57 results on '"Nursing home patients -- Patient outcomes"'
Search Results
2. Regulators to review nursing home deaths
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Fraser, Jayme and Penzenstadler, Nick
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United States. Centers for Medicare and Medicaid Services -- Powers and duties ,Nursing home patients -- Patient outcomes ,Nursing homes -- Investigations ,Company legal issue ,News, opinion and commentary - Abstract
Byline: Jayme Fraser and Nick Penzenstadler, USA TODAY Federal regulators will review the official tally of COVID-19 deaths at one of the nation's largest nursing home chains after the company [...]
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- 2022
3. Nursing homes try to fend off COVID-19 suits
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Alltucker, Ken
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Negligence -- Cases ,Nursing home patients -- Patient outcomes ,Nursing homes -- Cases -- Safety and security measures ,Company legal issue ,News, opinion and commentary - Abstract
Byline: Ken Alltucker, USA TODAY With coronavirus cases circulating through Fair Acres Geriatric Center nursing home in June 2020, Christopher Beaty had alarming news His roommate at the Lima, Pennsylvania, [...]
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- 2022
4. Free press praised after USA TODAY investigations
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Carroll, Nicole
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Investigative reporting ,Nursing home patients -- Patient outcomes ,Misconduct in office -- Investigations ,Nursing homes -- Investigations -- Safety and security measures ,College administrators -- Investigations -- Appointments, resignations and dismissals ,Company legal issue ,News, opinion and commentary ,The California State University -- Investigations -- Officials and employees - Abstract
Byline: Nicole Carroll, Editor-in-chief, USA TODAY When we talk about the goal of investigative journalism, we talk about holding the powerful accountable and being watchdogs for the vulnerable. Two stories [...]
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- 2022
5. Nursing home reform has federal attention
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Penzenstadler, Nick
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United States. Department of Health and Human Services -- Powers and duties ,Nursing home patients -- Patient outcomes ,Nursing home care -- Investigations ,Nursing homes -- Safety and security measures -- Investigations ,Company legal issue ,News, opinion and commentary - Abstract
Byline: Nick Penzenstadler, USA TODAY Health policy advisers to President Joe Biden cited a USA TODAY investigation into nursing home care during the pandemic as evidence of a troubled industry [...]
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- 2022
6. Dying for care
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Stein, Letitia, Fraser, Jayme, Penzenstadler, Nick, and Lowenstein, Jeff Kelly
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Epidemics -- Statistics -- United States ,Corporate governance ,Nursing home patients -- Patient outcomes ,Nursing home care -- Evaluation ,Nursing homes -- Safety and security measures -- Evaluation ,News, opinion and commentary - Abstract
Byline: Letitia Stein, Jayme Fraser, Nick Penzenstadler and Jeff Kelly Lowenstein USA TODAY Martha Miles, one of the first to die, gasped for air. She pressed her nursing home call [...]
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- 2022
7. Cuomo's Aides Hid Covid Data For 5 Months
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Goodman, J. David, McKinley, Jesse, and Hakim, Danny
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New York -- Health aspects ,Nursing home patients -- Patient outcomes ,Company distribution practices ,General interest ,News, opinion and commentary - Abstract
Aides to the New York governor, Andrew M. Cuomo, repeatedly prevented state health officials from releasing the number of nursing home deaths in the pandemic. The effort by Gov. Andrew [...]
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- 2021
8. First, 40 Deaths. Now, 40 Layoffs
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Leland, John and Occhicone, Christopher
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Nursing homes -- Safety and security measures -- Human resource management ,Epidemics -- Distribution -- Patient outcomes -- New York ,Nursing home patients -- Patient outcomes ,COVID-19 -- Distribution -- Patient outcomes ,Company distribution practices ,Company personnel management ,General interest ,News, opinion and commentary - Abstract
On a recent morning in Staten Island, the quiet at Clove Lakes Health Care and Rehabilitation Center was unsettling. Employees in sanitary gowns and face masks moved through a brightly [...]
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- 2020
9. For the virus, Canada is two countries
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Epidemics -- Control -- Patient outcomes -- Canada ,Nursing home patients -- Patient outcomes ,COVID-19 -- Patient outcomes -- Control ,Coronaviruses ,Nursing homes ,Coronavirus infections ,Public health ,Public health movements ,General interest ,News, opinion and commentary - Abstract
Lead The COVID-19 pandemic has revealed two different Canadas: one that has done better than many other countries at limiting the spread of the coronavirus in the general population; and [...]
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- 2020
10. Predicting mortality in nursing home residents with lower respiratory tract infection: The Missouri LRI study. (ORIGINAL CONTRIBUTION)
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Mehr, David R., Binder, Ellen F., Kruse, Robin L., Zweig, Steven C., Madsen, Richard, Popejoy, Lori, and D'Agostino, Ralph B.
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Health status indicators -- Evaluation ,Nursing home patients -- Patient outcomes ,Respiratory tract infections -- Patient outcomes - Abstract
Researchers have developed a health status indicator that can identify nursing home patients who have a high risk of death from a respiratory tract infection. The indicator includes blood urea nitrogen, white blood cell count, body mass index, pulse rate, activities of daily living status, absolute lymphocyte count, sex, and mood changes., Context Lower respiratory tract infection (LRI) is a leading cause of mortality and hospitalization in nursing home residents, Treatment decisions may be aided by a clinical prediction rule that identifies residents at low and high risk of mortality. Objective To identify patient characteristics predictive of 30-day mortality in nursing home residents with an LRI. Design, Setting, and Patients Prospective cohort study of 1406 episodes of LRI in 1044 residents of 36 nursing homes in central Missouri and the St Louis, Mo, area between August 15,1995, and September 30, 1998. Main Outcome Measure Thirty-day all-cause mortality. Results Thirty-day mortality was 14.7% (n = 207). In a logistic analysis, using generalized estimating equations to adjust for clustering, we developed an 8-variable model to predict 30-day mortality, including serum urea nitrogen, white blood cell count, body mass index, pulse rate, activities of daily living status, absolute lymphocyte count of less than 800/[micro]L (0.8 X 10(9)/L), male sex, and deterioration in mood over 90 days. In validation testing, the model exhibited reasonable discrimination (c = .76) and calibration (nonsignificant Hosmer-Lemeshow goodness-of-fit statistic, P = 54). A point score based on this model's variables fit to the entire data set closely matched observed mortality. Fifty-two percent of residents had low (score of 0-4) or relatively low (score of 5-6) predicted 30-day mortality, with 2.2% and 6.2% actual mortality, respectively. Conclusions Our model distinguishes nursing home residents at relatively low risk for mortality due to LRI. If independently validated, our findings could help physicians identify nursing home residents in need of different therapeutic approaches for LRI.
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- 2001
11. State Variation in Nursing Home Mortality Outcomes According to Do-Not-Resuscitate Status
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Egleston, Brian L., Rudberg, Mark A., and Brody, Jacob A.
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Nursing home patients -- Patient outcomes ,CPR (First aid) -- Research ,Health ,Seniors - Abstract
Background. This study compares mortality outcomes of Medicaid-reimbursed nursing home residents with and without do-not-resuscitate (DNR) orders in two diverse states. Methods. We used 1994 Minimum Data Set Plus (MDS+) information on 3215 nursing home residents from two states. We used Kaplan-Meier analyses to examine unadjusted mortality among those with and without DNR orders across states. We used a proportional hazard regression with main and interaction variables to model the likelihood of survival in the nursing home. Results. Approximately 27% of nursing home residents with DNR orders in State A die within the year, and approximately 40% of nursing home residents with DNR orders in State B die within the year. Regression results indicate that neither having a DNR order nor state of residence were independently associated with mortality. However, residing in State B and having a DNR order was associated with an increased risk of mortality compared with all others in the sample (risk ratio = 1.73; 95% confidence interval = 1.09, 2.75). Conclusion. This study demonstrates that DNR orders are associated with varying mortality across states. Future research is needed to identify the reasons why state level differences exist.
