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Savage RD, Sutradhar R, Luo J, Strauss R, Guan J, Rochon PA, Gruneir A, Sanmartin C, Goel V, Rosella LC, Stall NM, Chamberlain SA, Yu C, Bronskill SE. Sex-based trajectories of health system use in lonely and not lonely older people: A population-based cohort study. J Am Geriatr Soc 2024; 72:1100-1111. [PMID: 38407328 DOI: 10.1111/jgs.18833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND There is growing interest in understanding the care needs of lonely people but studies are limited and examine healthcare settings separately. We estimated and compared healthcare trajectories in lonely and not lonely older female and male respondents to a national health survey. METHODS We conducted a retrospective cohort study of community-dwelling, Ontario respondents (65+ years) to the 2008/2009 Canadian Community Health Survey-Healthy Aging. Respondents were classified at baseline as not lonely, moderately lonely, or severely lonely using the Three-Item Loneliness Scale and then linked with health administrative data to assess healthcare transitions over a 12 -year observation period. Annual risks of moving from the community to inpatient, long-stay home care, long-term care settings-and death-were estimated across loneliness levels using sex-stratified multistate models. RESULTS Of 2684 respondents (58.8% female sex; mean age 77 years [standard deviation: 8]), 635 (23.7%) experienced moderate loneliness and 420 (15.6%) severe loneliness. Fewer lonely respondents remained in the community with no transitions (not lonely, 20.3%; moderately lonely, 17.5%; and severely lonely, 12.6%). Annual transition risks from the community to home care and long-term care were higher in female respondents and increased with loneliness severity for both sexes (e.g., 2-year home care risk: 6.1% [95% CI 5.5-6.6], 8.4% [95% CI 7.4-9.5] and 9.4% [95% CI 8.2-10.9] in female respondents, and 3.5% [95% CI 3.1-3.9], 5.0% [95% CI 4.0-6.0], and 5.4% [95% CI 4.0-6.8] in male respondents; 5-year long-term care risk: 9.2% [95% CI 8.0-10.8], 11.1% [95% CI 9.3-13.6] and 12.2% [95% CI 9.9-15.3] [female], and 5.3% [95% CI 4.2-6.7], 9.1% [95% CI 6.8-12.5], and 10.9% [95% CI 7.9-16.3] [male]). CONCLUSIONS Lonely older female and male respondents were more likely to need home care and long-term care, with severely lonely female respondents having the highest probability of moving to these settings.
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Affiliation(s)
- Rachel D Savage
- Women's Age Lab, Women's College Hospital, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Jin Luo
- ICES, Toronto, Ontario, Canada
| | | | | | - Paula A Rochon
- Women's Age Lab, Women's College Hospital, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Division of Geriatric Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Gruneir
- ICES, Toronto, Ontario, Canada
- Department of Family Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Claudia Sanmartin
- Analytical Studies and Modelling Branch, Statistics Canada, Ottawa, Ontario, Canada
| | - Vivek Goel
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Laura C Rosella
- ICES, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nathan M Stall
- Women's Age Lab, Women's College Hospital, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Division of Geriatric Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie A Chamberlain
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Christina Yu
- Women's Age Lab, Women's College Hospital, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Susan E Bronskill
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Gill A, Meadows L, Ashbourne J, Kaasalainen S, Shamon S, Pereira J. 'Confidence and fulfillment': a qualitative descriptive study exploring the impact of palliative care training for long-term care physicians and nurses. Palliat Care Soc Pract 2024; 18:26323524241235180. [PMID: 38449569 PMCID: PMC10916492 DOI: 10.1177/26323524241235180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/08/2024] [Indexed: 03/08/2024] Open
Abstract
Objective To explore the impact of a 2-day, in-person interprofessional palliative care course for staff working in long-term care (LTC) homes. Methods A qualitative descriptive study design was employed. LTC staff who had participated in Pallium Canada's Learning Essential Approaches to Palliative Care LTC Course in Ontario, Canada between 2017 and 2019 were approached. Semi-structured interviews were conducted, using an online videoconferencing platform in mid-2021 in Ontario, Canada. These were done online, recorded, and transcribed. Data were coded inductively. Results Ten persons were interviewed: four registered practical nurses, three registered nurses, one nurse practitioner, and two physicians. Some held leadership roles. Participants described ongoing impact on themselves and their ability to provide end-of-life (EOL) care (micro-level), their services and institutions (meso-level), and their healthcare systems (macro-level). At a micro-level, participants described increased knowledge and confidence to support residents and families, and increased work fulfillment. At the meso-level, their teams gained increased collective knowledge and greater interprofessional collaboration to provide palliative care. At the macro level, some participants connected with other LTC homes and external stakeholders to improve palliative care across the sector. Training provided much-needed preparedness to respond to the impact of the COVID-19 pandemic, including undertaking advance care planning and EOL conversations. The pandemic caused staff burnout and shortages, creating challenges to applying course learnings. Significance of results The impact of palliative care training had ripple effects several years after completing the training, and equipped staff with key skills to provide care during the COVID-19 pandemic. Palliative care education of staff remains a critical element of an overall strategy to improve the integration of palliative care in LTC.
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Affiliation(s)
- Ashlinder Gill
- Division of Palliative Care, Department of Family Medicine, McMaster University, 5th Floor, 100 Main Street West, Hamilton, ON, Canada L8P 1H6
| | - Lynn Meadows
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jessica Ashbourne
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Sharon Kaasalainen
- Faculty of Health Sciences, Division of Palliative Care, Department of Family Medicine, School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Sandy Shamon
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, ON, Canada
- Temmy Latner Centre for Palliative Care, Toronto, ON, Canada
| | - José Pereira
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, ON, Canada
- Pallium Canada, Ottawa, ON, Canada
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Pan X, Xu J, Rullán PJ, Pasqualini I, Krebs VE, Molloy RM, Piuzzi NS. Are All Patients Going Home after Total Knee Arthroplasty? A Temporal Analysis of Discharge Trends and Predictors of Nonhome Discharge (2011-2020). J Knee Surg 2024; 37:254-266. [PMID: 36963431 DOI: 10.1055/a-2062-0468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Abstract
Value-based orthopaedic surgery and reimbursement changes for total knee arthroplasty (TKA) are potential factors shaping arthroplasty practice nationwide. This study aimed to evaluate (1) trends in discharge disposition (home vs nonhome discharge), (2) episode-of-care outcomes for home and nonhome discharge cohorts, and (3) predictors of nonhome discharge among patients undergoing TKA from 2011 to 2020. The National Surgical Quality Improvement Program database was reviewed for all primary TKAs from 2011 to 2020. A total of 462,858 patients were identified and grouped into home discharge (n = 378,771) and nonhome discharge (n = 84,087) cohorts. The primary outcome was the annual rate of home/nonhome discharges. Secondary outcomes included trends in health care utilization parameters, readmissions, and complications. Multivariable logistic regression analyses were performed to evaluate factors associated with nonhome discharge. Overall, 82% were discharged home, and 18% were discharged to a nonhome facility. Home discharge rates increased from 65.5% in 2011 to 94% in 2020. Nonhome discharge rates decreased from 34.5% in 2011 to 6% in 2020. Thirty-day readmissions decreased from 3.2 to 2.4% for the home discharge cohort but increased from 5.6 to 6.1% for the nonhome discharge cohort. Female sex, Asian or Black race, Hispanic ethnicity, American Society of Anesthesiology (ASA) class > II, Charlson comorbidity index scores > 0, smoking, dependent functional status, and age > 60 years were associated with higher odds of nonhome discharge. Over the last decade, there has been a major shift to home discharge after TKA. Future work is needed to further assess if perioperative interventions may have a positive effect in decreasing adverse outcomes in nonhome discharge patients.
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Affiliation(s)
- Xuankang Pan
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - James Xu
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Pedro J Rullán
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ignacio Pasqualini
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Viktor E Krebs
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Robert M Molloy
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio
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Edelstein J, Li CY, Meythaler J, Weaver JA, Graham JE. Inpatient Rehabilitation Facility Ownership Type Yields Mixed Performances on Quality Measures. Arch Phys Med Rehabil 2024; 105:443-451. [PMID: 37907161 PMCID: PMC11006015 DOI: 10.1016/j.apmr.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE To evaluate the effects of inpatient rehabilitation facility (IRF) ownership type on IRF-Quality Reporting Program (IRF-QRP) measures. DESIGN Cross-sectional, observational design. SETTING We used 2 Centers for Medicare and Medicare publicly-available, facility-level data sources: (1) IRF compare files and (2) IRF rate setting files - final rule. Data from 2021 were included. PARTICIPANTS The study sample included 1092 IRFs (N=1092). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES We estimated the effects of IRF ownership type, defined as for-profit and nonprofit, on 15 IRF-QRP measures using general linear models. Models were adjusted for the following facility-level characteristics: (1) Centers for Medicare and Medicaid census divisions; (2) number of discharges; (3) teaching status; (4) freestanding vs hospital unit; and (5) estimated average weight per discharge. RESULTS Ownership type was significantly associated with 9 out of the fifteen IRF-QRP measures. Nonprofit IRFs performed better with having lower readmissions rates within stay and 30-day post discharge. For-profit IRFs performed better for all the functional measures and with higher rates of returning to home and the community. Lastly, for-profit IRFs spent more per Medicare beneficiary. CONCLUSIONS Ideally, IRF performance would not vary based on ownership type. However, we found that ownership type is associated with IRF-QRP performance scores. We suggest that future studies investigate how ownership type affects patient-level outcomes and the longitudinal effect of ownership type on IRF-QRP measures.
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Affiliation(s)
- Jessica Edelstein
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO.
| | - Chih-Ying Li
- Department of Occupational Therapy, School of Health Professions, University of Texas Medical Branch, Galveston, TX
| | - Jay Meythaler
- Department of Physical Medicine and Rehabilitation, Wayne State University, Detroit, MI
| | - Jennifer A Weaver
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO
| | - James E Graham
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO
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Tanuseputro P, Roberts RL, Milani C, Clarke AE, Webber C, Isenberg SR, Kobewka D, Turcotte L, Bush SH, Boese K, Arya A, Robert B, Sinnarajah A, Simon JE, Howard M, Lau J, Qureshi D, Fremont D, Downar J. Palliative End-of-Life Medication Prescribing Rates in Long-Term Care: A Retrospective Cohort Study. J Am Med Dir Assoc 2024; 25:532-538.e8. [PMID: 38242534 DOI: 10.1016/j.jamda.2023.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Medications are often needed to manage distressing end-of-life symptoms (eg, pain, agitation). OBJECTIVES In this study, we describe the variation in prescribing rates of symptom relief medications at the end of life among long-term care (LTC) decedents. We evaluate the extent these medications are prescribed in LTC homes and whether prescribing rates of end-of-life symptom management can be used as an indicator of quality end-of-life care. DESIGN Retrospective cohort study using administrative health data. SETTING AND PARTICIPANTS LTC decedents in all 626 publicly funded LTC homes in Ontario, Canada, between January 1, 2017, and March 17, 2020. METHODS For each LTC home, we measured the percent of decedents who received 1+ prescription(s) for a subcutaneous end-of-life symptom management medication ("end-of-life medication") in their last 14 days of life. We then ranked LTC homes into quintiles based on prescribing rates. RESULTS We identified 55,916 LTC residents who died in LTC. On average, two-thirds of decedents (64.7%) in LTC homes were prescribed at least 1 subcutaneous end-of-life medication in the last 2 weeks of life. Opioids were the most common prescribed medication (overall average prescribing rate of 62.7%). LTC homes in the lowest prescribing quintile had a mean of 37.3% of decedents prescribed an end-of-life medication, and the highest quintile mean was 82.5%. In addition, across these quintiles, the lowest prescribing quintile had a high average (30.3%) of LTC residents transferred out of LTC in the 14 days compared with the highest prescribing quintile (12.7%). CONCLUSIONS AND IMPLICATIONS Across Ontario's LTC homes, there are large differences in prescribing rates for subcutaneous end-of-life symptom relief medications. Although future work may elucidate why the variability exists, this study provides evidence that administrative data can provide valuable insight into the systemic delivery of end-of-life care.
