Medical conditions of nursing home admissions

Gilberte Van Rensbergen, Tim Nawrot, Gilberte Van Rensbergen, Tim Nawrot

Abstract

Background: As long-term nursing home care is likely to increase with the aging of the population, identifying chronic medical conditions is of particular interest. Although need factors have a strong impact on nursing home (NH) admission, the diseases causing these functional disabilities are lacking or unclear in the residents' file. We investigated the medical reason (primary diagnosis) of a nursing home admission with respect to the underlying disease.

Methods: This study is based on two independent, descriptive and comparative studies in Belgium and was conducted at two time points (1993 and 2005) to explore the evolution over twelve years. Data from the subjects were extracted from the resident's file; additional information was requested from the general practitioner, nursing home physician or the head nurse in a face-to-face interview. In 1993 we examined 1332 residents from 19 institutions, and in 2005 691 residents from 7 institutions. The diseases at the time of admission were mapped by means of the International Classification of Diseases--9th edition (ICD-9). Longitudinal changes were assessed and compared by a chi-square test.

Results: The main chronic medical conditions associated with NH admission were dementia and stroke. Mental disorders represent 48% of all admissions, somatic disorders 43% and social/emotional problems 8%. Of the somatic disorders most frequently are mentioned diseases of the circulatory system (35%) [2/3 sequels of stroke and 1/5 heart failure], followed by diseases of the nervous system (15%) [mainly Parkinson's disease] and the musculoskeletal system (14%) [mainly osteoarthritis]. The most striking evolution from 1993 to 2005 consisted in complicated diabetes mellitus (from 4.3 to 11.4%; p < 0.0001) especially with amputations and blindness. Symptoms (functional limitations without specific disease) like dizziness, impaired vision and frailty are of relevance as an indicator of admission.

Conclusion: Diseases like stroke, diabetes and mobility problems are only important for institutionalisation if they cause functional disability. Diabetes related complications as cause of admission increased almost three-fold between 1993 and 2005.