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- 2000
12. Effect of Antibiotic Guidelines on Outcomes of Hospitalized Patients with Nursing Home-Acquired Pneumonia
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Solh, Ali A. El, Akinnusi, Morohunfolu E., Alfarah, Ziad, and Patel, Anil
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Medical colleges -- Analysis ,Nursing home patients -- Patient outcomes ,Nursing home patients -- Analysis ,Hospital patients -- Patient outcomes ,Hospital patients -- Analysis ,Antibiotics -- Analysis ,Health ,Seniors - Abstract
To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1532-5415.2009.02279.x Byline: Ali A. El Solh (*[dagger][double dagger]), Morohunfolu E. Akinnusi ([dagger]), Ziad Alfarah ([dagger]), Anil Patel ([double dagger]) Keywords: nursing home acquired pneumonia; guidelines; antibiotics; mortality Abstract: OBJECTIVES: To compare the 2003 community-acquired pneumonia (CAP) guideline and the 2005 healthcare-associated pneumonia (HCAP) guideline on time to clinical stability, length of hospital stay, and mortality in nursing home patients hospitalized for pneumonia. DESIGN: Retrospective study. SETTING: Three tertiary-care hospitals. PARTICIPANTS: Three hundred thirty-four nursing home patients. MEASUREMENTS: Patients were classified according to the antibiotic regimens they received based on the 2003 CAP guideline or the 2005 HCAP guideline. Time to clinical stability, time to switch therapy, and mortality were evaluated in an intention-to-treat analysis. A multivariate survival model using propensity analysis was used to adjust for heterogeneity between the two groups. RESULTS: Of the 334 patients, 258 (77%) were treated according to the 2003 HCAP guideline. Time to clinical stability did not differ between those treated according to the 2003 CAP or the 2005 HCAP guidelines. Only the Pneumonia Severity Index (P=.006) and multilobar involvement (P=.005) were significantly associated with delay in achieving clinical stability. Adjusted in-hospital and 30-day mortality were comparable in both cohorts (odds ratio (OR)=0.87, 95% confidence interval (CI)=0.49-1.34, and OR=0.79, 95% CI=0.42-1.31, respectively), although time to switch therapy and length of stay were longer for those treated according to the 2005 HCAP guideline. CONCLUSION: In hospitalized nursing home patients with pneumonia, treatment with an antibiotic regimen according to the 2003 CAP guideline achieved comparable time to clinical stability and in-hospital and 30-day mortality with a regimen based on the 2005 HCAP guideline. Author Affiliation: (*)Veterans Affairs Western New York Healthcare System, Buffalo, New York; and ([dagger])Western New York Respiratory Research Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, School of Medicine and Biomedical Sciences and ([double dagger])Department of Social and Preventive Medicine, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, New York. Article note: Address correspondence to Ali El Solh, Medical Research, Bldg. 20 (151) VISN02, VA Western New York Healthcare System, 3495 Bailey Avenue, Buffalo, NY 14215. E-mail: solh@buffalo.edu
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- 2009
13. Safety outcomes in the United States: trends and challenges in measurement
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Greenberg, Michael D., Haviland, Amelia M., Yu, Hao, and Farley, Donna O.
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Medical errors -- Measurement ,Safety regulations -- Measurement ,Bedsores -- Patient outcomes ,Bedsores -- Measurement ,Medical research -- Measurement ,Medicine, Experimental -- Measurement ,Nursing home patients -- Patient outcomes ,Nursing home patients -- Measurement ,Nursing homes -- Measurement ,Medical care -- Quality management ,Medical care -- Measurement ,Patients -- Care and treatment ,Patients -- Measurement - Abstract
Objective. To prepare Agency for Healthcare Research and Quality (AHRQ) for monitoring the impact of its own patient safety initiative, by exploring available outcomes data, assessing usability of measures, and estimating national trends in patient outcomes. Data Sources. Annual summary data on incidence of Joint Commission Sentinel Events, MEDMARX medication error events, and MDS measures of falls and pressure ulcers in nursing home residents. HCUP National Inpatient Sample (NIS) administrative claims data. Methods. Description and assessment of published summary data on selected safety measures. Analysis of selected Patient Safety Indicators (PSIs) and Utah- Missouri adverse event measures using HCUP NIS claims data (1994-2003). Principal Findings. Interpretation of safety outcome trends requires close attention to the characteristics of underlying data sources and measures. Encounter-based measures have been affected by changes in definitions and ICD-9 coding, as well as by changes in the structure of administrative datasets like HCUP NIS. Historical trends are mixed for the safety outcome measures reviewed, with some measures showing improvement, others deterioration, and still others remaining fairly stable. Conclusions. Constructing national trends of safety outcomes is difficult because of limitations in available data sources and measures. Tracking growth in the adoption of safe practices could offer an important strategy for complementing existing safety measurement capabilities. Key Words. Patient safety, measurement, national trends, epidemiology, methods, One of the key components of any effort to track national trends in patient safety involves measuring patient outcomes. Ultimately, outcomes at the clinical level can be understood as the [...]
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- 2009
14. The staffing--outcomes relationship in nursing homes
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Konetzka, R. Tamara, Stearns, Sally C., and Park, Jeongyoung
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Company business management ,Nursing home patients -- Patient outcomes ,Nursing home patients -- Research ,Nursing homes -- Quality management ,Nursing homes -- Research ,Registered nurses -- Services ,Registered nurses -- Research ,Medical care -- Quality management ,Medical care -- Management ,Medical care -- Research - Abstract
Objective. To assess longitudinally whether a change in registered nurse (RN) staffing and skill mix leads to a change in nursing home resident outcomes while controlling for the potential endogeneity of staffing. Data Sources. Minimum Data Set (MDS) nursing home resident assessment data from five states merged with Online Survey Certification and Reporting (OSCAR) data from 1996 through 2000. Study Design. Resident-level longitudinal analysis with facility fixed effects and instrumental variables. Outcomes studied are incidence of pressure sores and urinary tract infections. RN staffing was measured as the care hours per resident-day and skill mix was measured as RN staffing hours as a proportion of total staffing hours. Data Extraction Method. We use all quarterly MDS assessments that fall within 120 days of an annual OSCAR data point, resulting in 399,206 resident-level observations. Principal Findings. Controlling for endogeneity of staffing increases the estimated impact of staffing on outcomes in nursing homes. Greater RN staffing significantly decreases the likelihood of both adverse outcomes. Increasing skill mix only reduces the incidence of urinary tract infections. Conclusions. Research that fails to account for endogeneity of the staffing-outcomes relationship may underestimate the benefit from increased RN staffing. Increases in RN staffing are likely to reduce adverse outcomes in some nursing homes. More research using a broader array of instruments and a national sample would be beneficial. Key Words. Staffing, nursing homes, quality of care, instrumental variables, endogeneity, The quality of care in nursing homes has long been an issue of concern to policy makers and the public. Following the Institute of Medicine report that documented serious abuses [...]
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- 2008
15. Innovations in dying in the nursing home: the impact of market characteristics
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Castle, Nicholas G.
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Nursing home patients -- Patient outcomes ,Terminal care facilities -- Economic aspects ,Psychology and mental health ,Sociology and social work - Abstract
During the 1980s nursing homes emerged as a dominant site of death for the elderly. This may precipitate more innovative approaches to death and dying in the nursing home and may account for the recent emergence of hospice care and pain management programs in nursing homes. However, the provision of hospice care and pain management in nursing homes are trends about which we have virtually no information. As a first step in examining these phenomena we provide a descriptive analysis of nursing homes that provide hospice cue or pain management programs and an analysis of the impact of market characteristics as determinants of nursing homes providing them. Our findings suggest that the provision of pain management programs and hospice care are becoming prevalent in nursing home settings and that nursing homes are quite sensitive to their market environment indicating that policy changes could encourage further increases in these service innovations in death and dying.
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- 1998
16. The tragedy of Tye Green Lodge care home is a parable of government neglect
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Cowley, Jason
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Nursing homes -- Management -- Distribution ,Epidemics -- Control -- Patient outcomes -- Prevention -- United Kingdom ,Nursing home patients -- Patient outcomes ,COVID-19 -- Distribution -- Prevention -- Patient outcomes ,Public health administration ,Company business management ,Company distribution practices ,Literature/writing ,Political science - Abstract
In July last year an old friend who now lives in Brighton mentioned that he and his mother, Margaret, were visiting Harlow for the first time in many years. He [...]
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- 2020
17. Infectious diseases and mortality among US nursing home residents
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Beck-Sague, Consuelo, Banerjee, Shailen, and Jarvis, William R.
