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Do care homes increase risk of dehydration?
- Author:
- DIX Ann
- Journal article citation:
- Nursing Times, 111(34/35), 2015, p.15.
- Publisher:
- Nursing Times
This article summarises key findings from a recent study by A. Wolf published in the Journal of Royal Society of Medicine which compared dehydration levels of older hospital patients arriving from care homes with those living in their own homes. Laboratory data was used to assess whether patients were dehydrated on admission and whether they subsequently died in hospital. The results found that older people living in care home were 10 time more likely to be admitted to hospital with dehydration than patients who lived in their own homes. (Edited publisher abstract)
Informal caregivers and the risk of nursing home admission among individuals enrolled in the program of all-inclusive care for the elderly
- Authors:
- FRIEDMAN Susan M., et al
- Journal article citation:
- Gerontologist, 46(4), August 2006, pp.456-463.
- Publisher:
- Oxford University Press
This American study sought to determine whether participants in the Program of All-Inclusive Care for the Elderly (PACE) with an informal caregiver have a higher or lower risk of nursing home admission than those without caregivers. PACE is a community-based system of preventive, primary, acute and long-term care that care for older adults that qualify for nursing home care. A secondary data analysis was performed of 3,189 participants aged 55 years or older who were enrolled in 11 PACE programs during the period from June 1, 1990 through June 30, 1998. Cox proportional hazard models determined whether having any caregiver, as well as specific caregiver characteristics, such as either living separately from the enrollee, being over the age of 75 years, providing personal care, not reducing or quitting work to provide care, or not being a spouse, predicted time to nursing home admission. Fewer than half of the participants (49.4%) lived with a caregiver, and 12.4% had no caregiver. Individuals who lived with their caregiver were frailer than either those who lived separately or those without a caregiver. The study measured frailty in terms of functional and cognitive status, incontinence, and multiple behavioral disturbances. The presence of a caregiver did not change the risk for institutionalization. None of the caregiver characteristics were associated with a higher risk of nursing home admission. Unlike individuals in the general population, participants in PACE who lack an informal caregiver are not at higher risk of institutionalization. Further research is required to ascertain whether PACE's comprehensive formal services compensate for the lack of informal caregiving in limiting the risk for institutionalization.
Readmissions - an evaluation of reasons for unplanned readmissions of older people: a United Kingdom and international studies literature review
- Author:
- DOBRZANSKA Linda
- Journal article citation:
- Quality in Ageing, 5(4), December 2004, pp.20-28.
- Publisher:
- Pier Professional
- Place of publication:
- Brighton
A literature review study used to research the causes for unplanned readmissions of older patients. The evidence was produced using a wide geographic of sources from electronic databases dated 1990-2003. In total, 92 articles were identified. From these, 83 papers were selected which met the inclusion criteria and corresponded to the aims of the review. The author found that many international studies were inconsistent in their approach to defining terms. Yet despite this, in the United Kingdom researchers generally agreed that the reason for the majority of readmissions was a result of a relapse or complication of an initial illness. Furthermore, Amercian studies reveal that the readmission of older patients is caused by a specific disease and the antecedent care process.
The association of physical illness and self-harm resulting in hospitalisation among older people in a population-based study
- Authors:
- MITCHELL Rebecca, et al
- Journal article citation:
- Aging and Mental Health, 21(3), 2017, pp.279-288.
- Publisher:
- Taylor and Francis
Objectives: This research aims to identify the association of physical illness with hospitalisations following self-harm compared to non-self-harm injury among older people. Method: A population-based cohort study of individuals aged 50+ years admitted to hospital either for a self-harm or a non-self-harm injury using linked hospital admission and mortality records during 2003–2012 in New South Wales, Australia was conducted. Logistic regression and survival plots were used to examine the association of 21 physical illnesses and mortality at 12 months by injury intent, respectively. Age-adjusted health outcomes, including length of stay, readmission and mortality were examined by injury intent. Results: There were 12,111 hospitalisations as a result of self-harm and 474,158 hospitalisations as a result of non-self-harm injury. Self-harm compared to non-self-harm hospitalised injury was associated with higher odds of mental health conditions (i.e. depression, schizophrenia, bipolar and anxiety disorders), neurological disorders (excluding dementia), other disorders of the nervous system, diabetes, chronic lower respiratory disease, liver disease, tinnitus and pain. Tinnitus, pain, malignancies and diabetes all had a higher likelihood of occurrence for self-harm compared to non-self-harm hospitalisations even after adjusting for mental health conditions, number of comorbidities and alcohol and drug dependency. Conclusion: Older people who are experiencing chronic health conditions, particularly tinnitus, malignancies, diabetes and chronic pain may be at risk of self-harm. Targeted screening may assist in identifying older people at risk of self-harm. (Edited publisher abstract)
Use and cost of hospitalization in dementia: longitudinal results from a community-based study
- Authors:
- ZHU Carolyn W., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 30(8), 2015, pp.833-841.