References

    1. Andersen R, Aday L. Access to medical care in the United States: realized and potential. Medical Care. 1978;16:533–46. doi: 10.1097/00005650-197807000-00001.
    1. Jette AM, Branch LG, Sleeper LA, Feldman H, Sullivan LM. High-risk profiles for nursing home admission. The Gerontologist. 1992;32(5):634–640.
    1. Winograd CH, Gerety HB, Chung A. Screening for frailty: criteria and predictors of outcomes. J Am Geriat Soc. 1991;39:778–784.
    1. Trydegard G. Public long term care in Sweden. Differences and similarities between home-based and institution-based care of elderly people. Journal of Gerontological Social Work. 1998;29(4):13–34. doi: 10.1300/J083V29N04_03.
    1. Penrod JD. Functional disability at nursing home admission: a comparison of urban and rural admission cohorts. J Rural Health. 2001;17(3):229–38. doi: 10.1111/j.1748-0361.2001.tb00960.x.
    1. Van Rensbergen G, Nawrot TS, Van Hecke E, Nemery B. Where do the elderly die? The impact of nursing home utilisation on the place of death. Observations from a mortality cohort study in Flanders. BMC Public Health. 2006;6:178. doi: 10.1186/1471-2458-6-178.
    1. Miller EA, Weissert WG. Predicting Elderly People's Risk for Nursing Home Placement, Hospitalization, Functional Impairment and mortality: A Synthesis. Medical Care research and Review. 2000;57(3):259–297. doi: 10.1177/107755870005700301.
    1. Gaugler JE, Duval S, Anderson KA, Kane RL. Predicting nursing home admission in the U.S: a meta-analysis. BMC Geriatr. 2007;7:13. doi: 10.1186/1471-2318-7-13.
    1. Gabrel CS. Centers for Disease Control and Prevention. U.S. department of Health and Human Services; 2000. Characteristics of elderly nursing home current residents and discharges: data from the 1997 National Nursing Home Survey; p. nr 312.
    1. Banaszak-Holl J, Fendrick AM, Foster NL, Herzog AR, Kabeto MU, Kent DM, Straus WL, Langa KM. Predicting nursing home admission: estimates from a 7-year follow-up of a nationally representative sample of older Americans. Alzheimer Dis Assoc Disord. 2004;18(2):83–9. doi: 10.1097/01.wad.0000126619.80941.91.
    1. Chan KM, Wong SF, Yoong T. Nursing home applications; reasons and possible interventions. Singapore Med J. 1998;39(10):451–5.
    1. McNabey MK, Wolff JL, Semanick LM, Kasper JD, Boult C. Care needs of higher-functioning nursing home residents. J Am Med Dir Assoc. 2007;8(6):409–12. doi: 10.1016/j.jamda.2007.03.001.
    1. Nakasato YR, Carnes BA. Health promotion in older adults. Promoting successful aging in primary care settings. Geriatrics. 2006;61(4):27–31.
    1. World Health Organization. International Classification of Diseases, ninth revision (ICD-9) Geneva: World Health Organization; 1977.
    1. Qualidem report. Research project of the universities of Leuven and Liège, Belgium, 1999-2002, concerning dementia
    1. Devroey D, Van Casteren V, De Lepeleire J. Placements in psychiatric institutions, nursing homes and homes for the elderly by Belgian general practitioners. Aging Ment Health. 2002;6(3):286–92. doi: 10.1080/13607860220142404.
    1. Brandt HE, Deliens L, Ooms ME, van der Steen JT, van der Wal G, Ribbe MW. Symptoms, signs, problems and diseases of terminally ill nursing home patients: a nationwide observational study in the Netherlands. Arch Intern Med. 2005;165(3):314–20. doi: 10.1001/archinte.165.3.314.
    1. Roelands M, Wostyn P, Dom H, Baro F. The prevalence of dementia in Belgium: a population based door-to-door survey in a rural community. Neuro epidemiology. 1994;13:155–161.
    1. Hofman A, Rocca WA, Brayne C, Breteler MM, Clarke M, Cooper B, Copeland JR, Dartigues JF, da Silva Droux A, Hagnell O. The prevalence of dementia in Europe: a collaborative study of 1980-1990 findings. Eurodem Prevalence Research Group. Int J Epidemiol. 1991;20:736–748.
    1. Ferri C, Ferri CP, Prince M, Brayne C, Brodaty H, Fratiglioni L, Ganguli M, Hall K, Hasegawa K, Hendrie H, Huang Y, Jorm A, Mathers C, Menezes PR, Rimmer E, Scazufca M. Global prevalence of dementia: a Delphi concensus study. Lancet. 2005;366:2112–17. doi: 10.1016/S0140-6736(05)67889-0.
    1. Ritchie K, Kildea D. Is senile dementia 'age-related' or 'ageing-related'? Evidence from meta analysis of dementia prevalence in the oldest old. Lancet. 1995;346:931–33. doi: 10.1016/S0140-6736(95)91556-7.
    1. European Collaboration on dementia (EuroCoDe); Working Group of the European Commission. A new Look at the prevalence of Dementia in Europe. Dementia in Europe, The Alzheimer Europe Magazine. 2009.
    1. Stevens T, Livingston G, kitchen G, Manela M, Walker Z, Katona C. Islington Study of dementia subtypes in the community. Br J Psychiatry. 2002;180:270–76. doi: 10.1192/bjp.180.3.270.
    1. Liu LF, Tinker A. Factors associated with nursing home entry for older people in Taiwan, Republic of China. J Interprof Care. 2001;15(3):245–55. doi: 10.1080/13561820120063138.
    1. IKED (Initiative for quality improvement and Epidemiology of Diabetes) IKED Report 2007. National Public Health Institute, Brussel, Belgium;
    1. Valiyeva E, Russell LB, Miller JE, Safford MM. Lifestyle-related risk factors and risk of future nursing home admission. Arch Intern Med. 2006;166(9):985–90. doi: 10.1001/archinte.166.9.985.
    1. Ahmed A, Allman RM, Delong JF. Predictors of nursing home admission for older adults hospitalized with heart failure. Arch Gerontol Geriatr. 2003;36(2):117–26. doi: 10.1016/S0167-4943(02)00063-8.
    1. Binder EF, Miller JP, Ball LJ. Development of a test of physical performance for the nursing home setting. Gerontologist. 2001;41(5):671–79.
    1. Maring W, Deelman BG. The cognitive screening test: short and long. Tijdschr Geront Geriatr. 1999;30:205–211.
    1. Cummings JL, Benson DF, Loverme S Jr. Reversible dementia. Illustrative cases, definition and review. JAMA. 1980;243:2434–2439. doi: 10.1001/jama.243.23.2434.
    1. Palmer HD. The view from 1946. Mental disorders of old age, part II. Geriatrics. 2006;61(7):15–18.
    1. Stewart JT. The frontal/subcortical dementias. Common dementing illnesses associated with prominent and disturbing behavioural changes. Geriatrics. 2006;61(8):23–27.
    1. Lobo A, Fratiglioni L, Launer LJ, Andersen K, Breteler MM, Copeland JR, Dartigues JF, Lobo A, Martinez-Lage J, Soininen H, Hofman A. Prevalence of dementia and major subtypes in Europe: a collaborative study of population-based cohorts. Neurology. 2000;54(11 suppl 5):S4–9.
    1. Zaccai J, McCracken C, Brayne C. A systematic review of prevalence and incidence studies of dementia with Lewy bodies. Age and Ageing. 2005;34:561–66. doi: 10.1093/ageing/afi190.
    1. Schnelle JF, Wood S, Schnelle ER, Simmons SF. Measurement sensitivity and the Minimum Data Set depression quality indicator. Gerontologist jun. 2001;41(3):401–5.
    1. Nihtilä EK, Martikainen PT, Koskinen SVP, Reunanen AR, Noro AM, Häkkinen UT. Chronic conditions and the risk of long-term institutionalization among older people. The European Journal of Public Health. 2008;18(1):77–84. doi: 10.1093/eurpub/ckm025.
    1. Gaugler JE, Yu F, krichbaum K, Wyman JF. Predictors of nursing home admission for persons with dementia. Med Care. 2009;47(2):191–8. doi: 10.1097/MLR.0b013e31818457ce.
    1. Yap LKP, Au SYL, Ang YH, Kwan KY, Ng SC, Ee CH. Who are the residents of a Nursing Home in Singapore? Singapore Med J. 2003;44(2):65–73.

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