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Affiliation(s)
- Peter Tanuseputro
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Bruyère Research Institute, Bruyère Continuing Care, Ottawa, Ontario, Canada.
| | - Rhiannon L Roberts
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Christina Milani
- Bruyère Research Institute, Bruyère Continuing Care, Ottawa, Ontario, Canada
| | - Anna E Clarke
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Colleen Webber
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sarina R Isenberg
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Bruyère Research Institute, Bruyère Continuing Care, Ottawa, Ontario, Canada
| | - Daniel Kobewka
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Luke Turcotte
- Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Shirley H Bush
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Bruyère Research Institute, Bruyère Continuing Care, Ottawa, Ontario, Canada
| | - Kaitlyn Boese
- Bruyère Research Institute, Bruyère Continuing Care, Ottawa, Ontario, Canada
| | - Amit Arya
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Kensington Research Institute, Toronto, Ontario, Canada
| | - Benoit Robert
- Centre of Excellence in Frailty-Informed Care, Perley Health, Ottawa, Ontario, Canada
| | | | - Jessica E Simon
- Department of Oncology, Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michelle Howard
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jenny Lau
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Palliative Care, University Health Network, Toronto, Ontario, Canada
| | - Danial Qureshi
- Bruyère Research Institute, Bruyère Continuing Care, Ottawa, Ontario, Canada
| | - Deena Fremont
- Bruyère Research Institute, Bruyère Continuing Care, Ottawa, Ontario, Canada
| | - James Downar
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Bruyère Research Institute, Bruyère Continuing Care, Ottawa, Ontario, Canada
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Hoben M, Dymchuk E, Doupe MB, Keefe J, Aubrecht K, Kelly C, Stajduhar K, Banerjee S, O'Rourke HM, Chamberlain S, Beeber A, Salma J, Jarrett P, Arya A, Corbett K, Devkota R, Ristau M, Shrestha S, Estabrooks CA. Counting what counts: assessing quality of life and its social determinants among nursing home residents with dementia. BMC Geriatr 2024; 24:177. [PMID: 38383339 PMCID: PMC10880372 DOI: 10.1186/s12877-024-04710-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/15/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Maximizing quality of life (QoL) is a major goal of care for people with dementia in nursing homes (NHs). Social determinants are critical for residents' QoL. However, similar to the United States and other countries, most Canadian NHs routinely monitor and publicly report quality of care, but not resident QoL and its social determinants. Therefore, we lack robust, quantitative studies evaluating the association of multiple intersecting social determinants with NH residents' QoL. The goal of this study is to address this critical knowledge gap. METHODS We will recruit a random sample of 80 NHs from 5 Canadian provinces (Alberta, British Columbia, Manitoba, Nova Scotia, Ontario). We will stratify facilities by urban/rural location, for-profit/not-for-profit ownership, and size (above/below median number of beds among urban versus rural facilities in each province). In video-based structured interviews with care staff, we will complete QoL assessments for each of ~ 4,320 residents, using the DEMQOL-CH, a validated, feasible tool for this purpose. We will also assess resident's social determinants of QoL, using items from validated Canadian population surveys. Health and quality of care data will come from routinely collected Resident Assessment Instrument - Minimum Data Set 2.0 records. Knowledge users (health system decision makers, Alzheimer Societies, NH managers, care staff, people with dementia and their family/friend caregivers) have been involved in the design of this study, and we will partner with them throughout the study. We will share and discuss study findings with knowledge users in web-based summits with embedded focus groups. This will provide much needed data on knowledge users' interpretations, usefulness and intended use of data on NH residents' QoL and its health and social determinants. DISCUSSION This large-scale, robust, quantitative study will address a major knowledge gap by assessing QoL and multiple intersecting social determinants of QoL among NH residents with dementia. We will also generate evidence on clusters of intersecting social determinants of QoL. This study will be a prerequisite for future studies to investigate in depth the mechanisms leading to QoL inequities in LTC, longitudinal studies to identify trajectories in QoL, and robust intervention studies aiming to reduce these inequities.
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Affiliation(s)
- Matthias Hoben
- School of Health Policy and Management, Faculty of Health, York University, Room 301E Stong College, 4700 Keele StreetON, Toronto, M3J 1P3, Canada.
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada.
| | - Emily Dymchuk
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Malcolm B Doupe
- Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Janice Keefe
- Nova Scotia Centre on Aging, Mount Saint Vincent University, Halifax, Canada
| | - Katie Aubrecht
- Department of Sociology, Faculty of Arts, St. Francis Xavier University, Antigonish, NS, Canada
| | - Christine Kelly
- Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Kelli Stajduhar
- School of Nursing, Faculty of Human & Social Development, University of Victoria, Victoria, BC, Canada
| | - Sube Banerjee
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Hannah M O'Rourke
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Stephanie Chamberlain
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Anna Beeber
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Jordana Salma
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Pamela Jarrett
- Faculty of Medicine, Dalhousie University, Horizon Health Network, Saint John, New Brunswick, Canada
| | - Amit Arya
- Freeman Centre for the Advancement of Palliative Care, North York General Hospital, Toronto, ON, Canada
- Specialist Palliative Care in Long-Term Care Outreach Team, Kensington Gardens Long-Term Care, Kensington Health, Toronto, ON, Canada
- Division of Palliative Care, Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Kyle Corbett
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Rashmi Devkota
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Melissa Ristau
- Dr. Gerald Zetter Care Centre, The Good Samaritan Society, Edmonton, AB, Canada
| | - Shovana Shrestha
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
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Inacio MC, Davies L, Jorissen R, Air T, Eshetie T, Mittinty M, Caughey G, Miller C, Wesselingh S. Excess mortality in residents of aged care facilities during COVID-19 in Australia, 2019-22. Int J Epidemiol 2024; 53:dyad168. [PMID: 38102926 DOI: 10.1093/ije/dyad168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND To date, the excess mortality experienced by residential aged care facility (RACF) residents related to COVID-19 has not been estimated in Australia. This study examined (i) the historical mortality trends (2008-09 to 2021-22) and (ii) the excess mortality (2019-20 to 2021-22) of Australian RACF residents. METHODS A retrospective population-based study was conducted using the Australian Institute of Health and Welfare's GEN website data (publicly available aged care services information). Non-Aboriginal, older (≥65 years old) RACF residents between 2008-09 and 2021-22 were evaluated. The observed mortality rate was estimated from RACF exits compared with the RACF cohort yearly. Direct standardization was employed to estimate age-standardized mortality rates and 95% CIs. Excess mortality and 95% prediction intervals (PIs) for 2019-20 to 2021-22 were estimated using four negative binomial (NB) and NB generalized additive models and compared. RESULTS The age-standardized mortality rate in 2018-19 was 23 061/100 000 residents (95% CI, 22 711-23 412). This rate remained similar in 2019-20 (23 023/100 000; 95% CI, 22 674-23 372), decreased in 2020-21 (22 559/100 000; 95% CI, 22 210-22 909) and increased in 2021-22 (24 885/100 000; 95% CI, 24 543-25 227). The mortality rate increase between 2020-21 and 2021-22 was observed in all age and sex groups. All models yielded excess mortality in 2021-22. Using the best-performing model (NB), the excess mortality for 2019-20 was -160 (95% PI, -418 to 98), -958 (95% PI, -1279 to -637) for 2020-21 and 4896 (95% PI, 4503-5288) for 2021-22. CONCLUSIONS In 2021-22, RACF residents, who represented <1% of the population, experienced 21% of the Australian national excess mortality (4896/22 886). As Australia adjusts to COVID-19, RACF residents remain a population vulnerable to COVID-19.
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Affiliation(s)
- Maria C Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Allied Health and Human Performance Academic Unit, University of South Australia, Adelaide, SA, Australia
| | - Ling Davies
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Allied Health and Human Performance Academic Unit, University of South Australia, Adelaide, SA, Australia
- School of Public Health, University of Adelaide, Adelaide, SA, Australia
| | - Robert Jorissen
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Tracy Air
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Tesfahun Eshetie
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Allied Health and Human Performance Academic Unit, University of South Australia, Adelaide, SA, Australia
- Clinical & Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Murthy Mittinty
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Gillian Caughey
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Allied Health and Human Performance Academic Unit, University of South Australia, Adelaide, SA, Australia
| | - Caroline Miller
- School of Public Health, University of Adelaide, Adelaide, SA, Australia
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Steve Wesselingh
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
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Crea-Arsenio M, Baumann A, Antonipillai V, Akhtar-Danesh N. Factors associated with pressure ulcer and dehydration in long-term care settings in Ontario, Canada. PLoS One 2024; 19:e0297588. [PMID: 38295099 PMCID: PMC10830047 DOI: 10.1371/journal.pone.0297588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 01/08/2024] [Indexed: 02/02/2024] Open
Abstract
Pressure ulcers and dehydration are common conditions among residents of long-term care facilities that result in negative health effects. They have been associated with signs of neglect and increased 30-day mortality among LTC residents. However, they are both preventable and with proper care can be effectively managed and treated. We conducted a retrospective cohort study to examine factors associated with pressure ulcers and dehydration among long-term care residents in the province of Ontario, Canada. Results indicated that close to one-fifth of residents were dehydrated (17.3%) or had a pressure ulcer (18.9%) during the study period. Advanced age was significantly associated with the presence of pressure ulcers and dehydration for both men and women. However, men were more likely to present with a pressure ulcer while women were more likely to exhibit symptoms of dehydration. Study findings also demonstrate the presence of both conditions being higher in municipal and not-for-profit homes compared to for-profit homes. The significant differences observed in relation to home ownership which require further investigation to identify the most relevant factors in explaining these differences. Overall, pressure ulcers and dehydration are preventable conditions that warrant attention from policymakers to ensure quality of care and resident safety are prioritized.
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Affiliation(s)
| | - Andrea Baumann
- Global Health, McMaster University, Hamilton, Ontario, Canada
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | | | - Noori Akhtar-Danesh
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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9
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Kunkel MC, Applebaum R, Nelson M. Strategies to Address COVID-19 Vaccine Hesitancy Among Ohio Nursing Home Staff. THE GERONTOLOGIST 2023; 63:1510-1517. [PMID: 36165713 PMCID: PMC9619465 DOI: 10.1093/geront/gnac147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Despite federal legislation requiring nursing home (NH) staff members to be vaccinated against coronavirus disease 2019 (COVID-19), unvaccinated staff pose an ongoing public health risk. The research question guiding this study is as follows: What is the relationship between strategies to address vaccine hesitancy and vaccination rates among staff? We used the diffusion of innovation (DOI) theory as a theoretical framework. RESEARCH DESIGN AND METHODS The sample (N = 627) included Ohio-based NHs. Using national and state NH data, multivariable linear regression techniques demonstrated the relationship between strategies to address vaccine hesitancy and vaccination rates among NH staff. RESULTS Peer counseling and providing sick time or time off for vaccine symptoms were both statistically significant strategies. Compared to facilities that did not engage in peer counseling, those that did saw an average increase of 3.2% of their staff vaccinated. Those that provided sick time or time off saw an average increase of 3.9% of their staff vaccinated. There was no statistically significant relationship between hiring full- or part-time facility infection preventionists and vaccination rates. DISCUSSION AND IMPLICATIONS In order to foster vaccine confidence among long-term services staff, peer counseling, and providing sick time or time off are examples of strategies that can affect vaccination rates among staff. According to DOI, these strategies target the communication channels and social systems of an organization. While this study focuses on NHs, results remain critically important to the remainder of the long-term services system, which does not have vaccine requirements similar to the NH industry.
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Affiliation(s)
- Miranda C Kunkel
- Miami University, Department of Sociology and Gerontology, Oxford, Ohio, USA
| | - Robert Applebaum
- Miami University, Department of Sociology and Gerontology, Oxford, Ohio, USA
- Scripps Gerontology Center, Miami University, Oxford, Ohio, USA
| | - Matt Nelson
- Scripps Gerontology Center, Miami University, Oxford, Ohio, USA
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10
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Chae HW, Zhao J, Ah YM, Choi KH, Lee JY. Potentially inappropriate medication use as predictors of hospitalization for residents in nursing home. BMC Geriatr 2023; 23:467. [PMID: 37532993 PMCID: PMC10394923 DOI: 10.1186/s12877-023-04165-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 07/11/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Hospitalization of nursing home (NH) residents impose a significant healthcare burden. However, there is still a lack of information regarding the risk of hospitalization from inappropriate prescribing in NH residents. We aimed to estimate the nationwide prevalence of potentially inappropriate medication (PIM) use among NH residents using the Korean tool and 2019 Beers criteria and to assess their associations with hospitalization or emergency department (ED) visits. METHODS We included older adults aged 65 years or above who were admitted to NHs between July 2008 and December 2018 using national senior cohort database. The prevalence of PIM use based on the Korean medication review tool and Beers criteria on the date of admission to NH was estimated. And the adjusted hazard ratios (aHRs) of polypharmacy, numbers of PIM, each PIM category for hospitalization/ED visits within 30 days of admission to NH was calculated using Cox proportional hazard model to show the association. RESULTS Among 20,306 NH residents, the average number of medications per person was 7.5 ± 4.7. A total of 89.3% and 67.9% of the NH residents had at least one PIM based on the Korean tool and 2019 Beers criteria, respectively. The risk of ED visits or hospitalization significantly increased with the number of PIMs based on the Korean tool (1-3: aHR = 1.24, CI 1.03-1.49; ≥4: aHR = 1.46, CI 1.20-1.79). Having four or more PIMs based on the Beers criteria increased the risk significantly (aHR = 1.30, CI 1.06-1.53) while using 1-3 PIMs was not significantly associated (aHR = 1.07, CI 0.97-1.19). Residents with any potential medication omission according to the Korean criteria, were at 23% higher risk of hospitalization or ED visits (aHR = 1.23, CI 1.07-1.40). CONCLUSIONS This study demonstrated that PIMs, based on the Korean tool and Beers criteria, were prevalent among older adults living in NHs and the use of PIMs were associated with hospitalization or ED visits. The number of PIMs based on the Korean tool showed dose-response increase in the risk of hospitalization or ED visits.
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Affiliation(s)
- Hyun-Woo Chae
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - Jing Zhao
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - Young-Mi Ah
- College of Pharmacy, Yeungnam University, 280 Daehak-Ro, Gyeongsan, Gyeongsangbuk, 38541, Republic of Korea
| | - Kyung Hee Choi
- College of Pharmacy, Gachon University, 191 Hambakmoero, Yeonsu-gu, Incheon, 21936, Republic of Korea
| | - Ju-Yeun Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea.
