annemans L, Duyck J, Janssens B, Simoens S, Verhaeghe N, Putman K. Oral healthcare delivery in institutionalised older people: A health-economic evaluation. Gerodontology 2021; 39:107-120. [PMID: 33491785 DOI: 10.1111/ger.12530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/30/2020] [Accepted: 12/15/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This health-economic evaluation aimed to assess the cost-effectiveness of a number of alternatives for preventive and curative oral health care in institutionalised older people in Flanders. METHODS A six-state Markov model was used to compare expected costs and healthy oral years (HOYs) of four alternatives: (1) usual care; (2) on-site preventive care; (3) on-site preventive care + curative care in the community; and (4) on-site preventive care + on-site curative care. A healthcare payer perspective was adopted, and the time horizon was 10 years. Deterministic and probabilistic sensitivity analyses were performed. RESULTS Incremental cost-effectiveness ratios (ICERs) of alternatives 2, 3 and 4 (all compared to alternative 1) were as follows: (2) 7944 €/HOY gained; (3) 1576 €/HOY gained; and (4) 1132 €/HOY gained. Hence, alternatives 2 and 3 were not cost-effective compared to alternative 4. The probability that oral care interventions are more effective and cost-saving than usual care was <3% for all three interventions. CONCLUSIONS For institutionalised older people, on-site solutions for preventive and curative oral health care might be the most cost-effective alternative. It should be kept in mind that on-site solutions require large initial investment and that the advanced age of the population and the high costs of oral health care make it unlikely that these interventions would become cost-saving, even in the long term.
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Affiliation(s)
- Amber Werbrouck
- Department of Public Health and Primary Care, Interuniversity Centre for Health Economics Research (I-CHER), Ghent University, Ghent, Belgium.,Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.,Department of Public Health, Interuniversity Centre for Health Economics Research (I-CHER), Vrije Universiteit Brussel, Brussels, Belgium
| | - Masja Schmidt
- Department of Public Health, Interuniversity Centre for Health Economics Research (I-CHER), Vrije Universiteit Brussel, Brussels, Belgium
| | - Lieven Annemans
- Department of Public Health and Primary Care, Interuniversity Centre for Health Economics Research (I-CHER), Ghent University, Ghent, Belgium.,Department of Public Health, Interuniversity Centre for Health Economics Research (I-CHER), Vrije Universiteit Brussel, Brussels, Belgium
| | - Joke Duyck
- Department of Oral Health Sciences, KU Leuven & University Hospitals Leuven, Leuven, Belgium
| | - Barbara Janssens
- Department of Oral Health Sciences, Special Needs in Oral Health, Gerodontology, Ghent University, Ghent, Belgium
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Nick Verhaeghe
- Department of Public Health and Primary Care, Interuniversity Centre for Health Economics Research (I-CHER), Ghent University, Ghent, Belgium.,HIVA Research Institute for Work and Society, KU Leuven, Leuven, Belgium
| | - Koen Putman
- Department of Public Health, Interuniversity Centre for Health Economics Research (I-CHER), Vrije Universiteit Brussel, Brussels, Belgium
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28
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Kennelly SP, Dyer AH, Noonan C, Martin R, Kennelly SM, Martin A, O’Neill D, Fallon A. Asymptomatic carriage rates and case fatality of SARS-CoV-2 infection in residents and staff in Irish nursing homes. Age Ageing 2021; 50:49-54. [PMID: 32986806 PMCID: PMC7543256 DOI: 10.1093/ageing/afaa220] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Indexed: 11/25/2022] Open
Abstract
Background SARS-CoV-2 has disproportionately affected nursing homes (NH). In Ireland, the first NH case COVID-19 occurred on 16/03/2020. A national point-prevalence testing program of all NH residents and staff took place (18/04/2020–05/05/2020). Aims To examine characteristics of NHs across three Irish Community Health Organisations (CHOs), proportions with COVID-19 outbreaks, staff and resident infection rates symptom-profile, and resident case-fatality. Methods Forty-five NHs surveyed requesting details on occupancy, size, COVID-19 outbreak, outbreak timing, total symptomatic/asymptomatic cases, and outcomes for residents from 29/02/2020–22/05/2020. Results Surveys were returned from 62.2% (28/45) of NHs (2043 residents, 2,303 beds). Three-quarters (21/28) had COVID-19 outbreaks (1741 residents, 1972 beds). Median time from first COVID-19 case in Ireland to first case in these NHs was 27.0 days. Resident incidence was 43.9% (764/1741): 40.8% (710/1741) laboratory-confirmed, with 27.2% (193/710) asymptomatic, and 3.1% (54/1741) clinically-suspected. Resident case-fatality was 27.6% (211/764) for combined laboratory-confirmed/clinically-suspected COVID-19. Similar proportions of residents in NHs with “early-stage” (<28 days) versus “later-stage” outbreaks developed COVID-19. Lower proportions of residents in “early” outbreak NHs had recovered compared to those with “late” outbreaks (37.4% vs 61.7%; χ2 = 56.9, P < 0.001). Of 395 NH staff across twelve sites with confirmed COVID-19, 24.7% (99/398) were asymptomatic. There was a significant correlation between the proportion of staff with symptomatic COVID-19 and resident numbers with confirmed/suspected COVID-19 (Spearman’s rho = 0.81, P < 0.001). Conclusion This study demonstrates the significant impact of COVID-19 on the NH sector. Systematic point-prevalence testing is necessary to reduce risk of transmission from asymptomatic carriers and manage outbreaks in this setting.