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Nursing home patients -- Patient outcomes ,Infection -- Risk factors ,Government ,Health care industry - Abstract
Data collected in the 1985 National Nursing Home Survey were analyzed to identify risk factors for infections and mortality and to explore their relationship in US nursing homes. An infection was recorded in 166 609 (14%) discharges. Risk of pneumonia was found to be higher among bedbound patients (54.5 vs 13.1 per 100 discharges); urinary tract and other infections were most frequent among residents with indwelling catheters (6.6 vs 1.0 per 100 discharges). Residents with pneumonia were more likely than those with other infections to die (35% vs 28%), or be discharged to hospitals if alive (94% vs 66%). Thus, immobility and catheterization were associated with infections in US nursing homes, and pneumonia was found to contribute to mortality. (Am J Public Health. 1993;83:1739-1742), Nursing home patients who are immobile and have urination problems may be at an increased risk of infection while those with pneumonia may have an increased risk of death. The records of 1,220,816 nursing home patients were assessed. Their ages were between 2 and 109 years with residence from one month to 53 years. Almost 63% were female. A total of 14% had infections. Among these patients, 34% had urinary tract infections, 17% had bacterial, viral or parasitic infections and 49% had pneumonia. Death was highest among residents confined to bed, having urination problems, catheterized or having pneumonia. Residents with urinary tract infections or pneumonia were more likely to be transferred to a hospital. A delay in diagnoses of infections may contribute to the mortality of residents with pneumonia. Preventing infections while in nursing care homes may reduce the length of residency.
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- 1993
18. Patient characteristics and outcomes in institutional and community long-term care
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Braun, Kathryn L., Rose, Charles L., and Finch, Michael D.
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Long-term care of the sick -- Evaluation ,Outcome and process assessment (Health Care) -- Demographic aspects ,Nursing home patients -- Evaluation ,Aged -- Long term care ,Nursing home patients -- Patient outcomes ,Health ,Seniors - Abstract
The rapid growth of the elderly population has resulted in an increase in the number of elderly people in need of long-term care for chronic disabilities. As an alternative to costly institutional placement for the frail elderly, it has been recommended that home and community-based long-term care programs be developed for cost containment and better quality of life for the patient. The present paper reports the results of a comparison of the characteristics of elderly patients admitted to two types of care settings - nursing home and community-based care - and their six-month outcome in those settings. Data were collected from 352 patients certified to be in need of an intermediate care facility. They received the required services either in the community or in a nursing home. Patients were observed and interviewed, charts were reviewed, and patient functioning was discussed with formal and informal caregivers. Significantly more Caucasian patients and those with dementia, cancer, poor scores on measurements of functioning, and patients taking more medications were admitted to nursing homes as opposed to community-based programs. A greater proportion of nursing home patients died within six months of placement than did community-based patients. Being male was a predictor of death for nursing home patients, but not for community-based patients. In general, the best predictor of six-month outcome was level of functioning before admission. Patient characteristics affected outcome differently in the two settings. Controlling for initial patient differences, however, similar patient outcomes could be expected in the two types of settings. (Consumer Summary produced by Reliance Medical Information, Inc.)
- Published
- 1991
19. Effects of type of ownership of skilled nursing facilities on residents' mortality rates in Illinois
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Bell, Ralph and Krivich, Michael
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Nursing homes -- Management ,Nursing home patients -- Patient outcomes ,Nursing home care -- Research - Abstract
Effects of Type of Ownership of Skilled Nursing Facilities on Residents' Mortality Rates in Illinois Synopsis The effect of ownership on the quality and cost of care in skilled nursing […]
- Published
- 1990
20. Mortality from lower respiratory infection in nursing home residents: a pilot prospective community-based study
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Mehr, David R., Zweig, Steven C., Kruse, Robin L., Popejoy, Lori, Horman, Darla, Willis, Deanna, and Doyle, M. Elaine
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Nursing home patients -- Patient outcomes ,Respiratory tract diseases -- Patient outcomes ,Pneumonia -- Patient outcomes - Abstract
BACKGROUND. Lower respiratory infections (LRI) are an important cause of morbidity, mortality, and hospitalization of nursing home residents, yet treatment recommendations have primarily been based on the minority who are [...]
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- 1998
21. Pneumonia in a long-term care facility: a prospective study of outcome
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Muder, Robert R., Brennen, Carole, Swenson, David L., and Wagener, Marilyn
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Long-term care facilities -- Services ,Pneumonia -- Patient outcomes ,Nursing home patients -- Patient outcomes ,Health - Published
- 1996
22. Value of functional status as a predictor of mortality: results of a prospective study
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Reuben, David B., Rubenstein, Lisa V., Hirsch, Susan H., and Hays, Ron D.
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Aged -- Functional assessment ,Nursing home patients -- Patient outcomes ,Social interaction -- Health aspects ,Health ,Health care industry - Published
- 1992
23. Risk factors for mortality from lower respiratory infections in nursing home patients
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Mehr, David R., Foxman, Betsy, and Colombo, Paula
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Nursing home patients -- Patient outcomes ,Respiratory tract infections -- Patient outcomes ,Conduct of life -- Health aspects ,Aged -- Diseases - Abstract
Background. Little is known about the factors that predict whether nursing home residents with lower respiratory infection (LKI) will do well or poorly, although this information is critically important when making treatment decisions. Methods. Using nursing home and hospital medical records we performed a case-control study to identify risk factors for death from LRI among residents of a 110-bed, midwestern community nursing home. Three experienced geriatricians aided in the development of an operational definition of an LRI, In a 3 1/2 -year period, we identified 26 cases in which the patients died from LRI and 66 control episodes in which the patients recovered from LRI. Results. Compared with those who survived, those who died were 14 times more likely to be totally dependent with respect to activities of daily living (ADL) than the group of patients least ALD-dependent (odds ratio [OR] = 14; 95% confidence interval [95% CI] = 2.85 to 68.87). After adjusting for ADL, mortality was significantly decreased when a broad-spectrum oral antibiotic (trimethoprim-sulfamethoxazole, cefaclor, amoxicillin-clavulanate, or ciprofloxacin) was used as the initial therapy (OR = .14; 95% CI = .02 to .81). Conclusions. Better functional status and initial therapy with broad-spectrum oral antibiotics were strong predictors of surviving an LRI in this population of nursing home patients. The antibiotic effect may be a treatment effect or the consequence of underlying factors leading physicians to select particular antibiotics; however, it appears possible to identify low-risk persons who do not require the aggressive treatment and hospitalization that is often recommended for these patients. An approach to the treatment of nursing home LRI is suggested. As many as 12% of hospitalizations among community nursing home residents result from lower respiratory infections (LRI).[1] Estimates of pneumonia incidence in some veterans Administration (VA) chronic care nursing units have been over one per patient-year.[2,3] Death rates from lower respiratory infection as high as 82.6 death per 1000 patient-years have been reported.[4] Given the increasing size of the geriatric population,[5] if current patterns of hospital utilization continue, nursing home lower respiratory infections will consume even greater amounts of scarce medical resources. Little is known, however, concerning which nursing home residents with LRI will do poorly with or without hospital care. Review articles uniformly recommend that almost all nursing home residents with pneumonia should be hospitalized or at least treated with broad-spectrum parenteral antibiotics.[6-9] The studies of LRI in nursing homes that have been cited in support of such assertions evaluated only those nursing home patients who were hospitalized.[10-12] Hospitalized patients are probably a more severely ill group since those who respond to therapy in the nursing home are not admitted for hospital care. In our experience, physicians commonly manage LRIs with oral antibiotics at the nursing home and achieve good outcomes. If clinicians could identify those nursing home residents likely to die from an LRI, they would be faced with a clear choice of administering either aggressive inpatient therapy, which might or might not be successful, or palliative care in the nursing home with a high probability of death. Conversely, if clinicians could identify persons at low risk for adverse outcomes even when treated within the nursing home, this would support the choice of nursing home management for selected residents who develop LRI. We are aware of only two studies of the predictors of LRI outcomes in the elderly. Both concern pneumonia in hospitalized patients.