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11
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Shamon S, Gill A, Meadows L, Kruizinga J, Kaasalainen S, Pereira J. Providing palliative and end-of-life care in long-term care during the COVID-19 pandemic: a qualitative study of clinicians' lived experiences. CMAJ Open 2023; 11:E745-E753. [PMID: 37607749 PMCID: PMC10449019 DOI: 10.9778/cmajo.20220238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND A disproportionate number of COVID-19-related deaths in Canada occurred in long-term care homes, affecting residents, families and staff alike. This study explored the experiences of long-term care clinicians with respect to providing palliative and end-of-life care during the COVID-19 pandemic. METHODS We used a qualitative research approach. Long-term care physicians and nurse practitioners (NPs) in Ontario, Canada, participated in semistructured interviews between August and September of 2021. Interviews were undertaken virtually, and results were analyzed using thematic analysis. RESULTS Twelve clinicians (7 physicians and 5 NPs) were interviewed. We identified 5 themes, each with several subthemes: providing a palliative approach to care, increased work demands and changing roles, communication and collaboration, impact of isolation and visitation restrictions, and impact on the providers' personal lives. Clinicians described facing several concurrent challenges, including the uncertainty of COVID-19 illness, staffing and supply shortages, witnessing many deaths, and distress caused by isolation. These resulted in burnout and feelings of moral distress. Previous training and integration of the palliative care approach in the long-term care home, access to resources, increased communication and interprofessional collaboration, and strong leadership mitigated the impact and led to improved palliative care and a sense of pride while facing these challenges. INTERPRETATION The pandemic had a considerable impact on clinicians caring for residents in long-term care homes at the end of life. It is important to address these lived experiences and use the lessons learned to identify strategies to improve palliative care in long-term care homes and reduce the impact of future pandemics with respect to palliative care.
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Affiliation(s)
- Sandy Shamon
- Division of Palliative Care (Shamon, Gill, Pereira), Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Community Health Sciences, Cumming School of Medicine (Meadows), University of Calgary, Calgary, Alta.; School of Nursing (Kruizinga, Kaasalainen), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Pallium Canada (Pereira), Ottawa, Ont.
| | - Ashlinder Gill
- Division of Palliative Care (Shamon, Gill, Pereira), Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Community Health Sciences, Cumming School of Medicine (Meadows), University of Calgary, Calgary, Alta.; School of Nursing (Kruizinga, Kaasalainen), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Pallium Canada (Pereira), Ottawa, Ont
| | - Lynn Meadows
- Division of Palliative Care (Shamon, Gill, Pereira), Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Community Health Sciences, Cumming School of Medicine (Meadows), University of Calgary, Calgary, Alta.; School of Nursing (Kruizinga, Kaasalainen), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Pallium Canada (Pereira), Ottawa, Ont
| | - Julia Kruizinga
- Division of Palliative Care (Shamon, Gill, Pereira), Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Community Health Sciences, Cumming School of Medicine (Meadows), University of Calgary, Calgary, Alta.; School of Nursing (Kruizinga, Kaasalainen), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Pallium Canada (Pereira), Ottawa, Ont
| | - Sharon Kaasalainen
- Division of Palliative Care (Shamon, Gill, Pereira), Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Community Health Sciences, Cumming School of Medicine (Meadows), University of Calgary, Calgary, Alta.; School of Nursing (Kruizinga, Kaasalainen), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Pallium Canada (Pereira), Ottawa, Ont
| | - José Pereira
- Division of Palliative Care (Shamon, Gill, Pereira), Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Community Health Sciences, Cumming School of Medicine (Meadows), University of Calgary, Calgary, Alta.; School of Nursing (Kruizinga, Kaasalainen), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Pallium Canada (Pereira), Ottawa, Ont
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12
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Kruizinga J, Lucchese S, Vellani S, Rivas VM, Shamon S, Diedrich K, Gillespie L, Kaasalainen S. Perspectives across Canada about implementing a palliative approach in long-term care during COVID-19. BMC Palliat Care 2023; 22:32. [PMID: 36991407 PMCID: PMC10060130 DOI: 10.1186/s12904-023-01142-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 03/08/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Long-term care (LTC) homes have been disproportionately impacted during COVID-19. PURPOSE To explore the perspectives of stakeholders across Canada around implementing a palliative approach in LTC home during COVID-19. METHODS Qualitative, descriptive design using one-to-one or paired semi-structured interviews. RESULTS Four themes were identified: (1) the influence of the pandemic on implementing a palliative approach, (2) families are an essential part of implementing a palliative approach, (3) prioritizing advance care planning (ACP) and goals of care (GoC) discussions in anticipation of the overload of deaths and (4) COVID-19 highlighting the need for a palliative approach as well as several subthemes. CONCLUSION The COVID-19 pandemic influenced the implementation of a palliative approach to care, where many LTC homes faced an overwhelming number of deaths and restricted the presence of family members. A more concentrated focus on home-wide ACP and GoC conversations and the need for a palliative approach to care in LTC were identified.
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Affiliation(s)
- Julia Kruizinga
- School of Nursing, McMaster University, Hamilton, ON, Canada.
| | | | - Shirin Vellani
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | | | - Sandy Shamon
- Department of Family Medicine, Division of Palliative Care, McMaster University, Hamilton, ON, Canada
| | - Karine Diedrich
- Canadian Hospice Palliative Care Association, Ottawa, ON, Canada
| | - Laurel Gillespie
- Canadian Hospice Palliative Care Association, Ottawa, ON, Canada
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13
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Fassmer AM, Allers K, Helbach J, Zuidema S, Freitag M, Zieschang T, Hoffmann F. Hospitalization of German and Dutch Nursing Home Residents Depend on Different Long-Term Care Structures: A Systematic Review on Periods of Increased Vulnerability. J Am Med Dir Assoc 2023; 24:609-618.e6. [PMID: 36898411 DOI: 10.1016/j.jamda.2023.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVE To investigate proportions of hospitalized nursing home residents during periods of increased vulnerability, ie, the first 6 months after institutionalization and the last 6 months before death, and comparing the figures between Germany and the Netherlands. DESIGN Systematic review, registered in PROSPERO (CRD42022312506). SETTING AND PARTICIPANTS Newly admitted or deceased residents. METHODS We searched MEDLINE via PubMed, EMBASE, and CINAHL from inception through May 3, 2022. We included all observational studies that reported the proportions of all-cause hospitalizations among German or Dutch nursing home residents during these defined vulnerable periods. Study quality was assessed using the Joanna Briggs Institute's tool. We assessed study and resident characteristics and outcome information and descriptively reported them separately for both countries. RESULTS We screened 1856 records for eligibility and included 9 studies published in 14 articles (Germany: 8; Netherlands: 6). One study for each country investigated the first 6 months after institutionalization. A total of 10.2% of the Dutch and 42.0% of the German nursing home residents were hospitalized during this time. Overall, 7 studies reported on in-hospital deaths, with proportions ranging from 28.9% to 29.5% for Germany and from 1.0% to 16.3% for the Netherlands. Proportions for hospitalization in the last 30 days of life ranged from 8.0% to 15.7% (Netherlands: n = 2) and from 48.6% to 58.0% (Germany: n = 3). Only German studies assessed the differences by age and sex. Although hospitalizations were less common at older ages, they were more frequent in male residents. CONCLUSIONS AND IMPLICATIONS During the observed periods, the proportion of nursing homes residents being hospitalized differed greatly between Germany and the Netherlands. The higher figures for Germany can probably be explained by differences in the long-term care systems. There is a lack of research, especially for the first months after institutionalization, and future studies should examine the care processes of nursing home residents following acute events in more detail.
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Affiliation(s)
- Alexander M Fassmer
- Division of Outpatient Care and Pharmacoepidemiology, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Lower Saxony, Germany.
| | - Katharina Allers
- Division of Outpatient Care and Pharmacoepidemiology, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Lower Saxony, Germany
| | - Jasmin Helbach
- Division of Outpatient Care and Pharmacoepidemiology, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Lower Saxony, Germany
| | - Sytse Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michael Freitag
- Division of General Practice, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Lower Saxony, Germany
| | - Tania Zieschang
- Division of Geriatrics, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Lower Saxony, Germany
| | - Falk Hoffmann
- Division of Outpatient Care and Pharmacoepidemiology, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Lower Saxony, Germany
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14
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Grewal R, Kitchen SA, Nguyen L, Buchan SA, Wilson SE, Costa AP, Kwong JC. Effectiveness of a fourth dose of covid-19 mRNA vaccine against the omicron variant among long term care residents in Ontario, Canada: test negative design study. BMJ 2022; 378:e071502. [PMID: 35793826 PMCID: PMC9257064 DOI: 10.1136/bmj-2022-071502] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To estimate the marginal effectiveness of a fourth versus third dose and the vaccine effectiveness of mRNA covid-19 vaccines BNT162b2 and mRNA-1273 against any infection, symptomatic infection, and severe outcomes (hospital admission or death) related to the omicron variant. DESIGN Test negative design. SETTING Long term care facilities in Ontario, Canada, 30 December 2021 to 27 April 2022. PARTICIPANTS After exclusions, 61 344 residents aged 60 years or older across 626 long term care facilities in Ontario, Canada who were tested for SARS-CoV-2 were included. MAIN OUTCOME MEASURES Laboratory confirmed omicron SARS-CoV-2 infection (any and symptomatic) by reverse transcription polymerase chain reaction (RT-PCR), and hospital admission or death. Multivariable logistic regression was used to estimate marginal effectiveness (four versus three doses) and vaccine effectiveness (two, three, or four doses versus no doses) while adjusting for personal characteristics, comorbidities, week of test, and previous positive SARS-CoV-2 test result more than 90 days previously. RESULTS 13 654 residents who tested positive for omicron SARS-CoV-2 infection and 205 862 test negative controls were included. The marginal effectiveness of a fourth dose (95% of vaccine recipients received mRNA-1273 as the fourth dose) seven days or more after vaccination versus a third dose received 84 or more days previously was 19% (95% confidence interval 12% to 26%) against infection, 31% (20% to 41%) against symptomatic infection, and 40% (24% to 52%) against severe outcomes. Vaccine effectiveness in vaccine recipients (compared with unvaccinated) increased with each additional dose, and for a fourth dose was 49% (95% confidence interval 43% to 54%) against infection, 69% (61% to 76%) against symptomatic infection, and 86% (81% to 90%) against severe outcomes. CONCLUSIONS The findings suggest that compared with a third dose of mRNA covid-19 vaccine, a fourth dose improved protection against infection, symptomatic infection, and severe outcomes among long term care residents during an omicron dominant period. A fourth vaccine dose was associated with strong protection against severe outcomes in vaccinated residents compared with unvaccinated residents, although the duration of protection remains unknown.
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Affiliation(s)
| | | | | | - Sarah A Buchan
- Public Health Ontario, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, ON, Canada
| | - Sarah E Wilson
- Public Health Ontario, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, ON, Canada
| | - Andrew P Costa
- ICES, Toronto, ON, Canada
- Department of Medicine, Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Centre for Integrated Care, St Joseph's Health System, Hamilton, ON, Canada
| | - Jeffrey C Kwong
- Public Health Ontario, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
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15
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The Impact of Long-Term Care Home Ownership and Administration Type on All-Cause Mortality from March to April 2020 in Madrid, Spain. EPIDEMIOLGIA (BASEL, SWITZERLAND) 2022; 3:323-336. [PMID: 36417241 PMCID: PMC9620910 DOI: 10.3390/epidemiologia3030025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 12/14/2022]
Abstract
Our aim is to assess whether long-term care home (LTCH) ownership and administration type were associated with all-cause mortality in 470 LTCHs in the Community of Madrid (Spain) during March and April 2020, the first two months of the COVID-19 pandemic. There are eight categories of LTCH type, including various combinations of ownership type (for-profit, nonprofit, and public) and administration type (completely private, private with places rented by the public sector, administrative management by procurement, and completely public). Multilevel regression was used to examine the association between mortality and LTCH type, adjusting for LTCH size, the spread of the COVID-19 infection, and the referral hospital. There were 9468 deaths, a mortality rate of 18.3%. Public and private LTCHs had lower mortality than LTCHs under public-private partnership (PPP) agreements. In the fully adjusted model, mortality was 7.4% (95% CI, 3.1-11.7%) in totally public LTCHs compared with 21.9% (95% CI, 17.4-26.4%) in LTCHs which were publicly owned with administrative management by procurement. These results are a testimony to the fatal consequences that pre-pandemic public-private partnerships in long-term residential care led to during the first months of the COVID-19 pandemic in the Community of Madrid, Spain.
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16
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Delivering person-centred palliative care in long-term care settings: is humanism a quality of health-care employees or their organisations? AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22000459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Reflecting on sustained calls for patient-centredness and culture change in long-term care, we evaluated the relative importance of personal and organisational predictors of palliative care, hypothesising the former as weaker predictors than the latter. Health-care employees (N = 184) from four Canadian long-term care homes completed a survey of person-centred care, self-efficacy, employee wellbeing and occupational characteristics. Using backward stepwise regression models, we examined the relative contributions of these variables to person-centred palliative care. Specifically, blocks of variables representing personal, organisational and occupational characteristics; palliative care self-efficacy; and employee wellbeing were simultaneously regressed on variables representing aspects of person-centred care. The change in R2 associated with the removal of each block was examined to determine each block's overall contribution to the model. We found that occupational characteristics (involvement in care planning), employee wellbeing (compassion satisfaction) and self-efficacy were reliably associated with person-centred palliative care (p < 0.05). Facility size was not associated, and facility profit status was less consistently associated. Demographic characteristics (gender, work experience, education level) and some aspects of employee wellbeing (burnout, secondary trauma) were also not reliably associated. Overall, these results raise the possibility that humanistic care is less related to intrinsic characteristics of employees, and more related to workplace factors, or to personal qualities that can be cultivated in the workplace, including meaningful role engagement, compassion and self-efficacy.