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Affiliation(s)
- Sean P Kennelly
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin 24, Ireland
| | - Adam H Dyer
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin 24, Ireland
| | - Claire Noonan
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin 24, Ireland
| | - Ruth Martin
- Department of Medicine for the Elderly, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
| | - Siobhan M Kennelly
- Department of Medicine for the Elderly, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
| | - Alan Martin
- Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin 9, Ireland
| | - Desmond O’Neill
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin 24, Ireland
| | - Aoife Fallon
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin 24, Ireland
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Abstract
BACKGROUND Various factors affect the mortality of older adult residents of long-term care facilities. To provide adequate nursing care for older adults, it is necessary to understand the factors that affect their risk of mortality. PURPOSE This study was designed to (a) evaluate the 24-month survival rate and (b) identify the underlying cause of death in various dimensions, including cognitive, psychological, and physical function; nutritional status; and chronic disease. METHODS A longitudinal study was carried out between 2011 and 2013 at seven long-term care facilities. The participants comprised 276 residents who were all older than 65 years old. Baseline measurements included cognitive function (Mini-Mental State Examination for Dementia Screening), psychological function (Cornell Scale for Depression in Dementia), physical function (Barthel Index), nutritional status (Mini Nutritional Assessment, mid-arm circumference, and calf circumference), and chronic disease status (hypertension, diabetes mellitus, chronic respiratory disease, heart disease, and urinary incontinence). Data analysis included univariate and multivariate logistic regression to identify the main factors affecting mortality. RESULTS In 2011 (baseline), the mean age of the participants was 80.46 years (SD = 7.08) and most were female (73.6%). At the 24-month follow-up, 94 (34.1%) of the participants had died. The major factors affecting mortality were as follows: cognitive dysfunction (OR = 3.12, 95% CI [1.41, 6.90]), mid-arm circumference (< 22.5 cm; OR = 2.32, 95% CI [1.35, 3.96]), and urinary incontinence (OR = 2.04, 95% CI [1.16, 3.61]). CONCLUSIONS According to the findings, special attention is needed at the end of life to improve the quality of life of older adults with cognitive dysfunction, malnutrition (low mid-arm circumference), and urinary incontinence who reside in long-term care facilities.
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30
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Inacio MC, Lang CE, Khadka J, Watt AM, Crotty M, Wesselingh S, Whitehead C. Mortality in the first year of aged care services in Australia. Australas J Ageing 2020; 39:e537-e544. [PMID: 32815606 DOI: 10.1111/ajag.12833] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 06/08/2020] [Accepted: 06/20/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To examine the one-year mortality of Australians entering aged care services compared with the general population. METHODS A population-based analysis evaluating one-year mortality among people who received first ever aged care services in 2013 compared with the general population was conducted. RESULTS In 2013, 3.3 million Australians were ≥ 65 years and 34 919 (1%) entered permanent residential care, 23 288 (0.7%) respite care, 20 265 (0.6%) commenced home care packages, and 15 387 (0.5%) transition care. Individuals receiving aged care services had higher mortality than the general population, with those entering permanent residential care (age and sex direct standardised mortality rate ratio = 10.1, 95% CI: 9.8-10.5) having the greatest difference, followed by people accessing respite (7.2, 95% CI: 6.9-7.6), transition (4.6, 95% CI: 4.4-4.9) and home care (4.1, 95% CI: 3.9-4.4). Significant variation by sex and age was observed. CONCLUSION Our study has identified significant variations in mortality rates that highlight which cohorts entering aged care are the most vulnerable.
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Affiliation(s)
- Maria C Inacio
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia.,University of South Australia, Adelaide, South Australia, Australia
| | - Catherine E Lang
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Jyoti Khadka
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia.,School of Business/Commerce, University of South Australia, Adelaide, South Australia, Australia
| | - Amber M Watt
- Research and Evaluation, ECH Inc., Parkside, South Australia, Australia
| | - Maria Crotty
- Rehabilitation Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Steve Wesselingh
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Craig Whitehead
- Rehabilitation, Aged and Palliative Care, Southern Adelaide Local Health Network, Flinders University, Adelaide, South Australia, Australia
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31
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Forbat L, Liu WM, Koerner J, Lam L, Samara J, Chapman M, Johnston N. Reducing time in acute hospitals: A stepped-wedge randomised control trial of a specialist palliative care intervention in residential care homes. Palliat Med 2020; 34:571-579. [PMID: 31894731 DOI: 10.1177/0269216319891077] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Care home residents are frequently transferred to hospital, rather than provided with appropriate and timely specialist care in the care home. AIM To determine whether a model of care providing specialist palliative care in care homes, called Specialist Palliative Care Needs Rounds, could reduce length of stay in hospital. DESIGN Stepped-wedge randomised control trial. The primary outcome was length of stay in acute care (over 24-h duration), with secondary outcomes being the number and cost of hospitalisations. Care homes were randomly assigned to cross over from control to intervention using a random number generator; masking was not possible due to the nature of the intervention. Analyses were by intention to treat. The trial was registered with ANZCTR: ACTRN12617000080325. Data were collected between 1 February 2017 and 30 June 2018. SETTING/PARTICIPANTS 1700 residents in 12 Australian care homes for older people. RESULTS Specialist Palliative Care Needs Rounds led to reduced length of stay in hospital (unadjusted difference: 0.5 days; adjusted difference: 0.22 days with 95% confidence interval: -0.44, -0.01 and p = 0.038). The intervention also provided a clinically significant reduction in the number of hospitalisations by 23%, from 5.6 to 4.3 per facility-month. A conservative estimate of annual net cost-saving from reduced admissions was A$1,759,011 (US$1.3 m; UK£0.98 m). CONCLUSION The model of care significantly reduces hospitalisations through provision of outreach by specialist palliative care clinicians. The data offer substantial evidence for Specialist Palliative Care Needs Rounds to reduce hospitalisations in older people approaching end of life, living in care homes.