[13,14] We used a case-control design to examine risk factors for mortality from lower respiratory infection in community nursing home patients. We hypothesized that inability to perform activities of daily living (ADL), poor nutritional status, extreme old age, and cognitive impairment would all predispose a patient to dying from LRI. Furthermore, because we expected that more aggressive antibiotic therapy would be associated with more severe illness, we hypothesized that patients who received more aggressive antibiotic therapy would be more likely to die. MetHODS We compared potential risk factors for mortality that were present in nursing home residents who died of lower respiratory infections (cases with risk factors present in episodes where the person survived a lower respiratory infection (controls). Study cases and controls were identified from illnesses that occurred between January 1, 1986, and June 30, 1989, among residents of a 110-bed church-affiliated skilled and intermediate care facility in southeastern Michigan. Because mortality was the end point, some persons were included in both the case and control groups if they had experienced more than one episode of LRI while in the nursing home during the 3 1/2 year period. Otherwise, a substantial portion of the person-time during which individuals were at risk for mortality (time during an LRI episode) would have been excluded for sampling controls.[15] Data were collected by nursing home and hospital medical record review, including nurses' notes, physician progress notes, flow sheets, medication records, laboratory and x-ray film reports, and admission and discharge records. Cases (deaths from LRI) were identified from hospital transfers and nursing home deaths. Controls were identified from hospitalizations that did not end in death and from episodes of antibiotic therapy that were not associated with death. Definition of Lower Respiratory Infection Because there is no standard definition of an LRI in a nursing home patient,[16] an operational definition appropriate to the nursing home setting was developed. First, we formulated a tentative definition of an LRI based on the Centers for Disease Control (CDC) hospital nosocomial infection surveillance definition, which requires evidence of acute respiratory illness, exclusion of other conditions with similar signs and symptoms, and purulent sputum production or a "suggestive chest x-ray."[17] A panel of three geriatricians with extensive experience in the care of nursing home patients reviewed 23 nursing home medical records, four of which were included twice. Each panel member was asked to evaluate the probability that an episode was an LRI on a Likert scale of 1 to 6, ranging from "highly likely" to "highly unlikely." Based on the responses of the panel, we reformulated our original definition of an LRI to arrive at our final definition. There was good agreement between the final definition and the classification of LRI by the raters. If a mean score by the panel of less than 3 (3 = slightly likely to have been an LRI, 2 = moderately likely, 1 = highly likely) was counted as identifying an episode of LRI, agreement between the panel assignment and the final definition was present for 20 of 23 episodes (Cohen's kappa,[18] a measure of chance-corrected agreement, of .74). Following the CDC definition, we defined an LRI to be present for a hospitalized nursing home resident if there was evidence of an acute infection with either purulent sputum production or a suggestive infiltrate on chest radiograph. In residents not hospitalized, one of the following was required for the patient to be included in the study: 1. An infiltrate suggestive of pneumonia on chest radiograph associated with acute respiratory symptoms or with an acute status change (diminished eating, diminished activity, worse cognitive function, temperature above 37.5 [degrees] C [99.5 [degrees] F], or less than 5 days between the onset of respiratory symptoms and the initiation of antibiotic therapy); or 2. Production of abnormal appearing sputum associated with an acute status change; or 3. Abnormal pulmonary auscultatory findings associated with an acute status change including fever or, in the absence of fever, findings that were not symmetrical (for example, rales heard only in lower left lung). Our initial screening of nursing home records sought any episodes that could have possibly been considered a respiratory infection. Because of our interest in helping physicians make better treatment decisions, individuals deliberately not treated with antibiotics because of planned treatment limitation were excluded. In cases where an individual had multiple courses of antibiotic therapy, we required that a patient had taken no antibiotics for at least 7 days before an episode was considered distinct. Using these rules, we identified 156 potential case and control episode from the records of 98 nursing home patients. Five of these episodes were excluded because they were considered to have been a continuation of another episode or because the outcome could not be determined. Using the final definition, 92 of the 151 episodes were classified as an LRI. Seven of the 59 excluded episodes involved a hospitalization where review of the hospital record did not support the diagnosis of LRI. Of the remaining 52 episodes, in only three instances was a chest radiograph taken (all negative), and in only 5 instances (none associated with an acute status change) was there a report of abnormal sputum production. Some of these 52 episodes lacked evidence of an acute status change (16 episodes; many of these were probably upper respiratory infections), some lacked evidence of abnormal pulmonary findings (25 additional episodes), and some lacked sufficient specific evidence of an LRI (9 episodes). The 92 episodes that met our definition of LRI occurred in 65 persons: 48 had one episode, 10 had two episodes, 5 had three episodes, I had four episodes and 1 had five episodes. Sixteen of the episodes included in the study involved hospitalization. Reliability of Data Abstraction While initially reviewing records, information was also abstracted for analysis. The abstractor (P.C.) was blinded to the purpose of the study other than it involved lower respiratory infections. The abstractor performed a second review of 10 episodes to establish the intrarater reliability of data abstraction. For ordinal and interval variables, 90% of correlation coefficients were above .9 (range .82 to 1.00). In particular, for the number of ADL dependencies, the Spearman correlation coefficient was .99. For categorical variables, there was complete agreement 67% of the time, with no more than two disagreements out of ten in the other cases ([kappa] = 0.57 to 1.0). Exposure Variables We evaluated ADL dependency, cognitive impairment, low weight or body mass index, decubitus ulcer, age, and nursing home diagnoses before the episode as potential predictors of mortality. Cognitive status and ADL dependency were ascertained as close as possible to 7 days before the beginning of antibiotic treatment. Data for this assessment were obtained from nurses' notes and flow sheets. Subjects were classified in regard to ADL according to a modified Katz scale (simply counting the number of dependencies).[19] Coma, confusion, disorientation, dementia, and agitation were considered abnormal cognitive statuses. The patient's weight at the time of the LRI as well as the patient's weight 6 and 12 months prior to the LRI was recorded if available. A body mass index (weight/height[.sup.2]) was calculated based on recorded height (usually at admission) and most recent weight. This index provides a measure of adiposity; a low index suggests a very thin and possibly malnourished individual.[20] A decubitus ulcer was defined as a reported stage 1 (area of persistent erythema) or greater decubitus ulcer at the time of antibiotic theory. We classified initial antibiotic use into three mutually exclusive categories: (1) traditional oral antibiotics: penicillin, ampicillin, amoxicillin, erythromycin, tetracycline, cephalexin; (2) broad-spectrum oral antibiotics: trimethoprim-sulfamethoxazole, cefaclor, amoxicillin/clavulanate, ciprofloxacin; and (3) parenteral antibiotics: gentamicin or parenteral cephalosporin. Traditional oral antibiotics are used as the reference stratum for comparing the effect of each of the other two groups. Statistical Analysis Crude odds ratios of death from LRI and 95% confidence intervals were computed for each potential risk factor of interest, and adjusted odds ratios and confidence intervals were computed for potential confounders using the Mantel-Haenzsel technique.[21] As a further evaluation of confounding, multivariate logistic regression was used. Ordinal variables were assessed with a test for trend. The unit of analysis was an episode of infection; thus, some persons were included in both the case and control groups. Because so few episodes involved hospitalization, no separate analyses were performed of whether risk factors deffered in those hospitalized compared with those who received care exclusively in the nursing home. Statistical computations were performed using the following software packages: SAS,[22] Systat,[23] and dEPID,[24] Woolf/Taylor Series confidence intervals have been reported for crude odds ratios. Results Nursing home residents with LRI were a very elderly population with a mean age of 86.3 years (SD = 6.4 years). Twenty-six (28%) of the 92 episodes of LRI ended in death. Five (31%) of the 16 episodes of LRI involving hospitalization ended in death. All subjects were white, and 73 (79%) of the episodes occurred in women, while 19 (21%) occurred in men. As shown in Figure 1, ADL score was strongly related to outcome; death occurred in only 6.7% of the episodes in which the individual was independent or mildly dependent (zero to two dependencies) compared with 50% of episodes in which the individual was totally dependent, scoring six dependencies (Mantel-Haenzel test for trend, [CHI][.sup.2] = 14.2, P < .001). Sixty-two percent of deaths from LRI occurred in the most dependent group, which accounted for only 35% of the episodes. Compared with those who survived, those who died were 14 times more likely to be in the most dependent group than in the least dependent group (OR = 14.95% CI = 2.85 to 68.87). Furthermore, compared with those who survived, those who died were 