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Lamm AG, Goldstein R, Slocum CS, Silver JK, Grabowski DC, Schneider JC, Zafonte RD. For-Profit and Not-For-Profit Inpatient Rehabilitation in Traumatic Brain Injury: Analysis of Demographics and Outcomes. Arch Phys Med Rehabil 2022; 103:1051-1052. [PMID: 35093330 DOI: 10.1016/j.apmr.2022.01.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 11/02/2022]
Affiliation(s)
- Adam G Lamm
- Mary Free Bed Rehabilitation Hospital, 235 Wealthy St SE, Grand Rapids, MI
| | - Richard Goldstein
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital / Harvard Medical School, 300 First Avenue, Charlestown, MA
| | - Chloe S Slocum
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital / Harvard Medical School, 300 First Avenue, Charlestown, MA; Massachusetts General Hospital, 55 Fruit Street, Boston, MA
| | - Julie K Silver
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital / Harvard Medical School, 300 First Avenue, Charlestown, MA; Massachusetts General Hospital, 55 Fruit Street, Boston, MA; Brigham & Women's Hospital, 75 Francis Street, Boston, MA
| | - David C Grabowski
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA
| | - Jeffrey C Schneider
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital / Harvard Medical School, 300 First Avenue, Charlestown, MA
| | - Ross D Zafonte
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital / Harvard Medical School, 300 First Avenue, Charlestown, MA; Massachusetts General Hospital, 55 Fruit Street, Boston, MA; Brigham & Women's Hospital, 75 Francis Street, Boston, MA.
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Akhtar-Danesh N, Baumann A, Crea-Arsenio M, Antonipillai V. COVID-19 excess mortality among long-term care residents in Ontario, Canada. PLoS One 2022; 17:e0262807. [PMID: 35051237 PMCID: PMC8775534 DOI: 10.1371/journal.pone.0262807] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 01/05/2022] [Indexed: 12/03/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) has had devastating consequences worldwide, including a spike in global mortality. Residents of long-term care homes have been disproportionately affected. We conducted a retrospective cohort study to determine the scale of pandemic-related deaths of long-term care residents in the province of Ontario, Canada, and to estimate excess mortality due to a positive COVID-19 test adjusted for demographics and regional variations. Crude mortality rates for 2019 and 2020 were compared, as were predictors of mortality among residents with positive and negative tests from March 2020 to December 2020. We found the crude mortality rates were higher from April 2020 to June 2020 and from November 2020 to December 2020, corresponding to Wave 1 and Wave 2 of the pandemic in Ontario. There were also substantial increases in mortality among residents with a positive COVID-19 test. The significant differences in excess mortality observed in relation to long-term care home ownership category and geographic region may indicate gaps in the healthcare system that warrant attention from policymakers. Further investigation is needed to identify the most relevant factors in explaining these differences.
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Affiliation(s)
- Noori Akhtar-Danesh
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
| | - Andrea Baumann
- Global Health, McMaster University, Hamilton, Ontario, Canada
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19
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Tu W, Li R, Stump TE, Fowler NR, Carnahan JL, Blackburn J, Sachs GA, Hickman SE, Unroe KT. Age-specific rates of hospital transfers in long-stay nursing home residents. Age Ageing 2022; 51:6430100. [PMID: 34850811 DOI: 10.1093/ageing/afab232] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/09/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION hospital transfers and admissions are critical events in the care of nursing home residents. We sought to determine hospital transfer rates at different ages. METHODS a cohort of 1,187 long-stay nursing home residents who had participated in a Centers for Medicare and Medicaid demonstration project. We analysed the number of hospital transfers of the study participants recorded by the Minimum Data Set. Using a modern regression technique, we depicted the annual rate of hospital transfers as a smooth function of age. RESULTS transfer rates declined with age in a nonlinear fashion. Rates were the highest among residents younger than 60 years of age (1.30-2.15 transfers per year), relatively stable between 60 and 80 (1.17-1.30 transfers per year) and lower in those older than 80 (0.77-1.17 transfers per year). Factors associated with increased risk of transfers included prior diagnoses of hip fracture (annual incidence rate ratio or IRR: 2.057, 95% confidence interval (CI): [1.240, 3.412]), dialysis (IRR: 1.717, 95% CI: [1.313, 2.246]), urinary tract infection (IRR: 1.755, 95% CI: [1.361, 2.264]), pneumonia (IRR: 1.501, 95% CI: [1.072, 2.104]), daily pain (IRR: 1.297, 95% CI: [1.055,1.594]), anaemia (IRR: 1.229, 95% CI [1.068, 1.414]) and chronic obstructive pulmonary disease (IRR: 1.168, 95% CI: [1.010,1.352]). Transfer rates were lower in residents who had orders reflecting preferences for comfort care (IRR: 0.79, 95% CI: [0.665, 0.936]). DISCUSSION younger nursing home residents may require specialised interventions to reduce hospital transfers; declining transfer rates with the oldest age groups may reflect preferences for comfort-focused care.
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Affiliation(s)
- Wanzhu Tu
- Indiana University Center for Aging Research, Regenstrief Institute, Indianapolis, IN 46202, USA
- Department of Biostatistics & Health Data Science, Indianapolis, IN 46202, USA
| | - Ruohong Li
- Department of Biostatistics & Health Data Science, Indianapolis, IN 46202, USA
| | - Timothy E Stump
- Department of Biostatistics & Health Data Science, Indianapolis, IN 46202, USA
| | - Nicole R Fowler
- Indiana University Center for Aging Research, Regenstrief Institute, Indianapolis, IN 46202, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Jennifer L Carnahan
- Indiana University Center for Aging Research, Regenstrief Institute, Indianapolis, IN 46202, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Justin Blackburn
- Department of Health Policy and Management, Indiana University Fairbanks School of Public Health, Indianapolis, IN 46202, USA
| | - Greg A Sachs
- Indiana University Center for Aging Research, Regenstrief Institute, Indianapolis, IN 46202, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Susan E Hickman
- Indiana University Center for Aging Research, Regenstrief Institute, Indianapolis, IN 46202, USA
- Department of Community and Health Systems, Indiana University School of Nursing, Indianapolis, IN 46202, USA
| | - Kathleen T Unroe
- Indiana University Center for Aging Research, Regenstrief Institute, Indianapolis, IN 46202, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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20
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Lamm AG, Goldstein R, Slocum CS, Silver JK, Grabowski DC, Schneider JC, Zafonte RD. For-Profit and Not-For-Profit Inpatient Rehabilitation in Traumatic Brain Injury: Analysis of Demographics and Outcomes. Arch Phys Med Rehabil 2021; 103:851-857. [PMID: 34856156 DOI: 10.1016/j.apmr.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To describe differences in traumatic brain injury patient characteristics and outcomes by inpatient rehabilitation facility profit status. DESIGN Retrospective database review utilizing the Uniform Data System for Medical Rehabilitation® (UDSMR). SETTING Inpatient rehabilitation facilities. PARTICIPANTS Individual discharges (n = 53,630) from 877 distinct rehabilitation facilities for calendar years 2016 through 2018. INTERVENTION NA MAIN OUTCOME MEASURES: Patient demographic data (age, race, primary payer source), admission and discharge Functional Independence Measure® (FIM®), FIM® gain, length of stay efficiency, acute hospital readmission from for-profit and not-for-profit IRFs within 30 days, and community discharges by facility profit status. RESULTS Patients at for-profit facilities were significantly older (69.69 vs. 64.12 years), with lower admission FIM® scores (52 vs. 57), shorter lengths of stay (13 vs. 15 days), and higher discharge FIM® scores (88 vs. 86); for-profit facilities had higher rates of community discharges (76.8% vs. 74.6%), but also had higher rates of readmission (10.3% vs. 9.9%). CONCLUSIONS The finding that for-profit facilities admit older patients who are reportedly less functional on admission and more functional on discharge, with higher rates of community discharge but higher readmission rates than not-for-profit facilities is an unexpected and potentially anomalous finding. In general, older, less functional patients who stay for shorter periods of time would not necessarily be expected to make greater functional gains. These differences should be further studied, to determine if differences in patient selection, coding/billing, or other unreported factors underlie these differences.
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Affiliation(s)
- Adam G Lamm
- Mary Free Bed Rehabilitation Hospital, 235 Wealthy St SE, Grand Rapids, MI
| | - Richard Goldstein
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital / Harvard Medical School, 300 First Avenue, Charlestown, MA
| | - Chloe S Slocum
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital / Harvard Medical School, 300 First Avenue, Charlestown, MA; Massachusetts General Hospital, 55 Fruit Street, Boston, MA
| | - Julie K Silver
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital / Harvard Medical School, 300 First Avenue, Charlestown, MA; Massachusetts General Hospital, 55 Fruit Street, Boston, MA; Brigham & Women's Hospital, 75 Francis Street, Boston, MA
| | - David C Grabowski
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA
| | - Jeffrey C Schneider
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital / Harvard Medical School, 300 First Avenue, Charlestown, MA
| | - Ross D Zafonte
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital / Harvard Medical School, 300 First Avenue, Charlestown, MA; Massachusetts General Hospital, 55 Fruit Street, Boston, MA; Brigham & Women's Hospital, 75 Francis Street, Boston, MA.
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21
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Inacio MC, Jorissen RN, Wesselingh S, Sluggett JK, Whitehead C, Maddison J, Forward J, Bourke A, Harvey G, Crotty M. Predictors of hospitalisations and emergency department presentations shortly after entering a residential aged care facility in Australia: a retrospective cohort study. BMJ Open 2021; 11:e057247. [PMID: 34789497 PMCID: PMC8601069 DOI: 10.1136/bmjopen-2021-057247] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To: (1) examine the 90-day incidence of unplanned hospitalisation and emergency department (ED) presentations after residential aged care facility (RACF) entry, (2) examine individual-related, facility-related, medication-related, system-related and healthcare-related predictors of these outcomes and (3) create individual risk profiles. DESIGN Retrospective cohort study using the Registry of Senior Australians. Fine-Gray models estimated subdistribution HRs and 95% CIs. Harrell's C-index assessed risk models' predictive ability. SETTING AND PARTICIPANTS Individuals aged ≥65 years old entering a RACF as permanent residents in three Australian states between 1 January 2013 and 31 December 2016 (N=116 192 individuals in 1967 RACFs). PREDICTORS EXAMINED Individual-related, facility-related, medication-related, system and healthcare-related predictors ascertained at assessments or within 90 days, 6 months or 1 year prior to RACF entry. OUTCOME MEASURES 90-day unplanned hospitalisation and ED presentation post-RACF entry. RESULTS The cohort median age was 85 years old (IQR 80-89), 62% (N=71 861) were women, and 50.5% (N=58 714) had dementia. The 90-day incidence of unplanned hospitalisations was 18.0% (N=20 919) and 22.6% (N=26 242) had ED presentations. There were 34 predictors of unplanned hospitalisations and 34 predictors of ED presentations identified, 27 common to both outcomes and 7 were unique to each. The hospitalisation and ED presentation models out-of-sample Harrell's C-index was 0.664 (95% CI 0.657 to 0.672) and 0.655 (95% CI 0.648 to 0.662), respectively. Some common predictors of high risk of unplanned hospitalisation and ED presentations included: being a man, age, delirium history, higher activity of daily living, behavioural and complex care needs, as well as history, number and recency of healthcare use (including hospital, general practitioners attendances), experience of a high sedative load and several medications. CONCLUSIONS Within 90 days of RACF entry, 18.0% of individuals had unplanned hospitalisations and 22.6% had ED presentations. Several predictors, including modifiable factors, were identified at the time of care entry. This is an actionable period for targeting individuals at risk of hospitalisations.
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Affiliation(s)
- Maria C Inacio
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Robert N Jorissen
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Steve Wesselingh
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Janet K Sluggett
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Craig Whitehead
- Southern Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - John Maddison
- Northern Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
| | - John Forward
- Northern Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
| | - Alice Bourke
- Central Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
| | - Gillian Harvey
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Maria Crotty
- Southern Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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Todd S, Bernal J, Worth R, Shearn J, Brearley S, McCarron M, Hunt K. Hidden lives and deaths: the last months of life of people with intellectual disabilities living in long-term, generic care settings in the UK. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 34:1489-1498. [PMID: 34031949 DOI: 10.1111/jar.12891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 02/15/2021] [Accepted: 03/12/2021] [Indexed: 11/27/2022]
Abstract
RATIONALE This paper concerns mortality and needs for end-of-life care in a population of adults with ID living in generic care homes. METHODS Various sampling strategies were used to identify a difficult to find a population of people with ID in generic care homes. Demographic and health data were obtained for 132 people with ID. This included the Surprise Question. At T2, 12 months later, data were obtained on the survival of this sample. FINDINGS The average age was 68.6 years, and the majority were women (55.3%). Their health was typically rated as good or better. Responses to the Surprise Question indicated that 23.3% respondents might need EoLC. At T2, 18.0% of this population had died. The average of death was 72.2 years. The majority died within the care setting (62.9%). IMPLICATIONS The implications for end-of-life care and mortality research are discussed.