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Affiliation(s)
- Liz Forbat
- Faculty of Social Sciences, University of Stirling, Stirling, UK.,Australian Catholic University, Canberra, ACT, Australia
| | - Wai-Man Liu
- Australian National University, Canberra, ACT, Australia
| | - Jane Koerner
- Australian Catholic University, Canberra, ACT, Australia
| | - Lawrence Lam
- University of Technology Sydney, Ultimo, NSW, Australia
| | | | - Michael Chapman
- Australian National University, Canberra, ACT, Australia.,ACT Health, Canberra Hospital, Canberra, ACT, Australia
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32
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Collingridge Moore D, Payne S, Keegan T, Van den Block L, Deliens L, Gambassi G, Heikkila R, Kijowska V, Pasman HR, Pivodic L, Froggatt K. Length of stay in long-term care facilities: a comparison of residents in six European countries. Results of the PACE cross-sectional study. BMJ Open 2020; 10:e033881. [PMID: 32152166 PMCID: PMC7064078 DOI: 10.1136/bmjopen-2019-033881] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES This paper aims to investigate resident, facility and country characteristics associated with length of stay in long-term care facilities (LTCFs) across six European countries. SETTING Data from a cross-sectional study of deceased residents, conducted in LTCFs in Belgium, England, Finland, Italy, the Netherlands and Poland. PARTICIPANTS All residents aged 65 years and older at admission who died in a 3-month period residing in a proportional random sample of LTCFs were included. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was length of stay in days, calculated from date of admission and date of death. Resident, facility and country characteristics were included in a proportional hazards model. RESULTS The proportion of deaths within 1 year of admission was 42% (range 32%-63%). Older age at admission (HR 1.04, 95% CI 1.03 to 1.06), being married/in a civil partnership at time of death (HR 1.47, 95% CI 1.13 to 1.89), having cancer at time of death (HR 1.60, 95% CI 1.22 to 2.10) and admission from a hospital (HR 1.84, 95% CI 1.43 to 2.37) or another LTCF (HR 1.81, 95% CI 1.37 to 2.40) were associated with shorter lengths of stay across all countries. Being female (HR 0.72, 95% CI 0.57 to 0.90) was associated with longer lengths of stay. CONCLUSIONS Length of stay varied significantly between countries. Factors prior to LTCF admission, in particular the availability of resources that allow an older adult to remain living in the community, appear to influence length of stay. Further research is needed to explore the availability of long-term care in the community prior to admission and its influence on the trajectories of LTCF residents in Europe.
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Affiliation(s)
- Danni Collingridge Moore
- International Observatory on End of Life Care, Lancaster University Faculty of Health and Medicine, Lancaster, Lancashire, UK
| | - Sheila Payne
- International Observatory on End of Life Care, Lancaster University Faculty of Health and Medicine, Lancaster, Lancashire, UK
| | - Thomas Keegan
- International Observatory on End of Life Care, Lancaster University Faculty of Health and Medicine, Lancaster, Lancashire, UK
| | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
| | | | - Rauha Heikkila
- Ageing, Disability and Functioning Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Viola Kijowska
- Unit for Research on Aging Society, Department of Sociology, Chair of Epidemiology and Preventive Medicine, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - H Roeline Pasman
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Expertise center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Lara Pivodic
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
| | - Katherine Froggatt
- International Observatory on End of Life Care, Lancaster University Faculty of Health and Medicine, Lancaster, Lancashire, UK
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Franklin M, Hunter RM. A modelling-based economic evaluation of primary-care-based fall-risk screening followed by fall-prevention intervention: a cohort-based Markov model stratified by older age groups. Age Ageing 2019; 49:57-66. [PMID: 31711110 PMCID: PMC6939287 DOI: 10.1093/ageing/afz125] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Indexed: 12/25/2022] Open
Abstract
Background fall-risk assessment with fall-prevention intervention referral for at-risk groups to avoid falls could be cost-effective from a care-payer perspective. Aims to model the cost-effectiveness of a fall-risk assessment (QTUG compared to TUG) with referral to one of four fall-prevention interventions (Otago, FaME, Tai Chi, home safety assessment and modification) compared to no care pathway, when the decision to screen is based on older age in a primary care setting for community-dwelling people. Methods a cohort-based, decision analytic Markov model was stratified by five age groupings (65–70, 70–75, 65–89, 70–89 and 75–89) to estimate cost per quality-adjusted life years (QALYs). Costs included fall-risk assessment, fall-prevention intervention and downstream resource use (e.g. inpatient and care home admission). Uncertainty was explored using univariate, bivariate and probabilistic sensitivity analyses. Results screening with QTUG dominates (>QALYs; <costs) screening with TUG irrespective of subsequent fall-prevention intervention. The QTUG-based care pathways relative to no care pathway have a high probability of cost-effectiveness in those aged 75–89 (>85%), relative to those aged 70–74 (~10 < 30%) or 65–69 (<10%). In the older age group, only a 10% referral uptake is required for the QTUG with FaME or Otago modelled care pathways to remain cost-effective. Conclusion the highest probability of cost-effectiveness observed was a care pathway incorporating QTUG with FaME in those aged 75–89. Although the model does not fully represent current NICE Falls guidance, decision makers should still give careful consideration to implementing the aforementioned care pathway due to the modelled high probability of cost-effectiveness.