5.1 times more likely to be in the intermediate dependency group than in the least dependent group (OR = 5.1; 95% CI = 0.98 to 26.43). As age increased, so did the risk of death (Table 1), though with borderline statistical significance [CHI][.sup.2] = 3.68, P = .055). Compared with those who survived, however, those who died were 2.7 times as likely to be older than 90 years (OR = 2.7; 95% CI = 1.03 to 6.96). Body mass index was also strongly associated with death: 48% of the episodes involving a patient in the lowest quartile of the body mass index ended in death while only 14% of the episodes involving a patient in the highest quartile ended in death ([CHI][.sup.2] = 4.87, P = .027). The odds ratio for death from LRI for a patient in the lowest quartile, compared with the highest, was 5.76 (95% CI = 1.30 to 25.51). Nursing home residents who died were 2.7 times as likely to have a decubitus ulcer as those who survived an LRI (OR = 2.72; 95% CI = 1.03 to 7.23). Feeding tubes, oxygen therapy, report of choking, and Foley catheters were all uncommon and, therefore, a larger study would be necessary to adequately evaluate these potential risk factors. Sex, impaired cognitive status, and designation of limited treatment ("do not hospitalize" order) were not significantly related to death from LRI when crude odds ratios were calculated. Presence of a "do not hospitalize" order, however, varied as a risk factor for death from LRI depending on the age of the patient. Those who were less than 90 years of age, were less likely to die if they had a "do not hospitalize" order than were those without such an order (OR = .3; 95% CI = 0.07 to 1.19). Conversely, those aged 90 years or older were more likely to die if they had a "do not hospitalize" order (OR = 4.2; 95% CI = 0.84 to 21.05). Though neither of these odds ratios is statistically significant at the .05 level, the Breslow-Day test for homogeneity of the odds ratio provides strong statistical evidence that the odds ratios are different ([CHI][.sup.2] = 6.33; P = .012). Similarly, the association between death from an LRI and a subject's sex differs depending on the ADL score. In those totally dependent (six ADL dependencies), women were more likely to die of an LRI than men (OR = 4.2; 95% CI = 0.70 to 25.26); but among those with fewer than six ADL dependencies, men were more likely to die than women (OR = .24; 95% CI = 0.06 to 1.09). The Breslow-Day test again suggests significantly different odds ratios between the strata ([CHI][.sup.2] = 6.347; P = .012). For episodes in which the patient had a fever, the mean initial temperature was equal in case and control patients (38.2 [degrees] C [101.2 [degrees] F, and 101.1 [degrees] respectively]), but the mean value for the maximum temperature was slightly higher in the case study group (39.2 [degrees] C [102.6 [degrees] F], compared with patients in the control group 38.7 [degrees] C [101.6 [degrees] F], P = .005). In 21 of the 92 episodes, however, no information was available for either of these variables. The type of antibiotics prescribed at the beginning of an episode shows a striking relationship to the outcome. Parenteral antibiotics were associated with a poorer outcome (Table 1); however, the result was not statistically significant and was markedly attenuated when controlling for ADL with the Mantel-Haenzsel technique (OR = 1.1; 95% CI = 0.22 to 5.77). In contrast, when similarly controlling for ADL, initial use of broad-spectrum oral antibiotics was associated with much lower odds of dying than use of traditional oral antibiotics (OR = 0.14; 95% CI = 0.02 to 0.81). Among residents not hospitalized, none of the 13 episodes involving initial use of broad-spectrum oral antibiotics and fewer than six ADL dependencies resulted in death. One individual was started on broad-spectrum oral antibiotics and then hospitalized. That person survived the episode. [Table Data 1 Omitted] We also examined whether using only one episode per person would alter the results. Though there are some differences, odds ratios are similar for one episode as compared with all episodes. To further examine the relationships of the predictor variables, we used multivariate logistics regression. Neither body mass index nor the presence of a decubitus ulcer was a significant predictor when controlling for ADL with logistic regression. These findings are consistent with results from stratified analysis, which showed that when controlling for ADL, dichotomous classifications of age, boy mass index, and decubitus ulcer exhibited attenuated odds ratios and a loss of statistical efficiency. The logistic regression model supported the very strong relationship between initial treatment with a brood-spectrum oral antibiotic and survival; the adjusted odds ratio when compared with treatment with traditional oral antibiotics was 0.09 (95% CI = 0.01 to 0.54). Initial treatment with parenteral antibiotics was a weak predictor and not statistically significant. The model also reiterated how much better the outcomes were for those in the most independent ADL group than those in the intermediate or fully dependent groups. Because of the small number of patients in each ADL classification, confidence intervals were very wide. Discussion Previous nursing home studies of lower respiratory infection either have been purely descriptive or have been focused on causative factors and microbial pathogens rather than on outcome.[16] The ability to assess the risk of adverse outcome is crucial, however, to a treatment strategy for acutely ill nursing home residents with suspected LRI. Patients who are likely to do well may be candidates for nursing home therapy. Those who are likely to do poorly may be candidates for hospital admission if their preferences and their overall condition dictate aggressive treatment. Aside from decisions to limit treatment, there are multiple potential reasons for not hospitalizing a nursing home resident, including cost, precipitation of acute confusion, and the increased possibility of iatrogenesis in the hospital environment.[25] This study involved only white patients in a rural nursing home; therefore, the results should be generalized with caution. Our findings suggest, however, that a low-risk population can be identified in which patients with LRI can be appropriately treated with oral antibiotic therapy administered in the nursing home. The study by Zweig et al[13] of elderly hospitalized patients identified the following as significant independent predictors of mortality: impaired consciousness, tachypnea, lower than normal body temperature, leukocyte count above 20,000 mm[3], and cyanosis. Starczewski and co-workers[14] identified with mortality in those over 70 years of age at a general hospital in the United Kingdom. We were not able to adequately test many of these associations with our data. We did not find an association between cognitive status and outcome, but cognitive status was not consistently reported in nursing home records. Also, we examined cognitive status just before an episode as opposed to Zweig et al, who examined cognitive status at the time of hospitalization. Based on the present study, Zweig's hospital study,[13] and suggestions from Bentley's review of pneumonia in the elderly,[7] factors that might turn out to be high-risk indicators in elderly nursing home patients with pneumonia include: (1) very dependent ADL status; (2) low body temperature; (3) depressed level of consciousness; (4) a leukocyte count of less than 5000 or greater than 20,000 mm[3]; and (5) evidence of respiratory distress (cyanosis, respiratory rate greater than 30 breaths per minute, hypoxemia). Additionally, very high body temperature (eg, above 39.4 [degrees] C [103 [degrees] F]) is often associated with severe illness, though we are aware of no solid evidence linking it to mortality. These factors have never been tested jointly in any study and will likely not all turn out to be independently important; nonetheless, they may serve as basic guidelines for clinicians in the absence of better information. In the current study, episodes where broad-spectrum oral antibiotics were the initial therapy had very low mortality, and this relationship was even stronger when controlling for ADL status. Our data do not identify how clinicians made their specific decisions about therapy. Therefore, we do not know whether this represents a treatment effect or a possible selection bias in which less severely ill individuals might have been treated with broad-spectrum oral antibiotics. Whether the result of a treatment effect or good clinical judgment, or both, the clinician's treatment decisions were supported by the positive outcomes. This is particularly interesting when compared with the lack of a relationship between the iniial use of parenteral antibiotics and LRI mortality when controlling for ADL status. We hypothesized that persons who were more severely ill would be more likely to receive parenteral antibiotics, and therefore those who were initially treated with parenteral antibiotics would have pooper outcomes. The absence of any evident relationship when controlling for ADL reemphasizes the importance for ADL status in identifying those persons likely to have the poorest outcomes. Previous work has suggested that poor ADL status is a predictor of mortality in nursing home patients,[26] and Alvarez et al[2] found that a poor Karnofsky performance index (a global measure of ability to function) was a predictor of lower respiratory infections. However, to the best our our knowledge, this is the first study that relates ADL status to the outcome of LRI. Malnutrition has been linked to nursing home mortality.