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23
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Rangrej J, Kaufman S, Wang S, Kerem A, Hirdes J, Hillmer MP, Malikov K. Identifying Unexpected Deaths in Long-Term Care Homes. J Am Med Dir Assoc 2021; 23:1431.e21-1431.e28. [PMID: 34678267 DOI: 10.1016/j.jamda.2021.09.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Predicting unexpected deaths among long-term care (LTC) residents can provide valuable information to clinicians and policy makers. We study multiple methods to predict unexpected death, adjusting for individual and home-level factors, and to use as a step to compare mortality differences at the facility level in the future work. DESIGN We conducted a retrospective cohort study using Resident Assessment Instrument Minimum Data Set assessment data for all LTC residents in Ontario, Canada, from April 2017 to March 2018. SETTING AND PARTICIPANTS All residents in Ontario long-term homes. We used data routinely collected as part of administrative reporting by health care providers to the funder: Ontario Ministry of Health and Long-Term Care. This project is a component of routine policy development to ensure safety of the LTC system residents. METHODS Logistic regression (LR), mixed-effect LR (mixLR), and a machine learning algorithm (XGBoost) were used to predict individual mortality over 5 to 95 days after the last available RAI assessment. RESULTS We identified 22,419 deaths in the cohort of 106,366 cases (mean age: 83.1 years; female: 67.7%; dementia: 68.8%; functional decline: 16.6%). XGBoost had superior calibration and discrimination (C-statistic 0.837) over both mixLR (0.819) and LR (0.813). The models had high correlation in predicting death (LR-mixLR: 0.979, LR-XGBoost: 0.885, mixLR-XGBoost: 0.882). The inter-rater reliability between the models LR-mixLR and LR-XGBoost was 0.56 and 0.84, respectively. Using results in which all 3 models predicted probability of actual death of a resident at <5% yielded 210 unexpected deaths or 0.9% of the observed deaths. CONCLUSIONS AND IMPLICATIONS XGBoost outperformed other models, but the combination of 3 models provides a method to detect facilities with potentially higher rates of unexpected deaths while minimizing the possibility of false positives and could be useful for ongoing surveillance and quality assurance at the facility, regional, and national levels.
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Affiliation(s)
- Jagadish Rangrej
- Health Data Science Branch, Capacity Planning and Analytics Divisions, Ontario Ministry of Health, Toronto, ON, Canada; Ontario Ministry of Long-Term Care, Toronto, ON, Canada
| | - Sam Kaufman
- Analytics and Evidence Branch, Corporate Services Division, Ontario Ministry of Attorney General, Toronto, ON, Canada
| | - Sping Wang
- Health Data Science Branch, Capacity Planning and Analytics Divisions, Ontario Ministry of Health, Toronto, ON, Canada; Ontario Ministry of Long-Term Care, Toronto, ON, Canada
| | - Aidin Kerem
- Health Data Science Branch, Capacity Planning and Analytics Divisions, Ontario Ministry of Health, Toronto, ON, Canada; Ontario Ministry of Long-Term Care, Toronto, ON, Canada
| | - John Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Michael P Hillmer
- Health Data Science Branch, Capacity Planning and Analytics Divisions, Ontario Ministry of Health, Toronto, ON, Canada; Ontario Ministry of Long-Term Care, Toronto, ON, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Kamil Malikov
- Health Data Science Branch, Capacity Planning and Analytics Divisions, Ontario Ministry of Health, Toronto, ON, Canada; Ontario Ministry of Long-Term Care, Toronto, ON, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.
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24
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Kiss D, Pados E, Kovács A, Mádi P, Dervalics D, Bittermann É, Schmelowszky Á, Rácz J. "This is not life, this is just vegetation"-Lived experiences of long-term care in Europe's largest psychiatric home: An interpretative phenomenological analysis. Perspect Psychiatr Care 2021; 57:1981-1990. [PMID: 33811648 DOI: 10.1111/ppc.12777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/06/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Understanding the experiences of long-term care (LTC) may help to improve care by assisting mental health professionals and allowing mental health policies to be customized more effectively. DESIGN AND METHODS: Semistructured interviews were analyzed using interpretative phenomenological analysis (IPA). FINDINGS Three main themes emerged as a result: 1. Perception of selves, 2. Experience and representation of the institution, 3. Maintenance of safe spaces. PRACTICE IMPLICATIONS: Communication with patients, investigation of their identity processes, and relationship toward their past and present self during LTC might aid in well-being and sense of congruency in their identities. Nurses should encourage patients to keep connected with their memories and past selves through different activities.
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Affiliation(s)
- Dániel Kiss
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Eszter Pados
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Asztrik Kovács
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Péter Mádi
- Hungarian Rapid Response Police Unit, Budapest, Hungary
| | - Dóra Dervalics
- Kilátó Piarist Career Guidance and Labor Market Development Center, Budapest, Hungary
| | | | | | - József Rácz
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.,Department of Addictology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
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25
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Lopez LK, Weerasinghe N, Killackey T. The contemporary crisis of hallway healthcare: Implications of neoliberal health policy on the rise of emergency overcrowding. Nurs Inq 2021; 29:e12464. [PMID: 34558766 DOI: 10.1111/nin.12464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 09/04/2021] [Accepted: 09/11/2021] [Indexed: 11/28/2022]
Abstract
The provision of hallway healthcare is a growing concern within contemporary healthcare systems. Hallway healthcare or hallway medicine is defined as the use of unconventional spaces, such as hallways, to provide patient care in the acute care setting. Negative effects associated with the prevalence of hallway healthcare may hinder the healing trajectory of vulnerable and ageing populations. Nurses have an intimate role in the provision of care and can offer valuable insight for the advocacy of high quality and safe patient care. Moreover, hallway healthcare is associated with the development of suboptimal working conditions that have resulted in negative impacts on the nursing profession. The authors seek to better understand the occurrence of this phenomenon by exploring the development of healthcare policies in relation to the neoliberal tenets of, individualism, free market via deregulation and privatization, and decentralization. This article provides an analysis of the historical evolution of hallway healthcare and neoliberalism. Furthermore, the authors aim to explore and demonstrate how the COVID-19 pandemic has shed light on the inefficiency of neoliberalism ideologies for healthcare. Based on the analysis, the authors shall provide suggestions for nurses and stakeholders to enact meaningful change in an international context.
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Affiliation(s)
- Lorena K Lopez
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.,Trillium Health Partners-Credit Valley Hospital, Mississauga, Ontario, Canada
| | - Navisha Weerasinghe
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.,William Osler Health System-Brampton Civic Hospital, Brampton, Ontario, Canada
| | - Tieghan Killackey
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.,Child Health Evaluative Sciences (CHES), The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
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26
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Clemens S, Wodchis W, McGilton K, McGrail K, McMahon M. The relationship between quality and staffing in long-term care: A systematic review of the literature 2008-2020. Int J Nurs Stud 2021; 122:104036. [PMID: 34419730 DOI: 10.1016/j.ijnurstu.2021.104036] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Higher staffing levels in long-term care have been associated with better outcomes for residents in several landmark studies. However previous systematic reviews found mixed results, calling into question the effectiveness of higher levels of staff. With persistent concerns about quality, rising resident acuity, and a growing demographic of seniors requiring more services, understanding the relationship between quality and long-term care staffing is a growing concern. OBJECTIVES This review considered the following question: What is the influence of nursing and personal care staffing levels (registered nurse, licensed practical nurse, and nursing assistant) and / or skill mix on long-term care residents, measured by quality of care indicators? DESIGN Preferred Reporting Items for Systematic Review and Meta-analysis Protocols guided the report of this systematic review. DATA SOURCES Published articles focused on quality and nursing and personal care staffing in long-term care in peer-reviewed databases (MEDLINE, CINAHL, and AGELINE) and several Cochrane databases to retrieve studies published between January 2008 and June 2020. REVIEW METHODS A systematic review was conducted. 11,096 studies were identified, of which 34 were included in this review. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used to evaluate study quality and risk of bias, and five quality measures were selected for in-depth analyses: pressure ulcers, hospitalizations, physical restraints, deficiencies and catherization. RESULTS This review confirms previous review findings that evidence on the relationships between quality and long-term care staffing level and skill mix, remain mixed. Higher staffing levels and skill mix generally supported better rather than worse outcomes. Significant and consistent findings were more evident when staffing levels were further analyzed by indicator and staffing category. For example, registered nurses were consistently associated with significantly fewer pressure ulcers, hospitalizations, and urinary tract infections. Few studies examined the impact of total nursing and personal care hours compared to the impact of specific categories or classes of nursing staff on outcomes. CONCLUSIONS Evidence on the relationship between quality and long-term care staffing remains mixed, however some categories of nursing staff may be more effective at improving the quality of certain indicators. Study quality has improved minimally over the last decade. Although research continues to standardize units of measurement, and longitudinal and instrumental variable analyses are increasingly being used, very few studies controlled for endogeneity, conducted adequate risk-adjustment, and used resident-level data. Additional strides must still be made to improve the rigor of long-term care staffing research.
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Affiliation(s)
- Sara Clemens
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Ave Toronto, Ontario, Canada.
| | - Walter Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Ave Toronto, Ontario, Canada.
| | | | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, University of British Columbia, Canada.
| | - Meghan McMahon
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Ave Toronto, Ontario, Canada.
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27
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Sundaram M, Nasreen S, Calzavara A, He S, Chung H, Bronskill SE, Buchan SA, Tadrous M, Tanuseputro P, Wilson K, Wilson S, Kwong JC. Background rates of all-cause mortality, hospitalizations, and emergency department visits among nursing home residents in Ontario, Canada to inform COVID-19 vaccine safety assessments. Vaccine 2021; 39:5265-5270. [PMID: 34373124 PMCID: PMC8299226 DOI: 10.1016/j.vaccine.2021.07.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/26/2021] [Accepted: 07/20/2021] [Indexed: 12/03/2022]
Abstract
Background Nursing home (NH) residents are prioritized for COVID-19 vaccination. We report monthly mortality, hospitalizations, and emergency department (ED) visit incidence rates (IRs) during 2010–2020 to provide context for COVID-19 vaccine safety assessments. Methods We observed outcomes among all NH residents in Ontario using administrative databases. IRs were calculated by month, sex, and age group. Comparisons between months were assessed using one-sample t-tests; comparisons by age and sex were assessed using chi-squared tests. Results From 2010 to 2019, there were 83,453 (SD: 652.4) NH residents per month, with an average of 2.3 (SD: 0.28) deaths, 3.1 (SD: 0.16) hospitalizations, and 3.6 (SD: 0.17) ED visits per 100 residents per month. From March to December 2020, mortality IRs were increased, but hospitalization and ED visit IRs were reduced (p < 0.05). Conclusion We identified consistent monthly mortality, hospitalization, and ED visit IRs during 2010–2019. Marked differences in these rates were observed during 2020, coinciding with the COVID-19 pandemic.
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Affiliation(s)
- Maria Sundaram
- ICES, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Sharifa Nasreen
- ICES, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | | | | | - Susan E Bronskill
- ICES, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Women's College Research Institute, Toronto, ON, Canada
| | - Sarah A Buchan
- ICES, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Public Health Ontario, ON, Canada
| | - Mina Tadrous
- ICES, Toronto, ON, Canada; Women's College Research Institute, Toronto, ON, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Peter Tanuseputro
- ICES, Toronto, ON, Canada; Department of Medicine, University of Ottawa and Bruyere and Ottawa Hospital Research Institutes, Ottawa, ON, Canada
| | - Kumanan Wilson
- Department of Medicine, University of Ottawa and Bruyere and Ottawa Hospital Research Institutes, Ottawa, ON, Canada
| | - Sarah Wilson
- ICES, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Public Health Ontario, ON, Canada
| | - Jeffrey C Kwong
- ICES, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Public Health Ontario, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; University Health Network, Toronto, ON, Canada.
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28
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Liu M, Maxwell CJ, Armstrong P, Schwandt M, Moser A, McGregor MJ, Bronskill SE, Dhalla IA. La COVID-19 dans les foyers de soins de longue durée en Ontario et en Colombie-Britannique. CMAJ 2021; 193:E263-E269. [PMID: 33593958 PMCID: PMC8034325 DOI: 10.1503/cmaj.201860-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Michael Liu
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
| | - Colleen J Maxwell
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
| | - Pat Armstrong
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
| | - Michael Schwandt
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
| | - Andrea Moser
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
| | - Margaret J McGregor
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
| | - Susan E Bronskill
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
| | - Irfan A Dhalla
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
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Batista R, Prud'homme D, Rhodes E, Hsu A, Talarico R, Reaume M, Guérin E, Bouchard L, Desaulniers J, Manuel D, Tanuseputro P. Quality and Safety in Long-Term Care in Ontario: The Impact of Language Discordance. J Am Med Dir Assoc 2021; 22:2147-2153.e3. [PMID: 33434567 DOI: 10.1016/j.jamda.2020.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 12/03/2020] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study compared quality indicators across linguistic groups and sought to determine whether disparities are influenced by resident-facility language discordance in long-term care. DESIGN Population-based retrospective cohort study using linked databases. SETTING AND PARTICIPANTS Retrospective cohort of newly admitted residents of long-term care facilities in Ontario, Canada, between 2010 and 2016 (N=47,727). Individual residents' information was obtained from the Resident Assessment Instrument Minimum Data Set (RAI-MDS) to determine resident's primary language, clinical characteristics, and health care indicators. MEASURES Main covariates of interest were primary language of the resident and predominant language of the long-term care facility, which was determined using the French designation status as defined in the French Language Services Act. Primary outcomes were a set of quality and safety indicators related to long-term care: worsening of depression, falls, moderate-severe pain, use of antipsychotic medication, and physical restraints. Multivariable logistic regression models were used to assess the impact of resident's primary language, facility language, and resident-facility language discordance on each quality indicator. RESULTS Overall, there were few differences between francophones and anglophones for quality and safety indicators. Francophones were more likely to report pain (10.9% vs 9.9%; P = .001) and be physically restrained (7.3% vs 5.2%; P < .001), whereas a greater proportion of anglophones experienced worsening of depressive symptoms (24.0% vs 22.9%; P = .001). However, quality indicators were generally worse for francophones in Non-Designated facilities, except for pain, which was more commonly reported by francophones in French-Designated facilities. Anglophones were more likely to be physically restrained in French-Designated facilities (6.7% vs 5.1%; P < .001). CONCLUSIONS AND IMPLICATIONS For francophones, quality indicators tended to be worse in the presence of resident-facility language discordance. However, these findings did not persist after adjusting for individual- and facility-level characteristics, suggesting that the disparities observed at the population level cannot be attributed to linguistic factors alone.