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Affiliation(s)
- Matthew Franklin
- Health Economics and Decision Science (HEDS), ScHARR, University of Sheffield, West Court, 1 Mappin Street, S1 4DT Sheffield, UK
| | - Rachael Maree Hunter
- Research Department of Primary Care and Population Health, Royal Free Medical School, University College London, Royal Free Campus, Rowland Hill Street, NW3 2PF, London, UK
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Gustafson R, Gustafson P, Daly P. Reconciling randomized trial evidence on proximal versus distal outcomes, with application to trials of influenza vaccination for healthcare workers. Stat Med 2019; 38:4323-4333. [PMID: 31317576 DOI: 10.1002/sim.8299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/30/2019] [Accepted: 06/03/2019] [Indexed: 11/09/2022]
Abstract
When synthesizing the body of evidence concerning a clinical intervention, impacts on both proximal and distal outcome variables may be relevant. Assessments will be more defensible if results concerning a proximal outcome align with those concerning a corresponding distal outcome. We present a method to assess the coherence of empirical clinical trial results with biologic and mathematical first principles in situations where the intervention can only plausibly impact the distal outcome indirectly via the proximal outcome. The method comprises a probabilistic sensitivity analysis, where plausible ranges for key parameters are specified, resulting in a constellation of plausible pairs of estimated intervention effects, for the proximal and distal outcomes, respectively. Both outcome misclassification and sampling variability are reflected in the method. We apply our methodology in the context of cluster randomized trials to evaluate the impacts of vaccinating healthcare workers on the health of elderly patients, where the proximal outcome is suspected influenza and the distal outcome is death. However, there is scope to apply the method for other interventions in other disease areas.
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Affiliation(s)
- Reka Gustafson
- Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Paul Gustafson
- Department of Statistics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Patricia Daly
- Vancouver Coastal Health, Vancouver, British Columbia, Canada
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Romano-Lieber NS, Corona LP, Marques LFG, Secoli SR. Survival of the elderly and exposition to polypharmacy in the city of São Paulo, Brazil: SABE Study. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2019; 21Suppl 02:e180006. [PMID: 30726351 DOI: 10.1590/1980-549720180006.supl.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 10/15/2014] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION The use of polypharmacy may be due to the concomitant presence of chronic conditions, medical care by several doctors simultaneously and self-medication. Combined with the vulnerability of the elderly to the effects of drugs due to pharmacokinetic and pharmacodynamic changes, polypharmacy makes this population more susceptible to adverse outcomes. In Brazil, studies show that polypharmacy is a common problem among elderly people. However, few information is available on the association between polypharmacy and mortality. OBJECTIVE It was assessed the survival of the elderly from São Paulo city exposed to the use of polypharmacy (five or more medications). METHODS That was a population-based cohort, the Health, Well-Being and Aging Study (SABE Study), conducted from 2006 to 2010. The sample was composed of 1,258 individuals aged 60 years or more. The Kaplan-Meier method and Cox proportional risks model were used to examine the association between polypharmacy and mortality. RESULTS The probability of survival after five years of the users of polypharmacy at baseline was 77.2%, while among the non-users was 85.5%. Polypharmacy remained as a risk factor for death even after adjustment in other conditions associated with mortality, such as age, gender, income, chronic diseases and hospitalization. CONCLUSION The results point polypharmacy as an indicator of mortality in elderly people. The use of multiple medications by the elderly should be carefully assessed to avoid or minimize the damage to this population.
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Affiliation(s)
- Nicolina Silvana Romano-Lieber
- Departamento de Prática de Saúde Pública, Faculdade de Saúde Pública, Universidade de São Paulo - São Paulo (SP), Brasil
| | - Ligiana Pires Corona
- Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo - São Paulo (SP), Brasil
| | - Liete Fatima Gouveia Marques
- Departamento de Prática de Saúde Pública, Faculdade de Saúde Pública, Universidade de São Paulo - São Paulo (SP), Brasil
| | - Silvia Regina Secoli
- Departamento de Enfermagem Médico-Cirúrgica, Escola de Enfermagem, Universidade de São Paulo - São Paulo (SP), Brasil
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Singh I, Edwards C, Duric D, Rasuly A, Musa SO, Anwar A. Dementia in an Acute Hospital Setting: Health Service Research to Profile Patient Characteristics and Predictors of Adverse Clinical Outcomes. Geriatrics (Basel) 2019; 4:geriatrics4010007. [PMID: 31023975 PMCID: PMC6473705 DOI: 10.3390/geriatrics4010007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 12/27/2018] [Accepted: 12/28/2018] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Patients with dementia often have other associated medical co-morbidities resulting in adverse outcomes. The National Audit of Dementia (NAD) in the UK showed a wide variation in the quality and clinical care for acute dementia patients. This study aims to record the clinical profile and benchmark clinical outcomes of acute dementia patients admitted within Aneurin Bevan University Health Board, Wales (UK). METHODS This was a retrospective observational study based on analysis of the existing data for all acute dementia patients. Ethical approval was not required for this service evaluation. RESULTS In 2016, a total of 1770 dementia patients had 2474 acute admissions. We studied 1167 acute admissions (953 dementia patients) from 1st January 2016⁻30th June 2016. The mean age was 84.5 ± 7.8 years (females = 63.5%). Mean Charlson comorbidity index and the number of drugs were 6.0 ± 1.5 and 5.1 ± 2.1. 15.4% (147/953) patients were on antipsychotics. Overall mean hospital stay was 19.4 ± 27.2 days. 30-days readmission rate was 17.2% (138/800) with a mean hospital stay of 14.6 ± 17.9 days. 3.4% (32/953) patients were excluded due to a coding error. 70.3% (n = 670/953) were previously living in their own homes and only 26.3% (n = 251/953) were admitted from care homes. 59.5% patients (n = 399/670) were discharged back to their homes and 21.6% (145/670) were discharged to a new care home, which represents an approximately 1.68 times higher rate of new care home occupancy than the patients being originally admitted from a care home. Overall inpatient was 16.0% (153/953). 30-days and one-year mortality were 22.3% (213/953) and 49.2% (469/953) respectively. The observed mortality rates between patients admitted from home or from a care home were highly significant for one-year mortality (p < 0.001). The inpatient falls rate was significantly higher (1.8 times) as compared to overall general medical inpatient falls rate. CONCLUSION Acute patients with dementia have a higher risk of adverse outcomes and the impact of hospitalisation. Prompt comprehensive geriatric assessment and quality improvement initiatives are needed to improve clinical outcomes and to enhance the quality of care.