[27] Our data suggest that very thin persons are at significantly higher risk of dying from LRI; however, in multivariate analysis, body mass index did not remain an important predictor. Similarly, ADL status was a better predictor of mortality than was age. Age and body mass index might remain significant independent factors when controlling for ADL in a larger study. The findings relating to subject's sex and treatment limitation are not obviously explained. In this population, person younger than 90 years with limited treatment orders were less likely to die than those younger than 90 years without limited treatment orders. We also found that women with severe ADL impairment were more likely to die than severely impaired men, while men with absent to moderate ADL impairment were more likely to die than women of similar ADL status. These findings are intriguing but need to be replicated before much significance is attached to them. The limitations of retrospective medical record review studies are well known. There is no way to ensure uniformity in what was recorded. Lacking adequate data to apply standard hospital LRI definitions, we went through a complex process to develop a nursing home LRI definition to establish eligibility for the study. Although the definition has not been previously used, it makes clinical sense (has face validity) and fits well with mean ratings by the panel. There was, however, significant variability in ratings between individual panel members. Clearly, having complete data to uniformly apply a more standard definition would have been preferable. Furthermore, using medical records as a source for data could create a spurious association if one of the exposures of interest is selectively underreported in case or control patients. Nonetheless, as a basis of generating hypotheses for prospective studies, this type of investigation has merit, and the strengh of the association of death with poor ADL status is unlikely to be wholly spurious. In fact, a strength of this study is that ADL status is apt to be better recorded in nursing home records than on hospital records. For both nursing home and hospital settings, future studies involving prospective data collection are needed to more precisely examine outcome predictors. The episode as the unit of analysis raises the question of whether observations are truly independent; however, it is appropriate to consider the same person as a case and a control at different time, particularly in studies with mortality as the end point.[15] In support of our approach, when we analyzed only the last episode for each individual, we obtained substantially similar results. Despite the limitation of our study, we did demonstrate that, at least in this nursing home, there was a significant subgroup of residents with LRI that did very well with treatment in the nursing home with broadspectrum oral antibiotics. The results also support the usefulness of simple, available clinical data in predicting outcome from LRI. If this approach can be extended and confirmed, it will provide a powerful clinical and research tool. The ability to predict outcomes on the basis of data available at the beginning of an illness could significantly aid in decision making, in the stratification of persons by expected outcome in future studies, and in the outcomebased assessment of quality of care in nursing homes. Acknowledgments Lynn Hostetler helped with initial literature searching. Jim Peggs, MD, Alan Dengiz, MD, and John Santinga, MD, volunteered their time to review nursing home records in formulating the definition of lower respiratory infection. The administration and staff of the Chelsea United Methodist Retirement Homes, Particularly the medical records coordinators, provided invaluable assistance. Similarly, the Chelsea Community Hospital medical records department was very helpful. Dan Gorenflo, PhD, performed some of the statistical analyses. Mindy Smith, MD, MS, and Barbara Reed, MD, MSPH, provided helpful comments. Mary Anne Hartness assisted with manuscript preparation.@ References [1.] Irvine PW, Van Buren N, Crossley K. Causes for hospitalization of nursing home residents: the role of infection. J Am Geriatr Soc 1984; 32:103-7. [2.] Alvarez S, Shell CG, Woolley TW, et al, Nosocomial infections in long-term facilities. J Gerontol 1988; 43:M9-17. [3.] Farber BF, Brennen C, Puntereri AJ, et al. A prospective study of nosocomial infections in a chronic care facility. Am Geriatr Soc 1984; 32:499-502. [4.] Nicolle LE, McIntyre M, Zacharias H, et al. Twelve-month surveillance of infections in institutionalized elderly men. J Am Geriatr Soc 1984;32:513-9. [5.] Guralnik JM, FitzSimmons SC. Aging in America: a demographic perspective. Cardiol Clin 1986; 4:175-83. [6.] Norman DC, Castle SC, Cantrell M. Infections in the nursing home. J Am Geriatr Soc 1987; 35L796-805. [7.] Bentley DW, Bacterial pnuemonia in the elderly: clinical features, diagnosis, etiology, and treatment. Gerontology 1984; 30:297-307. [8.] Niederman MS, Fein AM. Pneumonia in the elderly. Clin Geriatr Med 1986; 2:241-68. [9.] Yoshikawa TT. Pneumonia, UIT, and decubiti in the nursing home: optimal management. Geriatrics 1989; 44(10):32-4, 37-40, 43. [10.] Marrle TJ, Durant H, Kwan C. Nursing home-acquired pnuemonia: a case-control study. J Am Geriatr Soc 1986; 34:697-702. [11.] Garb JL, Brown B, Garb JR, et al. Differences in etiology of pneumonias in nursing home and community patients. JAMA 1978; 240:2169-72. [12.] Peterson PK, Stein D, Guay DRP, et al. Prospective study of lower respiratory tract infections in an extended-care nursing home program: potential role of oral ciprofloxacin. Am J Med 1988; 85: 164-71. [13.] Zweig S, Lawhorne L, Post R. Factors predicting mortality in rural elderly hospitalized for pneumonia. J Fam Pract 1990; 30: 153-9. [14.] Starczewski AR, Allen SC, Vargas E, Lyle M. Clinical prognostic indices of fatality in elderly patients admitted to hospital with acute pneumonia. Age Ageing 1988; 17:181-6. [15.] Rothman KH. Modern epidemiology. Boston: Little, Brown, 1986:66. [16.] Crossley KB, Thurn JR, Nursing home-acquired pneumonia. Semin Respir Infect 1989; 4:64-72. [17.] Garner JS, Bennett JV, Scheckler WE. et al. Surveillance of nosocomial infections. In: Brachman PS and Eickhoff TC, eds. Proceedings of the international conference on nosocomial infections. Baltimore: Waverly Press, 1971; 277-81. [18.] Fleiss JL. Statistical methods for rates and proportions, 2nd ed. New York: John Wiley & Sons, 1981. [19.] Katz S, Ford AB, Moskowitz RW. Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA 1963; 185:914-9. [20.] Garrow JS, Webster J. Quetelet's index (W/H2) as a measure of fatness. Int J Obes 1985; 9:147-5. [21.] Schlesselman JJ. Case control studies. New York: Oxford University Press, 1982. [22.] SAS Institute Inc. SAS user's guide: statistics. Version 5 edition. Cary, NC: SAS Institute Inc, 1985. [23.] Wilkinson, L. SYSTAT: the system for statistics. Evanston, Ill: SYSTAT, Inc, 1988. [24.] Sullivan KM, Foster DA. dEPID: a program for stratified and standardized analysis. Version 2.1 Atlanta, GA, and Ann Arbor, Mich, 1987. [25.] Rubenstein LZ, Ouslander JG, Wieland D. Dynamics and clinical implications of the nursing home-hospital interface. Clin Geriatr Med 1988; 4:471-91. [26.] Lichtenstein MJ, Federspiel CF, Schaffner W. Factors associated with early demise in nursing home residents: a case control study. J Am Geriatr Soc 1985;33:315-9. [27.] Rudman D, Feller AG. Protein-calorie undernutrition in the nursing home. J Am Geriatr Soc 1989; 37:173-83.
- Published
- 1992
24. The Transition From Home to Nursing Home Mortality Among People With Dementia
- Author
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Aneshensel, Carol S., Pearlin, Leonard I., Levy-Storms, Lene, and Schuler, Roberleigh H.
- Subjects
Nursing homes -- Admission ,Aged patients -- Patient outcomes ,Mentally ill aged -- Patient outcomes ,Nursing home patients -- Patient outcomes ,Health ,Psychology and mental health ,Seniors - Abstract
Objectives. This article examines the impact of nursing home admission on mortality among persons with dementia, comparing social selection and social causation explanations of excess deaths occurring immediately after relocation. Methods. Data from a multiwave panel survey of caregivers to persons with Alzheimer's Disease (N = 555) are analyzed with proportional hazard models of time from illness onset to death of the care recipient and, for those admitted to a nursing home (N = 272), time from admission until death (N = 272). Results. Relocation is associated with a two-fold increase in mortality risk net of health status. Social selection effects were found for poor health, advanced age, being male, and being White. Patients admitted for reasons other than poor health also experienced elevated mortality immediately following admission, which is inconsistent with a social selection interpretation, However, none of the specific indicators of stressful admission or unsatisfactory nursing home conditions are significantly related to mortality. Discussion. These data demonstrate selection processes for postadmission mortality, but indicate that the admission of patients in poor health may not fully account for the elevation in mortality that occurs immediately following admission.
- Published
- 2000
25. The 'Alzheimerization' of dementia research
- Author
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Royall, Donald
- Subjects
Aged -- Care and treatment ,Aged -- Health aspects ,Dementia -- Diagnosis ,Dementia -- Patient outcomes ,Cognition -- Health aspects ,Alzheimer's disease -- Physiological aspects ,Alzheimer's disease -- Psychological aspects ,Alzheimer's disease -- Diagnosis ,Nursing home patients -- Patient outcomes ,Nursing home patients -- Health aspects ,Medical research -- Methods ,Medicine, Experimental ,Health ,Seniors - Abstract
The 'Alzheimerization' of dementia research is discussed . A study on survival to late-stage dementia in Dutch nursing home patients touches on important issues related to clinical diagnosis of dem entia. Future studies should confirm diagnoses based on stages established by H. Braak et al. Not all Alzheimer's patients are demented.
- Published
- 2003
26. Mortality-related factors and 1-year survival in nursing home residents
- Author
-
Flacker, Jonathan M. and Kiely, Dan K.
- Subjects
Geriatrics -- Research ,Aged -- Health aspects ,Mortality -- Research ,Mortality -- Risk factors ,Nursing home patients -- Patient outcomes ,Death -- Risk factors ,Mortality -- United States ,Health ,Seniors - Abstract
A retrospective cohort study with development and validation cohorts was carried out to identify factors associated with one -year mortality in newly admitted and long-stay ( one year+ ) nursing home residents and to use them to create a tool for estimating risk l evels for one-year mortality. This was done by linking Minimum Data Set (MDS) information with data from the National Death Index . It was found that MDS data can be used to identify major factors associated with one-year mortality in the group studied.