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Affiliation(s)
- Ricardo Batista
- Institut du Savoir Montfort, Ottawa, Ontario, Canada; ICES, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Denis Prud'homme
- Institut du Savoir Montfort, Ottawa, Ontario, Canada; Hôpital Montfort, Sport Medicine Clinic, Ottawa, Ontario, Canada; School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Emily Rhodes
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Amy Hsu
- ICES, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Elizabeth Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Robert Talarico
- ICES, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Michael Reaume
- Institut du Savoir Montfort, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Eva Guérin
- Institut du Savoir Montfort, Ottawa, Ontario, Canada; Hôpital Montfort, Sport Medicine Clinic, Ottawa, Ontario, Canada
| | - Louise Bouchard
- Institut du Savoir Montfort, Ottawa, Ontario, Canada; School of Social and Anthropological Studies, University of Ottawa, Ottawa, Ontario, Canada
| | - Jacinthe Desaulniers
- Réseau des services de santé en français de l'Est de l'Ontario, Ottawa, Ontario, Canada
| | - Douglas Manuel
- ICES, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- ICES, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Elizabeth Bruyère Research Institute, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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30
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Liu M, Maxwell CJ, Armstrong P, Schwandt M, Moser A, McGregor MJ, Bronskill SE, Dhalla IA. COVID-19 in long-term care homes in Ontario and British Columbia. CMAJ 2020; 192:E1540-E1546. [PMID: 32998943 DOI: 10.1503/cmaj.201860] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Michael Liu
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
| | - Colleen J Maxwell
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
| | - Pat Armstrong
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
| | - Michael Schwandt
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
| | - Andrea Moser
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
| | - Margaret J McGregor
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
| | - Susan E Bronskill
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
| | - Irfan A Dhalla
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
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31
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Inacio MC, Lang CE, Khadka J, Watt AM, Crotty M, Wesselingh S, Whitehead C. Mortality in the first year of aged care services in Australia. Australas J Ageing 2020; 39:e537-e544. [PMID: 32815606 DOI: 10.1111/ajag.12833] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 06/08/2020] [Accepted: 06/20/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To examine the one-year mortality of Australians entering aged care services compared with the general population. METHODS A population-based analysis evaluating one-year mortality among people who received first ever aged care services in 2013 compared with the general population was conducted. RESULTS In 2013, 3.3 million Australians were ≥ 65 years and 34 919 (1%) entered permanent residential care, 23 288 (0.7%) respite care, 20 265 (0.6%) commenced home care packages, and 15 387 (0.5%) transition care. Individuals receiving aged care services had higher mortality than the general population, with those entering permanent residential care (age and sex direct standardised mortality rate ratio = 10.1, 95% CI: 9.8-10.5) having the greatest difference, followed by people accessing respite (7.2, 95% CI: 6.9-7.6), transition (4.6, 95% CI: 4.4-4.9) and home care (4.1, 95% CI: 3.9-4.4). Significant variation by sex and age was observed. CONCLUSION Our study has identified significant variations in mortality rates that highlight which cohorts entering aged care are the most vulnerable.
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Affiliation(s)
- Maria C Inacio
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia.,University of South Australia, Adelaide, South Australia, Australia
| | - Catherine E Lang
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Jyoti Khadka
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia.,School of Business/Commerce, University of South Australia, Adelaide, South Australia, Australia
| | - Amber M Watt
- Research and Evaluation, ECH Inc., Parkside, South Australia, Australia
| | - Maria Crotty
- Rehabilitation Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Steve Wesselingh
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Craig Whitehead
- Rehabilitation, Aged and Palliative Care, Southern Adelaide Local Health Network, Flinders University, Adelaide, South Australia, Australia
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32
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Stall NM, Jones A, Brown KA, Rochon PA, Costa AP. For-profit long-term care homes and the risk of COVID-19 outbreaks and resident deaths. CMAJ 2020; 192:E946-E955. [PMID: 32699006 PMCID: PMC7828970 DOI: 10.1503/cmaj.201197] [Citation(s) in RCA: 118] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Long-term care (LTC) homes have been the epicentre of the coronavirus disease 2019 (COVID-19) pandemic in Canada to date. Previous research shows that for-profit LTC homes deliver inferior care across a variety of outcome and process measures, raising the question of whether for-profit homes have had worse COVID-19 outcomes than nonprofit homes. METHODS We conducted a retrospective cohort study of all LTC homes in Ontario, Canada, from Mar. 29 to May 20, 2020, using a COVID-19 outbreak database maintained by the Ontario Ministry of Long-Term Care. We used hierarchical logistic and count-based methods to model the associations between profit status of LTC homes (for-profit, nonprofit or municipal) and COVID-19 outbreaks in LTC homes, the extent of COVID-19 outbreaks (number of residents infected), and deaths of residents from COVID-19. RESULTS The analysis included all 623 Ontario LTC homes, comprising 75 676 residents; 360 LTC homes (57.7%) were for profit, 162 (26.0%) were nonprofit, and 101 (16.2%) were municipal homes. There were 190 (30.5%) outbreaks of COVID-19 in LTC homes, involving 5218 residents and resulting in 1452 deaths, with an overall case fatality rate of 27.8%. The odds of a COVID-19 outbreak were associated with the incidence of COVID-19 in the public health unit region surrounding an LTC home (adjusted odds ratio [OR] 1.91, 95% confidence interval [CI] 1.19-3.05), the number of residents (adjusted OR 1.38, 95% CI 1.18-1.61), and older design standards of the home (adjusted OR 1.55, 95% CI 1.01-2.38), but not profit status. For-profit status was associated with both the extent of an outbreak in an LTC home (adjusted risk ratio [RR] 1.96, 95% CI 1.26-3.05) and the number of resident deaths (adjusted RR 1.78, 95% CI 1.03-3.07), compared with nonprofit homes. These associations were mediated by a higher prevalence of older design standards in for-profit LTC homes and chain ownership. INTERPRETATION For-profit status is associated with the extent of an outbreak of COVID-19 in LTC homes and the number of resident deaths, but not the likelihood of outbreaks. Differences between for-profit and nonprofit homes are largely explained by older design standards and chain ownership, which should be a focus of infection control efforts and future policy.
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Affiliation(s)
- Nathan M Stall
- Division of General Internal Medicine and Geriatrics (Stall), Sinai Health System and the University Health Network; Women's College Research Institute (Stall, Rochon), Women's College Hospital; Department of Medicine (Stall, Rochon) and Institute of Health Policy, Management and Evaluation (Stall, Rochon), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Jones, Costa), McMaster University, Hamilton, Ont.; Infection Prevention and Control (Brown), Public Health Ontario; Dalla Lana School of Public Health (Brown), University of Toronto, Toronto, Ont.; Schlegel Chair in Clinical Epidemiology and Aging (Costa), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont.
| | - Aaron Jones
- Division of General Internal Medicine and Geriatrics (Stall), Sinai Health System and the University Health Network; Women's College Research Institute (Stall, Rochon), Women's College Hospital; Department of Medicine (Stall, Rochon) and Institute of Health Policy, Management and Evaluation (Stall, Rochon), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Jones, Costa), McMaster University, Hamilton, Ont.; Infection Prevention and Control (Brown), Public Health Ontario; Dalla Lana School of Public Health (Brown), University of Toronto, Toronto, Ont.; Schlegel Chair in Clinical Epidemiology and Aging (Costa), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont
| | - Kevin A Brown
- Division of General Internal Medicine and Geriatrics (Stall), Sinai Health System and the University Health Network; Women's College Research Institute (Stall, Rochon), Women's College Hospital; Department of Medicine (Stall, Rochon) and Institute of Health Policy, Management and Evaluation (Stall, Rochon), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Jones, Costa), McMaster University, Hamilton, Ont.; Infection Prevention and Control (Brown), Public Health Ontario; Dalla Lana School of Public Health (Brown), University of Toronto, Toronto, Ont.; Schlegel Chair in Clinical Epidemiology and Aging (Costa), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont
| | - Paula A Rochon
- Division of General Internal Medicine and Geriatrics (Stall), Sinai Health System and the University Health Network; Women's College Research Institute (Stall, Rochon), Women's College Hospital; Department of Medicine (Stall, Rochon) and Institute of Health Policy, Management and Evaluation (Stall, Rochon), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Jones, Costa), McMaster University, Hamilton, Ont.; Infection Prevention and Control (Brown), Public Health Ontario; Dalla Lana School of Public Health (Brown), University of Toronto, Toronto, Ont.; Schlegel Chair in Clinical Epidemiology and Aging (Costa), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont
| | - Andrew P Costa
- Division of General Internal Medicine and Geriatrics (Stall), Sinai Health System and the University Health Network; Women's College Research Institute (Stall, Rochon), Women's College Hospital; Department of Medicine (Stall, Rochon) and Institute of Health Policy, Management and Evaluation (Stall, Rochon), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Jones, Costa), McMaster University, Hamilton, Ont.; Infection Prevention and Control (Brown), Public Health Ontario; Dalla Lana School of Public Health (Brown), University of Toronto, Toronto, Ont.; Schlegel Chair in Clinical Epidemiology and Aging (Costa), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont
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Chu CH, Donato-Woodger S, Dainton CJ. Competing crises: COVID-19 countermeasures and social isolation among older adults in long-term care. J Adv Nurs 2020; 76:2456-2459. [PMID: 32643787 PMCID: PMC7361866 DOI: 10.1111/jan.14467] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Charlene H Chu
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.,Affiliate Scientist, KITE, Toronto Rehab, University Health Network, Toronto, Canada.,Institute of Ageing and the Life Course, University of Toronto, Toronto, Canada
| | | | - Christopher J Dainton
- Grand River Hospital and St. Mary's Hospital, Kitchener, ON, Canada.,McMaster University, Hamilton, ON, Canada
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Poss J, McGrail K, McGregor MJ, Ronald LA. Long-Term Care Facility Ownership and Acute Hospital Service Use in British Columbia, Canada: A Retrospective Cohort Study. J Am Med Dir Assoc 2020; 21:1490-1496. [PMID: 32646822 DOI: 10.1016/j.jamda.2020.04.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 02/26/2020] [Accepted: 04/28/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Previous studies report higher hospitalization rates in for-profit compared with nonprofit long-term care facilities (LTCFs), but have not included staffing data, a major potential confounder. Our objective was to examine the effect of ownership on hospital admission rates, after adjusting for facility staffing levels and other facility and resident characteristics, in a large Canadian province (British Columbia). DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS Our cohort included individuals resident in a publicly funded LTCF in British Columbia at any time between April 1, 2012 and March 31, 2016. MEASURES Health administrative data were extracted from multiple databases, including continuing care, hospital discharge, and Minimum Data Set (MDS 2.0) assessment records. Cox extended hazards regression was used to estimate hospitalization risk associated with facility- and resident-level factors. RESULTS The cohort included 49,799 residents in 304 LTCF facilities (116 publicly owned and operated, 99 for-profit, and 89 nonprofit) over the study period. Hospitalization risk was higher for residents in for-profit (adjusted hazard ratio [adjHR] 1.34; 95% confidence interval [CI] 1.29-1.38) and nonprofit (adjHR 1.37; 95% CI 1.32-1.41) facilities compared with publicly owned and operated facilities, after adjustment for staffing, facility size, urban location, resident demographics, and case mix. Within subtypes, risk was highest in single-site facilities: for-profit (adjHR 1.42; 95% CI 1.36-1.48) and nonprofit (adjHR 1.38, 95% CI 1.33-1.44). CONCLUSIONS AND IMPLICATIONS This is the first Canadian study using linked health data from hospital discharge records, MDS 2.0, facility staffing, and ownership records to examine the adjusted effect of facility ownership characteristics on hospital use of LTCF residents. We found significantly lower adjHRs for hospital admission in publicly owned facilities compared with both for-profit and nonprofit facilities. Our finding that publicly owned facilities have lower hospital admission rates compared with for-profit and nonprofit facilities can help inform decision-makers faced with the challenge of optimizing care models in both nursing homes and hospitals as they build capacity to care for aging populations.
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Affiliation(s)
- Jeffrey Poss
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
| | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Margaret J McGregor
- Community Geriatrics, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa A Ronald
- Community Geriatrics, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
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Whiting SJ, Li W, Singh N, Quail J, Dust W, Hadjistavropoulos T, Thorpe LU. Predictors of hip fractures and mortality in long-term care homes in Saskatchewan: Does vitamin D supplementation play a role? J Steroid Biochem Mol Biol 2020; 200:105654. [PMID: 32169586 DOI: 10.1016/j.jsbmb.2020.105654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 02/11/2020] [Accepted: 03/09/2020] [Indexed: 10/24/2022]
Abstract
High rates of hip fracture (HF) in long-term care (LTC) lead to increased hospitalization and greater risk of death. Supplementation of residents with vitamin D3 (vitD) has been recommended, but may be infrequently acted upon. Using a prospective cohort design, we explored use of vitD at doses ≥800 IU for hip fractures (HF) and for mortality among permanent LTC residents in Saskatchewan between 2008 and 2012, using provincial administrative health databases (N = 23178). We used stepwise backward regression with Cox proportional hazard multivariate analysis for time to first HF or to death upon entry into LTC (excluding the first three months), the association of daily vitD (determined during the first three months), age, sex, age*sex interaction, prior HF, osteoporosis diagnosis and Charlson Comormidity Score (CCS) was determined. Users of VitD were more likely older, women and those with previous HF. For HF, no significant impact of vitD or CCS was found. Models for mortality, stratified by sex, showed in women only, that vitD use resulted in a significant inverse association with time to death [HR (0.91(0.87-0.96)]; for men it was 0.94(0.88-1.01). The impact of VitD supplementation in LTC deserves further investigation, however, the mechanisms for its effect on mortality remain unclear.