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Affiliation(s)
- Inderpal Singh
- Consultant Geriatrician, Department of Geriatric Medicine, Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board, Wales CF82 7EP, UK.
| | - Chris Edwards
- Department of Dermatology, St Wollas Hospital, Aneurin Bevan University Health Board, Newport NP20 4SZ, UK.
| | - Daniel Duric
- Speciality Doctor, Department of Geriatric Medicine, Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board, Wales CF82 7EP, UK.
| | - Aman Rasuly
- Speciality Doctor, Department of Geriatric Medicine, Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board, Wales CF82 7EP, UK.
| | - Sabdat Oziohu Musa
- Speciality Doctor, Department of Geriatric Medicine, Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board, Wales CF82 7EP, UK.
| | - Anser Anwar
- Speciality Doctor, Department of Geriatric Medicine, Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board, Wales CF82 7EP, UK.
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Sheikh Rezaei S, Weisshaar S, Litschauer B, Gouya G, Ohrenberger G, Wolzt M. ADMA and NT pro-BNP are associated with overall mortality in elderly. Eur J Clin Invest 2019; 49:e13041. [PMID: 30365159 PMCID: PMC6587535 DOI: 10.1111/eci.13041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 08/20/2018] [Accepted: 10/22/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Increased asymmetrical dimethylarginine (ADMA) and NT pro-BNP concentrations have been associated with mortality in patients with cardiovascular (CV) disease and the general population. The use of these prognostic markers in an older population is not established yet. The aim of the present study was to investigate the prognostic value of age, sex, BMI, co-medication and CV laboratory risk markers in geriatric care patients. MATERIALS AND METHODS In this prospective observational single-centre cohort study data of long-term geriatric care patients were collected. Blood samples were collected between 14.09.2009 and 16.12.2009, and mortality was recorded up to 90 months. ADMA, its symmetric isomer SDMA, L-arginine, NT pro-BNP and CRP were determined at study entry. Simple associations of risk factors for survival period were explored by Spearman correlation coefficient. Significant univariate predictors for survival period were used in the Cox proportional hazard model. RESULTS A total of 481 patients were screened, and data from 449 patients were analysed. A total of 381 patients died during the observation period. Full data sets from 344 patients were used for Cox regression analysis. Male sex, older age, lower BMI, use of neuroleptic medicine, peripheral artery disease, and elevated plasma concentrations of ADMA, NT pro-BNP, and CRP were significant predictors of mortality. CONCLUSION The concentration of ADMA and NT pro-BNP may be used as an early risk marker for overall mortality in geriatric care. Neuroleptic medicine is associated with increased mortality in this population.
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Affiliation(s)
| | - Stefan Weisshaar
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Brigitte Litschauer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Ghazaleh Gouya
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | | | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
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Lopes H, Mateus C, Rosati N. Impact of long term care and mortality risk in community care and nursing homes populations. Arch Gerontol Geriatr 2018. [PMID: 29524916 DOI: 10.1016/j.archger.2018.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To identify the survival time, the mortality risk factors and the individuals' characteristics associated with cognitive and physical status at discharge, among the Portuguese long-term care (LTC) populations. SETTINGS Home-and-Community-Based Services (HCBS) and three types of Nursing Homes (NH). PARTICIPANTS 20,984 individuals admitted and discharged in 2015. MEASUREMENTS The Kaplan-Meier survival analysis and the Cox Proportional Hazards Models were used to study the mortality risk; the Wilcoxon signed-rank test to identify the number of individuals with cognitive and physical changes between admission and discharge; two cumulative odds ordinal logistic regressions to predict the cognitive and physical dependence levels at discharge RESULTS: The mortality rate at HCBS was 30%, and 17% at the NH, with a median survival time of 173 and 200 days, respectively. The main factors associated with higher mortality were older age, male gender, family/neighbour support, neoplasms and cognitive/physical dependence at admission. In NH/HCBS, 26%/18% of individuals improve their cognitive status, while in physical status the proportion was 38%/27%, respectively. Finally, older age, being illiterate and being classified at the lowest cognitive and physical status at admission decrease the likelihood of achieving a higher level of cognitive and physical independence at discharge. CONCLUSIONS The adoption of a robust and complete assessment tool, the definition of guidelines to enable a periodical assessment of individuals' autonomy and the adoption of benchmark metrics allowing the comparison of results between similar units are some of the main goals to be taken into account for future developments of this care in Portugal.