- Published
- 2003
27. Survival to late dementia in Dutch nursing home patients
- Author
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Koopmans, Raymond T.C.M., Ekkerink, John L.P., and Weel, Chris van
- Subjects
Geriatrics -- Research ,Aged -- Health aspects ,Dementia -- Patient outcomes ,Dementia -- Research ,Nursing home patients -- Patient outcomes ,Nursing home patients -- Health aspects ,Nursing home patients -- Psychological aspects ,Aged women -- Health aspects ,Alzheimer's disease -- Patient outcomes ,Death -- Risk factors ,Health ,Seniors - Abstract
An observational analysis of a cohort of patients has been carried out followed by a prospective follow-up to investigate the determinants of survival to late dementia in Dutch nursing home patients. It was found that one of seven nursing home patients with dementia survived to late dementia. Such information is useful in giving information about a prognosis to relatives of a patient. Some patients lived 25 years after disease onset. Most who reached late dementia were women with A lzheimer's disease, and for most of them the phase lasted one year or less. Dementia shortens life expectancy.
- Published
- 2003
28. Nursing home facility risk factors for infection and hospitalization: importance of registered nurse turnover, administration, and social factors
- Author
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Zimmerman, Sheryl, Gruber-Baldini, Ann L., Hebel, J. Richard, Sloane, Philip D., and Magaziner, Jay
- Subjects
Geriatrics -- Research ,Aged -- Care and treatment ,Nursing homes -- Research ,Nursing homes -- Social aspects ,Nursing homes -- Quality management ,Infection -- Care and treatment ,Infection -- Risk factors ,Hospital care -- Risk factors ,Nursing -- Evaluation ,Nursing -- Social aspects ,Nursing home patients -- Health aspects ,Nursing home patients -- Care and treatment ,Nursing home patients -- Patient outcomes ,Nonprofit organizations -- Social aspects ,Nursing home care -- Research ,Political/non-profit organization software ,Company business planning ,Health ,Seniors - Abstract
Nursing home facility risk factors for infection and hospitalization are discussed with focus on findings related to the importance of registered nurse turnover, administration, and social factors. A stratified random sample of 59 nursing homes across Maryland was carried out for this study. The positive relationship between hospitalization for infection and for-profit ownership and chain affiliation could indicate policies not to treat acute illnesses inhouse exist.
- Published
- 2002
29. Effects of Influenza Vaccination of Health Care Workers on Mortality of Elderly People
- Author
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Merenstein, Daniel J., Rosenbaum, Daniel J., and Woolf, Steven H.
- Subjects
Influenza ,Allied health personnel -- Health aspects ,Influenza vaccines -- Usage ,Nursing home patients -- Patient outcomes - Abstract
* Carman W, Elder A, Wallace L, et al. Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care. Lancet 2000; 355:93-7 CLINICAL QUESTION Does [...]
- Published
- 2000
30. Biochemical predictors of short term mortality in elderly residents of chronic care institutions
- Author
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Woo, Jean, Chan, S.M., Mak, Y.T., and Swaminathan, R.
- Subjects
Aged -- Patient outcomes ,Nursing home patients -- Patient outcomes ,Aged -- Food and nutrition ,Nutrition disorders in old age -- Prognosis ,Health - Abstract
Little is known about the nutritional condition of patients residing in long-term care facilities in Asia. Malnutrition, however, is a problem universally recognized to exist among the institutionalized elderly. This has been identified as being due to deficient protein and vitamin intake. These deficiencies, among others, are significant contributors to morbidity and mortality in this patient population. A survey of 208 elderly residents (58 men and 150 women) residing in four long-term care facilities was conducted over a three-month period. The principal reasons for admission to an institution included cerebrovascular accident (stroke), hypertension and chronic heart disease. Over half of the patients were taking therapeutic drugs. Non-medical reasons, primarily social, were the reason for admission for one third of the women. The principal causes of death included infection, cardiorespiratory diseases, cerebrovascular accident, and malignancy. Fifty-seven different variables were examined in each patient. Findings for 28 of the variables differed significantly in the 29 patients who died within three months of the study from the survivors. Valuable predictors of mortality, as identified by statistical analyses in this study, were plasma levels of fructosamine, transferrin, glycosylated hemoglobin, prealbumin, and hemoglobin. These factors could be used to identify patients most in need of supplemental nutritional support. (Consumer Summary produced by Reliance Medical Information, Inc.)
- Published
- 1989
31. Long-term care and impending mortality: influence upon place of death and hospital utilization
- Author
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Montgomery, Patrick R., Kirshen, Albert J., and Roos, Noralou P.
- Subjects
Medical care -- Evaluation ,Nursing home patients -- Patient outcomes ,Aged -- Patient outcomes ,Health ,Seniors - Published
- 1988
32. Serving culture change at mealtimes: positive psychological and medical outcomes increase through a better dining experience
- Author
-
Andreoli, Nicole A., Breuer, Lorraine, Marbury, Diane, Williams, Sylvia, and Rosenblut, Michael N.
- Subjects
Nursing home patients -- Patient outcomes ,Weight loss -- Patient outcomes ,Nursing homes ,Business ,Health care industry - Abstract
The nutritional status of nursing home residents typically is poor and often results in negative health outcomes such as increased illness, disability, and psychological complaints, as well as unintended weight [...]
- Published
- 2007
33. Heat-related mortality among nursing-home patients
- Author
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Mackenbach, Johan P., Borst, Vincent, and Schols, Jos M.G.A.
- Subjects
Mortality -- Risk factors ,Atmospheric temperature -- Physiological aspects ,Nursing home patients -- Patient outcomes ,Aged -- Patient outcomes - Published
- 1997
34. Outcome of nursing home patients presenting to an emergency department in respiratory failure
- Author
-
Moore, Jason L., Munasinghe, Rajika, and MacDonald, Lawrence
- Subjects
Acute respiratory distress syndrome -- Risk factors ,Acute respiratory distress syndrome -- Patient outcomes ,Acute respiratory distress syndrome -- Research ,Nursing home patients -- Health aspects ,Nursing home patients -- Patient outcomes ,Mortality -- Statistics ,Mortality -- United States ,Health - Abstract
PURPOSE: There is limited information regarding the outcome and survival of institutionalized patients who present with acute respiratory failure. We investigated the inpatient outcome and one year mortality of nursing [...]
- Published
- 2005
35. Sleep apnea in female patients in a nursing home: increased risk of mortality
- Author
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Ancoli-Israel, Sonia, Klauber, Melville R., Kripke, Daniel F., Parker, Linda, and Cobarrubias, Marta
- Subjects
Mortality ,Aged women -- Patient outcomes ,Nursing home patients -- Patient outcomes ,Sleep apnea syndromes -- Patient outcomes ,Health ,Patient outcomes - Abstract
There has been much speculation on the risk of mortality associated with sleep apnea. We followed-up 233 elderly patients in nursing homes, 70 percent of whom had five or more [...]
- Published
- 1989
36. A cluster of unexplained deaths in a nursing home in Florida
- Author
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Sacks, Jeffrey J., Herndon, Joy L., Lieb, Spencer H., Sorhage, Faye E., McCaig, Linda F., and Withum, David G.
- Subjects
Florida. Department of Health -- Investigations ,Nursing home patients -- Patient outcomes ,Nursing home care -- Florida ,Nursing homes -- Investigations ,Government ,Health care industry - Published
- 1988
37. Teaching and grieving
- Author
-
Akins, Sherry D.
- Subjects
Nursing home patients -- Patient outcomes ,Nurses -- Personal narratives ,Health - Published
- 1999
38. Long-term antipsychotics boost mortality in AD: limited use of the drugs is still recommended, but only after the risks have been carefully weighed
- Author
-
Sullivan, Michele G.
- Subjects
Nursing home patients -- Patient outcomes ,Alzheimer's disease -- Patient outcomes ,Alzheimer's disease -- Drug therapy ,Drugs ,Mortality ,Antipsychotic drugs - Abstract
Antipsychotic appear to increase the risk of death in patients with Alzherimer's disease, especially if they were taken for more than 12 months, according to data from a randomized controlled [...]