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Affiliation(s)
- Susan J Whiting
- College of Pharmacy and Nutrition, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N 2T5 Canada.
| | - Wenbin Li
- Saskatchewan Health Quality Council, Saskatoon, SK, Canada
| | - Nirmal Singh
- Saskatchewan Health Quality Council, Saskatoon, SK, Canada
| | | | - William Dust
- Division of Orthopedic Surgery, Surgery, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Thomas Hadjistavropoulos
- Department of Psychology and Center on Aging and Health, University of Regina, Regina, SK, Canada
| | - Lilian U Thorpe
- Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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Omissions of Care in Nursing Home Settings: A Narrative Review. J Am Med Dir Assoc 2020; 21:604-614.e6. [DOI: 10.1016/j.jamda.2020.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/11/2020] [Accepted: 02/19/2020] [Indexed: 02/06/2023]
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Ng R, Lane N, Tanuseputro P, Mojaverian N, Talarico R, Wodchis WP, Bronskill SE, Hsu AT. Increasing Complexity of New Nursing Home Residents in Ontario, Canada: A Serial Cross-Sectional Study. J Am Geriatr Soc 2020; 68:1293-1300. [PMID: 32119121 DOI: 10.1111/jgs.16394] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 01/19/2020] [Accepted: 02/03/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The main objective of the study was to investigate annual changes in the sociodemographic characteristics, morbidity, and functional status of new nursing home residents in Ontario, Canada, between 2000 and 2015. A secondary objective was to develop and assess the quality of an algorithm for ascertaining admissions into publicly funded nursing homes in Ontario using a combination of health administrative data sources that indirectly identifies the residential status of new nursing home residents. DESIGN Population-based serial cross-sectional study with an accompanying quality assessment study of algorithms. SETTING Publicly funded nursing care homes in Ontario, Canada. PARTICIPANTS The reference standard for the assessment of algorithm performance was 21 544 newly admitted nursing home residents identified from the Resident Assessment Instrument-Minimum Data Set in 2012. The selected algorithm was then used to identify serial cross-sectional cohorts of newly admitted residents between 2000 and 2015 that ranged in size between 14 651 and 23 630 residents. MEASUREMENTS Sociodemographic characteristics, morbidity, and functional status of new residents were determined upon admission to examine patterns in the cohorts' profiles. RESULTS The proportion of residents aged 85 years and older increased from 45.1% to 53.8% over 16 years. The proportions of individuals with seven or more chronic conditions (from 14.1% to 22.1%) and with nine or more prescription medications (from 44.9% to 64.2%) have also increased in parallel over time. Hypertension, osteoarthritis, and dementia were the most prevalent conditions captured, with the proportion of incoming residents with dementia increasing from 42.3% to 54.1% between 2000 and 2015. Newly admitted residents were more likely to have extensive physical and cognitive impairments upon admission. CONCLUSION Admission trends show that new residents were older and had greater multimorbidity and limitations in physical functioning over time. J Am Geriatr Soc 68:1293-1300, 2020.
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Affiliation(s)
- Ryan Ng
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Natasha Lane
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
| | - Peter Tanuseputro
- ICES uOttawa, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
| | - Nassim Mojaverian
- ICES uOttawa, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Robert Talarico
- ICES uOttawa, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada.,Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Susan E Bronskill
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada.,Women's College Research Institute, Toronto, Ontario, Canada
| | - Amy T Hsu
- ICES uOttawa, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada
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Physician Availability in Long-Term Care and Resident Hospital Transfer: A Retrospective Cohort Study. J Am Med Dir Assoc 2019; 21:469-475.e1. [PMID: 31395493 DOI: 10.1016/j.jamda.2019.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 06/02/2019] [Accepted: 06/03/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To investigate whether same-day physician access in long-term care homes reduces resident emergency department (ED) visits and hospitalizations. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS 161 long-term care homes in Ontario, Canada, and 20,624 residents living in those homes. METHODS We administered a survey to Ontario long-term care homes from March to May 2017 to collect their typical wait time for a physician visit. We linked the survey to administrative databases to capture other long-term care home characteristics, resident characteristics, hospitalizations, and ED visits. We defined a cohort of residents living in survey-respondent homes between January and May 2017 and followed each resident for 6 months or until discharge or death. We estimated negative binomial regression models on counts of hospitalizations and ED visits with random intercepts for long-term care homes. We controlled for residents' sociodemographic and illness characteristics, long-term care home size, chain status, rurality, and nurse practitioner access. RESULTS Fifty-two homes (32%) reported same-day physician access. Among residents of homes with same-day physician access, 9% had a hospitalization and 20% had an ED visit during follow-up. In contrast, among residents in homes without same-day access, 12% were hospitalized and 22% visited an ED. The adjusted hospitalization and ED rates among residents of homes with same-day physician access were 21% lower (rate ratio = 0.79, P = .02) and 14% lower (rate ratio = 0.86, P = .07), respectively, than residents of other homes. We estimate that nearly 1 in 6 resident hospitalizations could be prevented if all long-term care homes had same-day physician access. CONCLUSIONS AND IMPLICATIONS Residents of long-term care homes with same-day physician access experience lower hospitalization and ED visit rates than residents in homes that wait longer for physicians, even after adjusting for important resident and home characteristics. Improved on-demand access to physicians has the potential to reduce hospital transfer rates.
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Batista R, Prud'homme D, Hsu AT, Guérin E, Bouchard L, Rhodes E, Talarico R, Desaulniers J, Manuel D, Tanuseputro P. The Health Impact of Living in a Nursing Home With a Predominantly Different Spoken Language. J Am Med Dir Assoc 2019; 20:1649-1651. [PMID: 31351860 DOI: 10.1016/j.jamda.2019.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 06/02/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Ricardo Batista
- Institut du Savoir Montfort, Ottawa, Ontario, Canada; ICES, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Denis Prud'homme
- Institut du Savoir Montfort, Ottawa, Ontario, Canada; Hôpital Montfort, Ottawa, Ontario, Canada; School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Amy T Hsu
- ICES, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Eva Guérin
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
| | - Louise Bouchard
- Institut du Savoir Montfort, Ottawa, Ontario, Canada; School of Social and Anthropological Studies, University of Ottawa, Ottawa, Ontario, Canada
| | - Emily Rhodes
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Robert Talarico
- ICES, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jacinthe Desaulniers
- Réseau des services de santé en français de l'Est de l'Ontario, Ottawa, Ontario, Canada
| | - Douglas Manuel
- ICES, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- ICES, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Do-Not-Resuscitate and Do-Not-Hospitalize Orders in Nursing Homes: Who Gets Them and Do They Make a Difference? J Am Med Dir Assoc 2019; 20:1169-1174.e1. [PMID: 30975587 DOI: 10.1016/j.jamda.2019.02.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/15/2019] [Accepted: 02/16/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To describe the rate of do-not-resuscitate (DNR) and do-not-hospitalize (DNH) orders among residents newly admitted into long-term care homes. We also assessed the association between DNR and DNH orders with hospital admissions, deaths in hospital, and survival. DESIGN A retrospective cohort study. SETTING AND PARTICIPANTS Admissions in all 640 publicly funded long-term care homes in Ontario, Canada, between January 1, 2010 and March 1, 2012 (n = 49,390). MEASURES We examined if a DNR and/or DNH was recorded on resident's admission assessment. All residents were followed until death, discharge, or end of study to ascertain rates of several outcomes, including death and hospitalization, controlling for resident characteristics. RESULTS Upon admission, 60.7% of residents were recorded to have a DNR and 14.8% a DNH order. Those who were older, female, widowed, lived in rural facilities, lived in higher income neighborhoods prior to entry, had higher health instability or cognitive impairment, and spoke English or French were more likely to receive a DNR or DNH. Survival time was only slightly shorter for those with a DNR and DNH with a mean of 145 and 133 days, respectively, vs 160 and 153 days for those without a DNR and DNH. After controlling for age, sex, rurality, neighborhood income, marital status, health instability, cognitive performance score, and multimorbidity, DNR and DNH were associated with an odds ratio of 0.57 [95% confidence interval (CI) 0.53-0.62] and 0.41 (95% CI 0.37-0.46) for dying in hospital, respectively. Those with a DNR and DNH, after adjustment, had an incidence rate ratio of 0.87 (95% CI 0.83-0.90) and 0.70 (95% CI 0.67-0.73), respectively, days spent in hospital. CONCLUSIONS AND IMPLICATIONS This study outlines identifiable factors influencing whether residents have a DNR and/or DNH order upon admission. Both orders led to lower rates, but not absolute avoidance, of hospitalizations near and at death.
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Damián J, Pastor-Barriuso R, García-López FJ, Ruigómez A, Martínez-Martín P, de Pedro-Cuesta J. Facility ownership and mortality among older adults residing in care homes. PLoS One 2019; 14:e0197789. [PMID: 30822307 PMCID: PMC6396963 DOI: 10.1371/journal.pone.0197789] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 02/19/2019] [Indexed: 11/18/2022] Open
Abstract
Background and objectives Nursing or care home characteristics may have a long-term impact on the residents’ mortality risks that has not been studied previously. The study’s main objective was to assess the association between facility ownership and long-term, all-cause mortality. Research design and methods We conducted a mortality follow-up study on a cohort of 611 nursing-home residents in the city Madrid, Spain, from their 1998–1999 baseline interviews up to September 2013. Residents lived in three types of facilities: public, subsidized and private, which were also sub-classified according to size (number of beds). Residents’ information was collected by interviewing the residents themselves, their caregivers and facility physicians. We used time-to-event multivariable models and inverse probability weighting to estimate standardized mortality risk differences. Results After a 3728 person-year follow-up (median/maximum of 4.8/15.2 years), 519 participants had died. In fully-adjusted models, the standardized mortality risk difference at 5 years of follow-up between medium-sized private facilities and large-sized public facilities was -18.9% (95% confidence interval [CI]: -33.4 to -4.5%), with a median survival (95% CI) of 3.6 (0.5 to 6.8) additional years. The fully-standardized 5-year mortality difference (95% CIs) between for-profit private facilities and not-for-profit public institutions was -15.1% (-31.1% to 0.9%), and the fully-standardized median survival difference (95% CIs) was 3.0 (-1.7 to 7.7) years. Discussion and implications These results are compatible with an association between factors related with the ownership of facilities and the long-term mortality risk of their residents. One of these factors, the facility size, could partly explain this association.
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Affiliation(s)
- Javier Damián
- National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Neurodegenerative Diseases (Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas—CIBERNED), Madrid, Spain
- * E-mail:
| | - Roberto Pastor-Barriuso
- National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública—CIBERESP), Madrid, Spain
| | - Fernando José García-López
- National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Neurodegenerative Diseases (Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas—CIBERNED), Madrid, Spain
| | - Ana Ruigómez
- Spanish Center for Pharmacoepidemiologic Research (Centro Español de Investigación Farmacoepidemiológica), Madrid, Spain
| | - Pablo Martínez-Martín
- National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Neurodegenerative Diseases (Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas—CIBERNED), Madrid, Spain
| | - Jesús de Pedro-Cuesta
- National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Neurodegenerative Diseases (Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas—CIBERNED), Madrid, Spain
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Resident-Level Factors Associated with Hospitalization Rates for Newly Admitted Long-Term Care Residents in Canada: A Retrospective Cohort Study. Can J Aging 2019; 38:441-448. [DOI: 10.1017/s0714980818000715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
RÉSUMÉChez les résidents en soins de longue durée (SLD), l’hospitalisation peut amener des complications telles que le déclin fonctionnel. L’objectif de notre étude était d’examiner l’association entre les données démographiques et de santé et le taux d’hospitalisation des résidents nouvellement admis en SLD. Nous avons mené une étude de cohorte rétrospective incluant tous les centres de SLD de six provinces et d’un territoire du Canada, à l’aide des données de la RAI-MDS 2.0 et de la Discharge Abstract Database. Nous avons inclus les résidents nouvellement admis ayant eu une évaluation entre le 1er janvier et le 31 décembre 2013 (n = 37 998). Les résidents de sexe masculin avec une santé plus instable et une déficience fonctionnelle de modérée à grave présentaient des taux d’hospitalisation plus élevés, tandis que les résidents avec une déficience cognitive de modérée à grave avaient des taux moindres. Les résultats de notre étude pourraient contribuer à l’identification des résidents nouvellement admis qui seraient plus à risque d’hospitalisation et à l’élaboration de stratégies préventives plus ciblées, incluant la réadaptation, la planification préalable de soins, les soins palliatifs et les services gériatriques spécialisés.