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Affiliation(s)
- Hugo Lopes
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal.
| | - Céu Mateus
- Health Economics Group, Division of Health Research, Lancaster University, Furness College, LA1 4YG, UK
| | - Nicoletta Rosati
- Instituto Superior de Economia e Gestão, Universidade de Lisboa, and CEMAPRE, Lisbon, Portugal
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Maheswaran R, Strong M, Clifford P, Brewins L. Socioeconomic deprivation, mortality and health of within-city migrants: a population cohort study. J Epidemiol Community Health 2018; 72:519-525. [PMID: 29434024 DOI: 10.1136/jech-2017-210166] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/19/2018] [Accepted: 01/21/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND Evidence linking selective migration (the situation where people in good health move from deprived to affluent areas, whilst people in poor health move in the opposite direction) within local areas to mortality is inconclusive. METHODS Mortality in within-city migrants was examined using a Sheffield population cohort, adjusted for moves to care homes. The cohort comprised 310 894 people aged 25+ years in 2001 followed up for 9.18 years, with 42 252 (13.6%) deaths. Information on pre-existing medical conditions, socioeconomic indicators and smoking was available from a sample survey. RESULTS Relative risks (95% CI) of mortality in migrants from deprived to affluent areas were lower compared with people remaining in deprived areas; 0.53 (0.42 to 0.65), 0.70 (0.61 to 0.80), 0.76 (0.68 to 0.86), 0.93 (0.88 to 1.00) and 0.98 (0.93 to 1.03) in the 25-44, 45-64, 65-74, 75-84 and 85+ year age bands, respectively. They also had lower prevalence ORs (95% CI) for bronchitis (0.59 (0.39 to 0.89)), asthma (0.70 (0.53 to 0.93)), depression (0.59 (0.38 to 0.94)), and were less likely to receive benefits (0.60 (0.47 to 0.76)) and less likely to smoke (0.66 (0.51 to 0.85)).Conversely, mortality relative risks in migrants from affluent to deprived areas were higher compared with people remaining in affluent areas; 1.71 (1.37 to 2.12), 1.59 (1.40 to 1.82), 1.44 (1.26 to 1.63), 1.18 (1.10 to 1.27) and 1.04 (1.00 to 1.09) in the corresponding age groups. They also had higher prevalence odds ratios for long-term illness (2.37 (1.71 to 3.29)), asthma (1.71 (1.25 to 2.35)), diabetes (3.03 (1.70 to 5.41)), depression (2.71 (1.74 to 4.21)), were more likely to receive benefits (2.25 (1.65 to 3.07)) and more likely to smoke (1.51 (1.12 to 2.05)). CONCLUSIONS People moving from deprived to affluent areas had lower mortality and better health, and vice versa, especially in the younger age groups. This study provides strong evidence linking selective migration within local areas to mortality.
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Affiliation(s)
- Ravi Maheswaran
- Public Health GIS Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Mark Strong
- Public Health GIS Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Phil Clifford
- North of England Commissioning Support, Sheffield, UK
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Bone AE, Gomes B, Etkind SN, Verne J, Murtagh FEM, Evans CJ, Higginson IJ. What is the impact of population ageing on the future provision of end-of-life care? Population-based projections of place of death. Palliat Med 2018; 32:329-336. [PMID: 29017018 PMCID: PMC5788077 DOI: 10.1177/0269216317734435] [Citation(s) in RCA: 168] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND Population ageing represents a global challenge for future end-of-life care. Given new trends in place of death, it is vital to examine where the rising number of deaths will occur in future years and implications for health and social care. AIM To project where people will die from 2015 to 2040 across all care settings in England and Wales. DESIGN Population-based trend analysis and projections using simple linear modelling. Age- and gender-specific proportions of deaths in hospital, care home, home, hospice and 'other' were applied to numbers of expected future deaths. Setting/population: All deaths (2004-2014) from death registration data and predicted deaths (2015-2040) from official population forecasts in England and Wales. RESULTS Annual deaths are projected to increase from 501,424 in 2014 (38.8% aged 85 years and over) to 635,814 in 2040 (53.6% aged 85 years and over). Between 2004 and 2014, proportions of home and care home deaths increased (18.3%-22.9% and 16.7%- 21.2%) while hospital deaths declined (57.9%-48.1%). If current trends continue, numbers of deaths in care homes and homes will increase by 108.1% and 88.6%, with care home the most common place of death by 2040. If care home capacity does not expand and additional deaths occur in hospital, hospital deaths will start rising by 2023. CONCLUSION To sustain current trends, end-of-life care provision in care homes and the community needs to double by 2040. An infrastructure across care settings that supports rising annual deaths is urgently needed; otherwise, hospital deaths will increase.
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Affiliation(s)
- Anna E Bone
- 1 Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Barbara Gomes
- 1 Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.,2 Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Simon N Etkind
- 1 Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | | | - Fliss E M Murtagh
- 1 Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.,4 Wolfson Palliative Care Research Centre, Hull York Medical School, Hull, UK
| | - Catherine J Evans
- 1 Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.,5 Brighton General Hospital, Sussex Community NHS Foundation Trust, Brighton, UK
| | - Irene J Higginson
- 1 Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
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Sultana J, Fontana A, Giorgianni F, Basile G, Patorno E, Pilotto A, Molokhia M, Stewart R, Sturkenboom M, Trifirò G. Can information on functional and cognitive status improve short-term mortality risk prediction among community-dwelling older people? A cohort study using a UK primary care database. Clin Epidemiol 2017; 10:31-39. [PMID: 29296099 PMCID: PMC5741068 DOI: 10.2147/clep.s145530] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Functional and cognitive domains have rarely been evaluated for their prognostic value in general practice databases. The aim of this study was to identify functional and cognitive domains in The Health Improvement Network (THIN) and to evaluate their additional value for the prediction of 1-month and 1-year mortality in elderly people. Materials and methods A cohort study was conducted using a UK nationwide general practitioner database. A total of 1,193,268 patients aged 65 years or older, of whom 15,300 had dementia, were identified from 2000 to 2012. Information on mobility, dressing and accommodation was recorded frequently enough to be analyzed further in THIN. Cognition data could not be used due to very poor recording of data in THIN. One-year and 1-month mortality was predicted using logistic models containing variables such as age, sex, disease score and functionality status. Results A significant but moderate improvement in 1-year and 1-month mortality prediction in elderly people was observed by adding accommodation to the variables age, sex and disease score, as the c-statistic (95% confidence interval [CI]) increased from 0.71 (0.70–0.72) to 0.76 (0.75–0.77) and 0.73 (0.71–0.75) to 0.79 (0.77–0.80), respectively. A less notable improvement in the prediction of 1-year and 1-month mortality was observed in people with dementia. Conclusion Functional domains moderately improved the accuracy of a model including age, sex and comorbidities in predicting 1-year and 1-month mortality risk among community-dwelling older people, but they were much less able to predict mortality in people with dementia. Cognition could not be explored as a predictor of mortality due to insufficient data being recorded.