- Published
- 2009
39. Unacceptable Nursing Home Deaths Unautopsied
- Author
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Mitka, Mike
- Subjects
Autopsy -- Analysis ,Nursing home patients -- Patient outcomes ,Nursing homes -- Investigations - Abstract
Most nursing home patients who die are never autopsied. In a 1990 survey of nursing home deaths in New York State between 1980 and 1984, only 0.8% were autopsied. Autopsies were done routinely in the past, but the threat of lawsuits and the cost of autopsies has led to a decline in the autopsy rate. This is a problem because studies of autopsies have consistently shown that about 40% reveal an undiagnosed condition that could have contributed to death. And many of these conditions are preventable. A federal investigation of 62 deaths in California nursing homes found that 34 of the patients received substandard care.
- Published
- 1998
40. Fecal Incontinence in the Institutionalized Elderly: Incidence, Risk Factors, and Prognosis
- Author
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Chassagne, Philippe, Landrin, Isabelle, Neveu, Christophe, Czernichow, Pierre, Bouaniche, Marc, Doucet, Jean, Denis, Philippe, and Bercoff, Eric
- Subjects
Fecal incontinence -- Risk factors ,Nursing home patients -- Patient outcomes ,Health ,Health care industry - Abstract
PURPOSE: This study was conducted to evaluate the incidence, identify the risk factors, and assess the prognosis of elderly institutionalized patients who develop fecal incontinence. PATIENTS AND METHODS: We enrolled 1,186 patients 60 years of age and older living in long-term care facilities who did not have fecal incontinence. We assessed their medical history, treatment, mobility, and cognitive function. Patients were followed up for 10 months to determine the incidence of fecal incontinence, defined as at least one involuntary loss of feces. Independent risk factors associated with fecal incontinence were identified using Cox proportional hazards models. The prognosis of incontinent patients was assessed by comparing their survival rate with that in the continent patients. RESULTS: Fecal incontinence occurred in 234 patients (20%), and was usually associated with acute diarrhea or fecal impaction. We identified five risk factors for the development of fecal incontinence: a history of urinary incontinence (rate ratio [RR]: 2.0, 95% confidence interval [CI] 1.5 to 2.6); neurological disease (RR: 1.9, 95% CI 1.0 to 3.4); poor mobility (RR: 1.7, 95% CI 1.2 to 2.4); severe cognitive decline (RR: 1.4, 95% CI 1.1 to 1.9); and age older than 70 years (RR: 1.7, 95% CI 1.0 to 2.8). Tenmonth mortality in the 89 patients with long-term ([is greater than or equal to] 8 days) incontinence was 26%, significantly greater than that observed in the continent group (6.7%) or in the 145 patients with transient incontinence (10%). CONCLUSIONS: Long-lasting or permanent fecal incontinence was associated with increased mortality, suggesting that this symptom is a marker of poor health in older patients. Actions that improve mobility might help prevent fecal incontinence in elderly patients. Am J Med. 1999;106:185-190. [C] 1999 by Excerpta Medica, Inc.
- Published
- 1999
41. Mortality of the Institutionalized Old-Old Hospitalized With Congestive Heart Failure
- Author
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Wang, Rebecca, Mouliswar, Mysore, Denman, Susan, and Kleban, Morton
- Subjects
Congestive heart failure -- Patient outcomes ,Aged patients -- Patient outcomes ,Nursing home patients -- Patient outcomes ,Health - Abstract
Background: Congestive heart failure is a major cause of mortality and morbidity in the elderly but the disease impact on the oldest and sickest population has not been defined. Objectives: To review the mortality and hospital readmission rate of institutionalized elderly persons with congestive heart failure and to examine the relation of baseline characteristics to subsequent clinical outcomes. Methods: This was a retrospective analysis based on chart review of 231 residents of the Philadelphia (Pa) Geriatric Center (63 congregate housing tenants and 168 nursing home residents) 80 years and older, hospitalized with congestive heart failure from 1989 to 1995. Patients' demographic data and clinical, electrocardiographic, and echocardiographic findings were obtained from their initial (index) hospitalization records. Subsequent outcomes were obtained from their outpatient (nursing home or office) records. Results: Thirteen percent died during the index hospitalization but the total mortality during the follow-up period was 87%. One hundred forty-six patients (63%) died in the first year with a mean [+ or -] SD survival of 4 [+ or -] 4 months and a readmission rate of 3.9 per patient-year. Eighty-five patients survived the first year with a readmission rate of 1.2 per patient-year and 54 patients subsequently died, with a mean [+ or -] SD survival of 28 [+ or -] 12 months. The first-year decedents and survivors were comparable in sex, age, medical history, and electrocardiographic findings. However, patients who died in the first year, compared with survivors, were more likely to be nursing home residents (81% vs 59%), have New York Heart Association class IV heart failure (54% vs 32%), have impaired left ventricular function by echocardiogram (53% vs 32%), and have renal insufficiency (32% vs 11%). Conclusions: Very elderly persons with congestive heart failure had a guarded long-term prognosis. Nursing home residency, class IV heart failure, impaired left ventricular function, and renal insufficiency were associated with higher risk for early death and repetitive hospitalizations. Arch Intern Med. 1998;158:2464-2468
- Published
- 1998
42. Survey: DNR orders more common among whites, severely impaired
- Subjects
Nursing homes -- Surveys ,Nursing home patients -- Patient outcomes ,Advance directives (Medicine) -- Demographic aspects ,Health ,Seniors - Abstract
Advance directives in nursing homes, which consist primarily of do not resuscitate (DNR) orders, are more prevalent among whites, those with severe cognitive and functional impairment, and the very old, [...]
- Published
- 1993
43. Simple nutrition program improves outcomes
- Subjects
Nursing home patients -- Patient outcomes ,Weight loss -- Patient outcomes ,Medical care, Cost of ,Business ,Health care industry - Abstract
Long-term care/geriatrics Simple nutrition program improves outcomes Supplements with meds boost compliance Sometimes its not what you do but when you do it that determines whether a treatment plan succeeds. [...]
- Published
- 1999
44. Screening for frailty among elderly predicts outcomes
- Subjects
Aged -- Patient outcomes ,Medical screening -- Usage ,Nursing home patients -- Patient outcomes ,Health ,Health care industry ,Psychology and mental health - Abstract
According to one study, rapid clinical screening using specific geriatric criteria is effective in identifying frail older subjects at risk for mortality and nursing home utilization. The study was conducted [...]
- Published
- 1991
45. Patients with DNR orders may be more likely to die
- Subjects
Nursing home patients -- Patient outcomes ,Resuscitation -- Statistics ,Long-term care of the sick -- Statistics ,Health ,Health care industry ,Psychology and mental health - Abstract
Patients with do-not-resuscitate (DNR) orders were four times as likely to die and twice as likely to be started on intravenous therapies as patients without DNR orders, according to Massachusetts [...]
- Published
- 1991
46. Resident's death highlights need for oral care. (In brief: news & studies)
- Subjects
Nursing home patients -- Care and treatment ,Nursing home patients -- Patient outcomes ,Business ,Insurance ,Law - Abstract
'In the nursing home population, poor oral hygiene is common, with a 50 [percent] prevalence of dental caries.' According to a recent report, the death of a 76-year old nursing [...]
- Published
- 2002
47. Dishwasher fluid kills resident in London nursing home. (Around the Globe)
- Subjects
Nursing home patients -- Patient outcomes ,Nurses -- Malpractice ,Medical errors -- Investigations ,Business ,Insurance ,Law - Abstract
On December 4, 2001, Philip Scott, managing director of Southern Cross Healthcare that operates the London-based Lady Astor Court nursing home, advised that a facility employee mistakenly gave 10 elderly [...]
- Published
- 2002
48. Mortality increases in NH population
- Author
-
Mor, Vincent
- Subjects
Nursing home patients -- Patient outcomes ,Health ,Health care industry ,Psychology and mental health - Published
- 1997
49. LTC residents have a CPR survival rate similar to community elders
- Subjects
Nursing home patients -- Patient outcomes ,CPR (First aid) -- Usage ,Health ,Health care industry ,Psychology and mental health - Abstract
Elders who live in nursing homes are just as likely to survive cardiopulmonary resuscitation (CPR) following cardiac arrest as comparable men and women who live in the community, according to [...]
- Published
- 1995
50. Simple nutritional index can predict residents' mortality
- Subjects
Nursing home patients -- Patient outcomes ,Nutrition -- Evaluation ,Health ,Health care industry ,Psychology and mental health - Abstract
A nutritional index, based on simple measures, can be a useful tool in evaluating the health status of elderly nursing home residents, according to a recent article in the Journal [...]
- Published
- 1994
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