10. tbl. 105. árg. 2019

Health and survival in Icelandic nursing homes 2003 – 2014, before and after the setting of stricter criteria for nursing home admission in December 2007

Heilsa og lifun íbúa fyrir og eftir setningu strangari skilyrða fyrir flutningi á hjúkrunarheimili 2007

Introduction: Many factors influence the nursing needs and survival of nursing home residents, including the admission criteria. The aim of the study was to compare health, survival and predictors for one- and two-year survival of people entering Icelandic nursing homes between 2003–2007 and 2008–2014.

Material and methods: Retrospective, descriptive, comparative study. The data was obtained from a Directorate of Health database for all interRAI assessments of Icelandic nursing homes from January 1, 2003, to December 31, 2014 (N = 8487).

Results: There was a significant difference in the health and survival of new nursing home residents before and after December 31, 2007. In the latter period, the mean age was 82.7 years. In the previous period, it was 82.1 years, and the prevalence of Alzheimer‘s disease, ischemic heart disease, heart failure, diabetes and COPD increased between the periods. One-year survival decreased from 73.4% to 66.5%, and two-year survival decreased from 56.9% to 49.1%. The strongest mortality risk factors were heart failure and chronic obstructive pulmonary disease, as well as high scores on the CHESS scale and ADL long scale.

Conclusion: After 2007, new residents were older, in poorer health, and their life expectancy was shorter than for those moving to nursing homes before that. The results suggest that the aim of the regulatory change was achieved, i.e., to prioritise those in worst health. Their care needs may therefore be different and greater than before.

 

Tabel I Comparison between new residents in the periods of 2003-2007 and 2008-2014. age, gender, BMI, and the frequency of selected medcal diagnosis. Mean + standard deviation for age and BMI, number and percentage (%) for other variables.

Table II  Comparison of the outcome of the six interRAI scales between new residents in the period of 2003-2007 and 2008-2014, respectively. Mean ± standard deviation.

Table III  The one-year survival Hazard Ratio of four background variables (control variables), 9 medical diagnoses og 6 interRAI scales among newly admitted nursing home residents in the periods of 2003-2007 and 2008-2013.

Table IV  The two-year survival Hazard Ratio of four background variables (control variables), 9 medical diagnoses og 6 interRAI scales among newly admitted nursing home residents in the periods of 2003-2007 and 2008-2012.

Figure I  Kaplan-Meier survival analysis during the first year after moving to a nursing home. Blue line: New residents in 2003-2007 (n = 1,832), 73.4% survival. Red line: New residents in 2008-2013 (n =2,895), 66.5% survival, p<0,0001, Cox`s F-test.

Figure II  Kaplan-Meier survival analysis during the first two years after moving to a nursing home. Blue line: New residents in 2003-2007 (n = 1,832), 56.9% survival. Red line: New residents in 2008-2012 (n =2,341), 49.1% survival, p<0,0001, Cox`s F-test.









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