- Publisher:
- Wiley
Objectives: The aim of this study is to examine the relative contribution of functional impairment and cognitive deficits in older people on risk of hospitalisation and costs. Methods: A prospective cohort of Medicare beneficiaries aged 65 and older who participated in the Washington Heights-Inwood Columbia Aging Project (WHICAP) were followed approximately every 18 months for over 10 years (1805 never diagnosed with dementia during study period, 221 diagnosed with dementia at enrollment). Hospitalisation and Medicare expenditures data (1999–2010) were obtained from Medicare claims. Multivariate analyses were conducted to examine (1) risk of all-cause hospitalisations, (2) hospitalizations from ambulatory care sensitive (ACSs) conditions, (3) hospital length of stay, and (4) Medicare expenditures. Propensity score matching methods were used to reduce observed differences between demented and non-demented groups at study enrolment. Analyses took into account repeated observations within each individual. Results: Compared to propensity-matched individuals without dementia, individuals with dementia had significantly higher risk for all-cause hospitalisation, longer hospital length of stay, and higher Medicare expenditures. Functional and cognitive deficits were significantly associated with higher risks for hospitalisations, hospital length of stay, and Medicare expenditures. Functional and cognitive deficits were associated with higher risks of for some ACS but not all admissions. Conclusions: These results allow us to differentiate the impact of functional and cognitive deficits on hospitalisations. To develop strategies to reduce hospitalisations and expenditures, better understanding of which types of hospitalisations and which disease characteristics impact these outcomes will be critical (Edited publisher abstract)
Homing in on improved care in the community
- Author:
- IMISON Candace
- Journal article citation:
- Health Service Journal, 20.9.12, 2012, pp.28-29.
- Publisher:
- Emap Healthcare
People over the age of 65 continue to experience high rates of emergency bed admissions. Often the admission is avoidable or the length of stay in hospital longer than necessary. Recent research from the King's Fund found a fourfold variation in emergency bed use by people over the age of 65. The article reports on the reasons for this variation and the lessons that can be learnt from Torbay, who now uses less emergency beds per head of the population (for people over 65) than anywhere else in England.
Dementia in the acute hospital: prospective cohort study of prevalence and mortality
- Authors:
- SAMPSON Elizabeth L., et al
- Journal article citation:
- British Journal of Psychiatry, 195(1), July 2009, pp.61-66.
- Publisher:
- Cambridge University Press
Increasing numbers of people will die with dementia, many in the acute hospital. It is often not perceived to be a life-limiting illness. This study set out to investigate the prevalence of dementia in older people undergoing emergency medical admission and its effect on outcomes. A longitudinal cohort study of 617 people (aged over 70) was carried out. The main outcome was mortality risk during admission. Of the cohort, 42.4% had dementia (only half diagnosed prior to admission). In men aged 70–79, dementia prevalence was 16.4%, rising to 48.8% of those over 90. In women, 29.6% aged 70–79 had dementia, rising to 75.0% aged over 90. Urinary tract infection or pneumonia was the principal cause of admission in 41.3% of the people with dementia. These individuals had markedly higher mortality; 24.0% of those with severe cognitive impairment died during admission. The authors conclude that the rising prevalence of dementia will have an impact on acute hospitals. Extra resources will be required for intermediate and palliative care and mental health liaison services.
Impact of sight loss in older people in Britain
- Authors:
- FLETCHER Astrid, EVANS Jennifer, SMEETH Liam
- Publisher:
- Thomas Pocklington Trust
- Publication year:
- 2009
- Pagination:
- 7p.
- Place of publication:
- London
This publication summarises findings from research to assess the impact of visual impairment on the risk of hospital and institutional admissions and health-related quality of life in people aged 75 years and above in Britain. The project used data collected from participants in the Medical Research Council (MRC) Trial of the Assessment and Management of Older People in the Community.
The association of individual and facility characteristics with psychiatric hospitalization among nursing home residents
- Authors:
- BECKER Marion, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(3), March 2009, pp.261-268.
- Publisher:
- Wiley
This study examined resident and facility characteristics associated with psychiatric hospitalizations (PH) for Medicaid enrolled nursing home (NH) residents. Participants were all Medicaid enrolled NH residents (n = 32,604) from all Medicaid certified nursing homes in Florida (n = 584) with complete data. Individual demographic and diagnostic characteristics were used, as well as facility characteristics, to explore risk of psychiatric hospitalization in this dataset. Using generalized estimating equations, it was found that younger age, male gender, poor physical health, serious mental illness, dementia, and drug use disorder were associated with risk of psychiatric hospitalization. Most notably, residents under 65 were more than three times more likely to undergo psychiatric hospitalization and dementia was associated with a three-fold increase in the risk of psychiatric hospitalization. Predictors of PH differed somewhat for younger and older residents. Among facility characteristics, greater facility size, low proportion of those paying via Medicare and high proportion of residents with serious mental illness were associated with increased risk of psychiatric hospitalization, whereas, low proportion of residents paying via Medicaid, high proportion of residents paying via Medicare, and low proportion of resident with serious mental illness were associated with reduced risk. Both resident and facility characteristics impact risk for psychiatric hospitalization. Attention to identified predictors may reduce risk and improve outcomes for nursing home residents.
Hazards of hospitalization: residence prior to admission predicts outcomes
- Authors:
- FRIEDMAN Susan M., et al
- Journal article citation:
- Gerontologist, 48(4), August 2008, pp.537-541.
- Publisher:
- Oxford University Press
This is a prospective, observational study of 212 sequential patients admitted during a 1-month period in 2006 to a 38-bed Acute Care for Elders unit in Rochester, New York and followed until discharge. Patients were categorised by residence prior to admission (i.e., community, assisted living, and nursing home). Outcome categories were: worsening function, delirium, depression, falls, pressure sores, and nursing home admission. After adjusting for multiple characteristics, results found that patients admitted from assisted living facilities were at substantially higher risk than those admitted from the community for functional decline and falls. Patients from nursing homes had a trend toward increased risk for these outcomes, but the trend did not reach statistical significance. More than three fourths of assisted living facility residents were discharged to a nursing home after hospitalization, with a relative risk of 9.41 (p <.001) versus community-dwellers for this outcome. People who are admitted to the hospital from assisted living facilities are at high risk for falls and functional decline during hospitalization. Assisted living residents are at a particularly high risk of nursing home admission following hospitalization. Targeted preventive programs should be developed with a goal of reducing risk in this vulnerable population.