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Affiliation(s)
- Janet Sultana
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.,Department of Medical Informatics, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Andrea Fontana
- Unit of Biostatistics, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Francesco Giorgianni
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Giorgio Basile
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Elisabetta Patorno
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - Alberto Pilotto
- Geriatrics Unit, Department of Geriatric Care, Ortho Geriatrics and Rehabilitation, Frailty Area, E.O. Galliera Hospital, Genova, Italy
| | - Mariam Molokhia
- Department of Primary Care and Public Health Sciences, King's College, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience King's College London, UK
| | - Miriam Sturkenboom
- Department of Medical Informatics, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Gianluca Trifirò
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.,Department of Medical Informatics, Erasmus University Medical Centre, Rotterdam, the Netherlands
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Lai CKY, Ho LYW, Chin KCW, Kwong EWY. Survival prediction among nursing home residents: A longitudinal study. Geriatr Gerontol Int 2017; 18:428-433. [PMID: 29139197 DOI: 10.1111/ggi.13197] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/11/2017] [Accepted: 09/12/2017] [Indexed: 11/29/2022]
Abstract
AIM To determine the survival time and predictors of survival of residents in a nursing home. METHODS Nursing home residents admitted from June 2008 (when the nursing home started operating) to December 2012 (n = 230) to a new nursing home in Hong Kong were prospectively followed. The predictors of survival in the residents were assessed annually, with the exception of those who did not want to continue with the study, or were hospitalized, discharged from the nursing home or died, to compare changes occurring from 2008 to 2012. Cox's regression analysis was used to examine the predictors of survival. RESULTS A total of 66 of the nursing home residents (28.7%) died during the study period. The median length of survival was 20.46 months. Sex, the number of diseases, depressive symptoms, cognitive status and nutritional status were found to be significant predictors of survival. CONCLUSIONS It is crucial for healthcare providers to offer quality care to residents in long-term care to enhance their well-being in the final sojourn of their lives. Although there are no consistent reports of predictors in the international literature, it is important to address the modifiable predictors, as this might lead to improvements in the quality of life of the residents. Geriatr Gerontol Int 2018; 18: 428-433.
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Affiliation(s)
- Claudia Kam Yuk Lai
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR
| | - Lily Yuen Wah Ho
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR
| | - Kenny Chi Wing Chin
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR
| | - Enid Wai Yung Kwong
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR
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Leelakanok N, Holcombe AL, Lund BC, Gu X, Schweizer ML. Association between polypharmacy and death: A systematic review and meta-analysis. J Am Pharm Assoc (2003) 2017; 57:729-738.e10. [DOI: 10.1016/j.japh.2017.06.002] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/27/2017] [Accepted: 06/01/2017] [Indexed: 12/30/2022]
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Todoroki K, Ikeya Y, Fukui S, Tanaka C, Sekine K, Imazeki R, Shizuma T, Fukuyama N, Mori H. The vital prognosis of elderly adults living in a group home in their mid-eighties. J Physiol Sci 2017; 67:561-568. [PMID: 27655021 PMCID: PMC10717574 DOI: 10.1007/s12576-016-0485-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 09/03/2016] [Indexed: 10/21/2022]
Abstract
The purpose of the present study is to evaluate the vital prognoses of elderly people in their mid-eighties living in a group home (GH) compared to age- and sex-matched outpatient clinic (OPC) in an observational study conducted over 6 years. We investigated the association between mortality and general, cardiac, and nutritional parameters, including eicosapentaenoic acid (EPA) in 54 GH residents (83 ± 8 years old) and 57 OPC attendees (83 ± 5 years old). Kaplan-Meier curves and Cox proportional hazard ratio analyses were used to assess the association between EPA drug administration and mortality in the GH residents and OPC attendees, respectively. The 54 GH residents had higher mortality and poorer nutritional states, as indicated by lower EPA/arachidonic acid values (median 0.20 vs 0.55, p < 0.001), and BMI under the condition without EPA drug administration (1800 mg daily) than did the OPC group. The significant factors that differed between survivors and deceased in the GH residents and OPC attendees were nutritional and cardiac factors. Cox proportional hazard ratio analysis confirmed that a possible determinant of the prognosis was a lower incidence of EPA drug administration and lower hemoglobin in GH. Kaplan-Meier curves and Cox proportional hazard ratio analyses revealed that EPA drug administration significantly reduced the relative mortality by 82 % in the GH residents (p < 0.001) but not in the OPC attendees. The vital prognosis in individuals from GHs was potentially improved by EPA drug administration, which was not the case in the OPC group; however, further prospective studies are needed.