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Luo H, Lou VWQ, Li Y, Chi I. Development and Validation of a Prognostic Tool for Identifying Residents at Increased Risk of Death in Long-Term Care Facilities. J Palliat Med 2018; 22:258-266. [PMID: 30383467 DOI: 10.1089/jpm.2018.0219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To promote better care at the end stage of life in long-term care facilities, a culturally appropriate tool for identifying residents at the end of life is crucial. OBJECTIVE This study aimed to develop and validate a prognostic tool, the increased risk of death (IRD) scale, based on the minimum data set (MDS). DESIGN A retrospective study using data between 2005 and 2013 from six nursing homes in Hong Kong. SETTING/SUBJECTS A total of 2380 individuals were randomly divided into two equal-sized subsamples: Sample 1 was used for the development of the IRD scale and Sample 2 for validation. MEASUREMENTS The measures were MDS 2.0 items and mortality data from the discharge tracking forms. The nine items in the IRD scale (decline in cognitive status, decline in activities of daily living, cancer, renal failure, congestive heart failure, emphysema/chronic obstructive pulmonary disease, edema, shortness of breath, and loss of weight), were selected based on bivariate Cox proportional hazards regression. RESULTS The IRD scale was a strong predictor of mortality in both Sample 1 (HRsample1 = 1.50, 95% confidence interval [CI]: 1.37-1.65) and Sample 2 (HRsample2 = 1.31, 1.19-1.43), after adjusting for covariates. Hazard ratios (HRs) for residents who had an IRD score of 3 or above for Sample 1 and Sample 2 were 3.32 (2.12-5.21) and 2.00 (1.30-3.09), respectively. CONCLUSIONS The IRD scale is a promising tool for identifying nursing home residents at increased risk of death. We recommend the tool to be incorporated into the care protocol of long-term care facilities in Hong Kong.
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Affiliation(s)
- Hao Luo
- 1 Department of Social Work and Social Administration, The University of Hong Kong , Hong Kong, China
| | - Vivian W Q Lou
- 2 Department of Social Work and Social Administration and Sau Po Centre on Ageing, The University of Hong Kong , Hong Kong, China
| | - Yuekang Li
- 1 Department of Social Work and Social Administration, The University of Hong Kong , Hong Kong, China
| | - Iris Chi
- 3 Suzanne Dworak-Peck School of Social Work, University of Southern California , Los Angeles, California
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McArthur C, Hirdes J, Chaurasia A, Berg K, Giangregorio L. Quality Changes after Implementation of an Episode of Care Model with Strict Criteria for Physical Therapy in Ontario's Long-Term Care Homes. Health Serv Res 2018; 53:4863-4885. [PMID: 30091461 DOI: 10.1111/1475-6773.13020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To describe the proportion of residents receiving rehabilitation in long-term care (LTC) homes, and scores on activities of daily living (ADL) and falls quality indicators (QIs) before and after change from fee-for-service to an episode of care model; and to evaluate the effect of the change on the QIs. DATA SOURCES Secondary data were collected from all LTC homes in Ontario, Canada, between January 1, 2011 and March 31, 2015. Variables of interest were the proportion of residents per home receiving physical therapy (PT), and the scores on seven ADL and one falls QI. STUDY DESIGN Retrospective, longitudinal study. DATA EXTRACTION All data were extracted from the Resident Assessment Instrument Minimum Data Set. PRINCIPAL FINDINGS Fewer residents received PT after the policy change (84.6 percent, 2011; 56.6 percent, 2015). The policy change was associated with improved performance on several ADL QIs. However, having a large proportion of residents receive no PT or little PT was associated with poorer performance on two of the QIs measuring improvement in ADLs [No PT: -0.029 (-0.043 to -0.014); -0.048 (-0.068 to -0.027). PT <45 minutes per week: -0.012 (-0.026 to -0.002); -0.026 (-0.045 to -0.007); p < .01]. CONCLUSIONS While controversial, the policy and subsequent PT service delivery change appears to be associated with improved performance on several ADL QIs, except in homes where a large proportion of residents receive no PT and low time-intensive PT.
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Affiliation(s)
- Caitlin McArthur
- GERAS Centre for Aging Research, McMaster University, Hamilton, ON, Canada
| | - John Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Ashok Chaurasia
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Katherine Berg
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Lora Giangregorio
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
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Freitas AR, Novais C, Duarte B, Pereira AP, Coque TM, Peixe L. High rates of colonisation by ampicillin-resistant enterococci in residents of long-term care facilities in Porto, Portugal. Int J Antimicrob Agents 2018; 51:503-507. [DOI: 10.1016/j.ijantimicag.2017.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 11/06/2017] [Accepted: 11/14/2017] [Indexed: 11/15/2022]
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Li S, Middleton A, Ottenbacher KJ, Goodwin JS. Trajectories Over the First Year of Long-Term Care Nursing Home Residence. J Am Med Dir Assoc 2017; 19:333-341. [PMID: 29108886 DOI: 10.1016/j.jamda.2017.09.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/19/2017] [Accepted: 09/20/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To describe the trajectories in the first year after individuals are admitted to long-term care nursing homes. DESIGN Retrospective cohort study. SETTING US long-term care facilities. PARTICIPANTS Medicare fee-for-service beneficiaries newly admitted to long-term care nursing homes from July 1, 2012, to December 31, 2013 (N=535,202). MEASUREMENTS Demographic characteristics were from Medicare data. Individual trajectories were conducted using the Minimum Data Set for determining long-term care stays and community discharge, and Medicare Provider and Analysis Reviews claims data for determining hospitalizations, skilled nursing facility stays, inpatient rehabilitation, long-term acute hospital and psychiatric hospital stays. RESULTS The median length of stay in a long-term care nursing home over the 1 year following admission was 127 [interquartile range (IQR): 24, 356] days. The median length of stay in any institution was 158 (IQR: 38, 365). Residents experienced a mean of 2.1 ± 2.8 (standard deviation) transitions over the first year. The community discharge rate was 36.5% over the 1-year follow-up, with 20.8% discharged within 30 days and 31.2% discharged within 100 days. The mortality rate over the first year of nursing home residence was 35.0%, with 16.3% deaths within 100 days. At 12 months post long-term care admission, 36.9% of the cohort were in long-term care, 23.4% were in community, 4.7% were in acute care hospitals or other institutions, and 35.0% had died. CONCLUSION After a high initial community discharge rate, the majority of patients newly admitted to long-term care experienced multiple transitions while remaining institutionalized until death or the end of 1-year follow-up.
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Affiliation(s)
- Shuang Li
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX
| | - Addie Middleton
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX; Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX
| | - Kenneth J Ottenbacher
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX; Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX
| | - James S Goodwin
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX; Department of Internal Medicine, Division of Geriatric Medicine, University of Texas Medical Branch, Galveston, TX.
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A Population-Based Study of Care at the End of Life Among People With HIV in Ontario From 2010 to 2013. J Acquir Immune Defic Syndr 2017; 75:e1-e7. [PMID: 27984556 PMCID: PMC5389586 DOI: 10.1097/qai.0000000000001268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Aging and increasing comorbidity is changing the end-of-life experience of people living with HIV (PLHIV) in the developed world. We quantified, at a population level, the receipt of health care services and associated costs across a comprehensive set of sectors among decedents with and without HIV. METHODS We conducted a retrospective population-level observational study of all decedents in Ontario and their receipt of health care services, captured through linked health administrative databases, between April 1, 2010 and March 31, 2013. We identified PLHIV using a validated algorithm. We described the characteristics of PLHIV and their receipt of health care services and associated costs by health care sector in the last year of life. RESULTS We observed 264,754 eligible deaths, 570 of whom had HIV. PLHIV were significantly younger than those without HIV (mean age of death 56.1 years vs. 76.6 years, [P < 0.01]). PLHIV spent a mean of 20.0 days in an acute care hospital in the last 90 days of life compared with 12.1 days for decedents without HIV (P < 0.01); after adjustment, HIV was associated with 4.5 more acute care days (P < 0.01). Mean cost of care in the last year was significantly higher among PLHIV ($80,885.62 vs. $53,869.77), mostly attributable to acute care costs. INTERPRETATION PLHIV in Ontario are dying younger, spending more time and dying more often in hospital, and incur significantly increased costs before death. Greater involvement of community-based palliative care may improve the dying experience for this complex population.
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Hoffmann F, Allers K. Variations over time in the effects of age and sex on hospitalization rates before and after admission to a nursing home: A German cohort study. Maturitas 2017; 102:50-55. [PMID: 28610683 DOI: 10.1016/j.maturitas.2017.04.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 04/13/2017] [Accepted: 04/26/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES We examined hospitalization rates for nursing home residents before and after their entry to the home, stratified by sex and age. STUDY DESIGN A cohort study was conducted using data from a large health insurance fund on 127,227 residents aged 65 years and over newly admitted to a nursing home between January 1, 2010, and December 31, 2014. MAIN OUTCOME MEASUREMENTS We assessed hospitalization rates and proportions being hospitalized in 6-month intervals one year before nursing home placement and up to 5 years thereafter. Multiple Poisson regression models were fitted to calculate relative risks (RR). RESULTS Mean age was 84.0 years and 74.6% of the cohort were females. Hospitalization rates were 194.4 per 100 person-years (PY) in the 12 months before entry to the nursing home and 120.0 per 100 PY thereafter. Rates were highest immediately before entry in both sexes. The influence of age was most pronounced in the 12-7 months before entry (RR: 2.37 for 65-74 vs. 95+ years) and declined thereafter (1.29-1.38 up to month 24 after entry). In contrast, the influence of sex was greater after entry (RR: 1.13 for males vs. females in the 12-7 months before and 1.23-1.31 up to month 24 after entry). CONCLUSIONS Hospitalization rates of nursing home residents are much higher in Germany than in other Western countries. We have provided some insight into the influence of age and sex on hospitalization rates, which varied over the period (time before and after entry to the nursing home) analyzed. We urgently recommend that future studies on the hospitalization of residents stratify their analyses by sex, age and period.
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Affiliation(s)
- Falk Hoffmann
- Carl von Ossietzky University Oldenburg, Department of Health Services Research, Oldenburg, Germany.
| | - Katharina Allers
- Carl von Ossietzky University Oldenburg, Department of Health Services Research, Oldenburg, Germany
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Tanuseputro P, Hsu A, Kuluski K, Chalifoux M, Donskov M, Beach S, Walker P. Level of Need, Divertibility, and Outcomes of Newly Admitted Nursing Home Residents. J Am Med Dir Assoc 2017; 18:616-623. [PMID: 28377155 DOI: 10.1016/j.jamda.2017.02.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 02/09/2017] [Accepted: 02/09/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To describe the level of need and divertibility of newly admitted nursing home residents, describe the factors that drive need, and describe the outcomes of residents across different levels of need. DESIGN Retrospective cohort study. SETTING A total of 640 publicly funded nursing homes (also known as long-term care facilities) in Ontario, Canada. PARTICIPANTS All newly admitted residents between January 1, 2010 and March 1, 2012. MEASUREMENTS We categorized residents into 36 groups based on different levels of (1) cognitive impairment, (2) difficulty in activities of daily living (ADL), (3) difficulty in instrumental ADLs, and (4) whether or not they had a caregiver at home. Residents were then categorized as having low, intermediate, or high needs; applying results from previous "Balance of Care" studies, we also captured the proportion who could have been cost-effectively diverted into the community. We then contrasted the characteristics of residents across the needs and divertible groupings, and compared 4 outcomes among these groups: hospital admissions, emergency department visits, mortality, and return to home. RESULTS A population-level cohort of 64,105 incident admissions was captured. About two-thirds had great difficulty performing ADLs (65%) and had mild to severe cognitive impairment (66%); over 90% had great difficulty with instrumental ADLs. Just less than 50% of the new admissions were considered to be residents with high care needs (cognitively impaired with great ADL difficulty), while only 4.5% (2880 residents) had low care needs (cognition and ADL intact). Those with dementia (71.0%) and previous stroke (21.5%) were over-represented in the high needs group. Those that cannot be divertible to anywhere else but an institution with 24 hour nursing care comprised 41.3% (n = 26,502) of residents. Only 5.4% (n = 3483), based on community resources available, could potentially be cost-effectively diverted to the community. Those at higher needs experienced higher rates of mortality, higher total cost across all health sectors, and lower rates of return to home. CONCLUSIONS The majority of those admitted into nursing homes have high levels of need (driven largely by dementia and stroke) and could not have their needs met cost-effectively elsewhere, suggesting that the system is at capacity. Caring for the long-term care needs of the aging population should consider the balance of investments in institution and community settings.
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Affiliation(s)
- Peter Tanuseputro
- Bruyère Research Institute, Bruyère Center of Learning, Research and Innovation in Long-Term Care, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada; Institute for Clinical Evaluative Sciences, Population Health and Primary Care, Ottawa, Ontario, Canada.
| | - Amy Hsu
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
| | - Kerry Kuluski
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Mathieu Chalifoux
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada; Institute for Clinical Evaluative Sciences, Population Health and Primary Care, Ottawa, Ontario, Canada
| | - Melissa Donskov
- Bruyère Research Institute, Bruyère Center of Learning, Research and Innovation in Long-Term Care, Ottawa, Ontario, Canada
| | - Sarah Beach
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
| | - Peter Walker
- Bruyère Research Institute, Bruyère Center of Learning, Research and Innovation in Long-Term Care, Ottawa, Ontario, Canada
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Staffing in Ontario's Long-Term Care Homes: Differences by Profit Status and Chain Ownership. Can J Aging 2017; 35:175-89. [PMID: 27223577 DOI: 10.1017/s0714980816000192] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Ontario has the highest proportion of for-profit nursing homes in Canada. These facilities, which are known in Ontario as long-term care (LTC) homes, offer 24-hour custodial as well as nursing care to individuals who cannot live independently. Increasingly, they are also operating as members of multi-facility chains. Using longitudinal data (1996-2011) from the Residential Care Facilities Survey (n = 627), our analysis revealed discernible differences in staffing levels by profit status and chain affiliation. We found for-profit LTC homes - especially those owned by a chain organization - provided significantly fewer hours of care, after adjusting for variation in the residents' care needs. Findings from this study offer new information on the impact of organizational structure on staffing levels in Ontario's LTC homes and have implications for other jurisdictions where a growing presence of private, chain-affiliated operators has been observed.
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