Predicting Future Health Transitions Among Newly Admitted Nursing Home Residents With Heart Failure

被引:17
作者
Heckman, George A. [1 ,2 ]
Hirdes, John P. [1 ]
Hebert, Paul C. [3 ,4 ]
Morinville, Anne [5 ]
Amaral, Andre C. K. B. [6 ,7 ]
Costa, Andrew [8 ]
McKelvie, Robert S. [9 ]
机构
[1] Res Inst Ageing, Waterloo, ON, Canada
[2] Univ Waterloo, Sch Publ Hlth & Hlth Syst, Waterloo, ON, Canada
[3] Univ Montreal, Dept Med, Montreal, PQ, Canada
[4] Ctr Hosp Univ Montreal, Montreal, PQ, Canada
[5] Ctr Hosp Univ Montreal, Ctr Rech, Montreal, PQ, Canada
[6] Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada
[7] Sunnybrook Hlth Sci Ctr, Dept Crit Care Med, Toronto, ON, Canada
[8] McMaster Univ, Dept Med, Hamilton, ON, Canada
[9] Western Univ, Dept Med, London, ON, Canada
关键词
Frailty; interRAI; heart failure; care transitions; nursing home; EMERGENCY-DEPARTMENT VISITS; CARE; MANAGEMENT; FACILITY; HOSPITALIZATIONS; READMISSION; ASSOCIATION; FREQUENCY; MORTALITY; OUTCOMES;
D O I
10.1016/j.jamda.2018.10.031
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
Objectives: To understand how a heart failure diagnosis and admission health instability predict health transitions and outcomes among newly admitted nursing home residents. Design: Retrospective cohort study of linked administrative data, including the Continuing Care Report System MDS 2.0 for nursing homes, the Discharge Abstract Database for hospitalized patients, and National Ambulatory Care Reporting System to track emergency department visits. Setting and participants: Older adults, aged 65 years and above, admitted to nursing homes in Ontario, Alberta, and British Columbia, Canada, from 2010 to 2016. Measures: Mortality and hospitalization were plotted over 1 year. Multistate Markov models were used to estimate adjusted odds ratios (ORs) for transitions to different states of health in stability, hospitalization, and death, stratified by heart failure diagnosis and by interRAI Changes in Health and End-stage disease Signs and Symptoms (CHESS) score, at 90 days following admission to a nursing home. Results: The final sample included 143,067 residents. Adverse events were most common in the first 90 days. A diagnosis of heart failure predicted worsening health instability, hospitalizations, and mortality. The effect of heart failure on hospitalizations and death was strongest for low baseline health instability (CHESS = 0; OR 1.63, 95% confidence interval (CI) 1.58-1.68, and OR 1.71, 95% CI 1.57-1.86, respectively), versus moderate instability (CHESS = 1-2; OR 1.36, 95% CI 1.32-1.39, and OR 1.48, 95% CI 1.41-1.55), versus high instability (CHESS = 3; OR 1.12, 95% CI 1.03-1.23, and OR 1.21, 95% CI 1.11-1.32). The magnitude of the impact of a heart failure diagnosis was greatest for lower baseline health instability. Residents with the highest degree of health instability were also most likely to die in hospital. Conclusions and implications: A diagnosis of heart failure and health instability provide complementary information to predict transfers, deaths, and adverse outcomes. Clearly identifying these at-risk patients may be useful in targeting interventions in nursing homes. (C) 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
引用
收藏
页码:438 / 443
页数:6
相关论文
共 50 条
[21]   Health Profile Transitions and the Association With Cognitive Impairment in Older Nursing Home Residents With Suicidal Ideation [J].
Yuan, Yiyang ;
Barooah, Adrita ;
Lapane, Kate L. ;
Mack, Deborah ;
Rothschild, Anthony J. ;
Ulbricht, Christine M. .
INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, 2024, 39 (10)
[22]   Differences in Staff-Assessed Pain Behaviors among Newly Admitted Nursing Home Residents by Level of Cognitive Impairment [J].
Morrison, Reynolds A. ;
Jesdale, Bill M. ;
Dube, Catherine E. ;
Nunes, Anthony P. ;
Bova, Carol A. ;
Liu, Shao-Hsien ;
Lapane, Kate L. .
DEMENTIA AND GERIATRIC COGNITIVE DISORDERS, 2020, 49 (03) :243-251
[23]   The Prevalence and Persistence of Sliding Scale Insulin Use Among Newly Admitted Elderly Nursing Home Residents With Diabetes Mellitus [J].
Pandya, Naushira ;
Thompson, Stephen ;
Sambamoorthi, Usha .
JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION, 2008, 9 (09) :663-669
[24]   Obesity and Pressure Ulcers Among Nursing Home Residents [J].
Cai, Shubing ;
Rahman, Momotazur ;
Intrator, Orna .
MEDICAL CARE, 2013, 51 (06) :478-486
[25]   Use of Diabetes Medications before and after a Heart Failure-Related Hospitalization among Nursing Home Residents [J].
Zhang, Tingting ;
Zullo, Andrew R. ;
Hayes, Kaleen N. ;
Kim, Dae Hyun ;
Lee, Yoojin ;
Daiello, Lori A. ;
Kiel, Douglas P. ;
Berry, Sarah D. .
JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION, 2024, 25 (03) :454-458
[26]   Effect of Forced Transitions on the Most Functionally Impaired Nursing Home Residents [J].
Thomas, Kali S. ;
Dosa, David ;
Hyer, Kathryn ;
Brown, Lisa M. ;
Swaminathan, Shailender ;
Feng, Zhanlian ;
Mor, Vincent .
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, 2012, 60 (10) :1895-1900
[27]   In-Hospital Cardiology Consultation and Evidence-Based Care for Nursing Home Residents With Heart Failure [J].
Aronow, Wilbert S. ;
Rich, Michael W. ;
Goodlin, Sarah J. ;
Birkner, Thomas ;
Zhang, Yan ;
Feller, Margaret A. ;
Aban, Inmaculada B. ;
Jones, Linda G. ;
Bearden, Donna M. ;
Allman, Richard M. ;
Ahmed, Ali .
JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION, 2012, 13 (05) :448-452
[28]   The Course of Depressive Symptoms Over 36 Months in 696 Newly Admitted Nursing Home Residents [J].
Borza, Tom ;
Selbaek, Geir ;
Lichtwarck, Bjorn ;
Benth, Jurate Saltyte ;
Bergh, Sverre .
JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION, 2022, 23 (11) :1838-+
[29]   Assessing the impact of Minnesota's return to community initiative for newly admitted nursing home residents [J].
Hass, Zachary ;
Woodhouse, Mark ;
Grabowski, David C. ;
Arling, Greg .
HEALTH SERVICES RESEARCH, 2019, 54 (03) :555-563
[30]   Differences between newly admitted nursing home residents in rural and nonrural areas in a national sample [J].
Bolin, JN ;
Phillips, CD ;
Hawes, C .
GERONTOLOGIST, 2006, 46 (01) :33-41