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Affiliation(s)
- Kikue Todoroki
- Department of Physiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Yoshimori Ikeya
- Department of Physiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Sayato Fukui
- Department of Physiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Chiharu Tanaka
- Department of Physiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Kaori Sekine
- Department of Physiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Ryoko Imazeki
- Department of Physiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Toru Shizuma
- Department of Physiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Naoto Fukuyama
- Department of Physiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Hidezo Mori
- Department of Physiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
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Abstract
The health care system introduced a reimbursement system based on the existing care when the prevalence rate of acute diseases was still. However, the types of diseases in developed countries are mostly noncommunicable diseases such as cancer or vascular disease, and thus, it impossible to fully recover from these chronic diseases. The increase in noncommunicable diseases is related to unhealthy lifestyle habits such as smoking, heavy drinking, and lack of exercise. Thus, the health care system is changing by improving the prevention of diseases and promoting healthy lifestyles. However, multimorbidities have emerged as an important concept in this process. In countries where the population is rapidly aging, those who have multimorbidities have become a burden to the health care system's revenue, manpower, and service quality. Therefore, health care reform to cope with those who are aging and have multimorbidities is necessary to establish. Reform measures can consist of the following suggestions. First, proper medical guidelines for multiple diseases need to be developed. Second, professional manpower should be trained. Third, the reimbursement system should be improved to relieve those with multimorbidities. Fourth, disease prevention services should be improved. Finally, instruments to measure health care service quality for chronic disease need to be developed.
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Kinley J, Stone L, Butt A, Kenyon B, Lopes NS. Developing, implementing and sustaining an end-of-life care programme in residential care homes. Int J Palliat Nurs 2017; 23:186-193. [DOI: 10.12968/ijpn.2017.23.4.186] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Julie Kinley
- Nurse Consultant for Care Homes; All part of the Care Home Project Team at St Christopher's Hospice, Sydenham, London UK
| | - Louisa Stone
- Practice Development Clinical Nurse Specialist; All part of the Care Home Project Team at St Christopher's Hospice, Sydenham, London UK
| | - Anna Butt
- Practice Development Clinical Nurse Specialist; All part of the Care Home Project Team at St Christopher's Hospice, Sydenham, London UK
| | - Barbara Kenyon
- Practice Development Clinical Nurse Specialist; All part of the Care Home Project Team at St Christopher's Hospice, Sydenham, London UK
| | - Nuno Santos Lopes
- Practice Development Clinical Nurse Specialist; All part of the Care Home Project Team at St Christopher's Hospice, Sydenham, London UK
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48
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Kong ST, Fang CMS, Lou VW. Organizational capacities for ‘residential care homes for the elderly’ to provide culturally appropriate end-of-life care for Chinese elders and their families. J Aging Stud 2017; 40:1-7. [DOI: 10.1016/j.jaging.2016.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 10/12/2016] [Accepted: 12/05/2016] [Indexed: 11/26/2022]
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Ribeiro AI, Krainski ET, Autran R, Teixeira H, Carvalho MS, de Pina MDF. The influence of socioeconomic, biogeophysical and built environment on old-age survival in a Southern European city. Health Place 2016; 41:100-109. [PMID: 27583526 DOI: 10.1016/j.healthplace.2016.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 07/15/2016] [Accepted: 08/09/2016] [Indexed: 10/21/2022]
Abstract
Old-age survival is a good indicator of population health and regional development. We evaluated the spatial distribution of old-age survival across Porto neighbourhoods and its relation with physical (biogeophysical and built) and socioeconomic factors (deprivation). Smoothed survival rates and odds ratio (OR) were estimated using Bayesian spatial models. There were important geographical differentials in the chances of survival after 75 years of age. Socioeconomic deprivation strongly impacted old-age survival (Men: least deprived areas OR=1.31(1.05-1.63); Women OR=1.53(1.24-1.89)), explaining over 40% of the spatial variance. Walkability and biogeophysical environment were unrelated to old-age survival and also unrelated to socioeconomic deprivation, being fairly evenly distributed through the city.
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Affiliation(s)
- Ana Isabel Ribeiro
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Portugal; i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal; INEB-Instituto de Engenharia Biomédica, Universidade do Porto, Portugal; Departamento de Epidemiologia Clínica, Medicina Preditiva e Saúde Pública, Faculdade de Medicina, Universidade do Porto, Portugal.
| | - Elias Teixeira Krainski
- Departamento de Estatística, Universidade Federal do Paraná, Curitiba, Brazil; The Norwegian University for Science and Technology, Trondheim, Norway.
| | - Roseanne Autran
- Centro de Investigação em Atividade Física, Saúde e Lazer-Faculdade de Desporto da Universidade do Porto, Portugal.
| | - Hugo Teixeira
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal; INEB-Instituto de Engenharia Biomédica, Universidade do Porto, Portugal.
| | - Marilia Sá Carvalho
- PROCC-Programa de Computação Científica, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
| | - Maria de Fátima de Pina
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal; ICICT/FIOCRUZ-Instituto de Comunicação e Informação Científica e Tecnológica em Saúde/Fundação Oswaldo Cruz, Rio de Janeiro, Brazil; CARTO-FEN/UERJ-Departamento de Engenharia Cartográfica, Faculdade de Engenharia da Universidade do Estado do Rio de Janeiro, Brazil.
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50
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Gott M, Moeke-Maxwell T, Morgan T, Black S, Williams L, Boyd M, Frey R, Robinson J, Slark J, Trussardi G, Waterworth S, Wharemate R, Hansen W, Smith E, Kaka K, Henare K, Henare E, Poto M, Tipene-Carter E, Hall DA. Working bi-culturally within a palliative care research context: the development of the Te Ārai Palliative Care and End of Life Research Group. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/13576275.2016.1216955] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Merryn Gott
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Tess Moeke-Maxwell
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Tessa Morgan
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Stella Black
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Lisa Williams
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Michal Boyd
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Rosemary Frey
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Jackie Robinson
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Julia Slark
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Gabriella Trussardi
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Susan Waterworth
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Rawiri Wharemate
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Whio Hansen
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Eliza Smith
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Kiripai Kaka
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Kohi Henare
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Eileen Henare
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Manaaki Poto
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Eliza Tipene-Carter
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Devi-ann Hall
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
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