Skip to main content
SpringerLink
Log in

Mortality and hospitalization at the end of life in newly admitted nursing home residents with and without dementia

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

The proportion of deaths occurring in nursing homes is increasing and end of life hospitalizations in residents are common. This study aimed to obtain the time from nursing home admission to death and the frequency of hospitalizations prior to death among residents with and without dementia.

Methods

This retrospective cohort study analyzed claims data of 127,227 nursing home residents aged 65 years and older newly admitted to a nursing home between 2010 and 2014. We analyzed hospitalizations during the last year of life and assessed mortality rates per 100 person-years. Factors potentially associated with time to death were analyzed in Cox proportional hazard models.

Results

The median time from nursing home admission to death was 777 and 635 days in residents with and without dementia, respectively. Being male, older age and a higher level of care decreased the survival time. Sex and age had a higher influence on survival time in residents with dementia, whereas level of care was found to have a higher influence in residents without dementia. Half of the residents of both groups were hospitalized during the last month and about 37% during the last week before death. Leading causes of hospitalizations were infections (with dementia: 20.6% vs. without dementia: 17.2%) and cardiovascular diseases (with dementia: 16.6% vs. without dementia: 19.0%).

Conclusions

A high proportion of residents with and without dementia are hospitalized shortly before death. There should be an open debate about the appropriateness of hospitalizing nursing home residents especially those with dementia near death.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Li Q, Zheng NT, Temkin-Greener H (2013) Quality of end-of-life care of long-term nursing home residents with and without dementia. J Am Geriatr Soc 61:1066–1073. https://doi.org/10.1111/jgs.12330

    Article  PubMed  PubMed Central  Google Scholar 

  2. Temkin-Greener H, Zheng NT, Xing J, Mukamel DB (2013) Site of death among nursing home residents in the United States: changing patterns, 2003–2007. J Am Med Dir Assoc 14:741–748. https://doi.org/10.1016/j.jamda.2013.03.009

    Article  PubMed  PubMed Central  Google Scholar 

  3. Dasch B, Blum K, Gude P, Bausewein C (2015) Place of death: trends over the course of a decade: a population-based study of death certificates from the years 2001 and 2011. Dtsch Arztebl Int 112:496–504. https://doi.org/10.3238/arztebl.2015.0496

    Article  PubMed  PubMed Central  Google Scholar 

  4. Sauer S, Müller R, Rothgang H (2015) Institutionalised dying in Germany. Trends in place of death distribution: home, hospitals and nursing homes. Z Gerontol Geriatr 48:169–175. https://doi.org/10.1007/s00391-013-0547-z

    Article  PubMed  CAS  Google Scholar 

  5. Kelly A, Conell-Price J, Covinsky K et al (2010) Length of stay for older adults residing in nursing homes at the end of life. J Am Geriatr Soc 58:1701–1706. https://doi.org/10.1111/j.1532-5415.2010.03005.x

    Article  PubMed  PubMed Central  Google Scholar 

  6. Steventon A, Roberts A (2012) Estimating length of stay in publicly-funded residential and nursing care homes: a retrospective analysis using linked administrative data sets. BMC Health Serv Res 12:377. https://doi.org/10.1186/1472-6963-12-377

    Article  PubMed  PubMed Central  Google Scholar 

  7. Hjaltadóttir I, Hallberg IR, Ekwall AK, Nyberg P (2011) Predicting mortality of residents at admission to nursing home: a longitudinal cohort study. BMC Health Serv Res 11:86. https://doi.org/10.1186/1472-6963-11-86

    Article  PubMed  PubMed Central  Google Scholar 

  8. McCann M, O’Reilly D, Cardwell C (2009) A Census-based longitudinal study of variations in survival amongst residents of nursing and residential homes in Northern Ireland. Age Ageing 38:711–717. https://doi.org/10.1093/ageing/afp173

    Article  PubMed  Google Scholar 

  9. Dale MC, Burns A, Panter L, Morris J (2001) Factors affecting survival of elderly nursing home residents. Int J Geriatr Psychiatry 16:70–76

    Article  PubMed  CAS  Google Scholar 

  10. Zheng NT, Mukamel DB, Caprio T et al (2011) Racial disparities in in-hospital death and hospice use among nursing home residents at the end of life. Med Care 49:992–998. https://doi.org/10.1097/MLR.0b013e318236384e

    Article  PubMed  PubMed Central  Google Scholar 

  11. Ramroth H, Specht-Leible N, König H-H, Brenner H (2006) Hospitalizations during the last months of life of nursing home residents: a retrospective cohort study from Germany. BMC Health Serv Res 6:70. https://doi.org/10.1186/1472-6963-6-70

    Article  PubMed  PubMed Central  Google Scholar 

  12. Pedone C, Ercolani S, Catani M et al (2005) Elderly patients with cognitive impairment have a high risk for functional decline during hospitalization: The GIFA Study. J Gerontol A Biol Sci Med Sci 60:1576–1580

    Article  PubMed  Google Scholar 

  13. Dwyer R, Gabbe B, Stoelwinder JU, Lowthian J (2014) A systematic review of outcomes following emergency transfer to hospital for residents of aged care facilities. Age Ageing 43:759–766. https://doi.org/10.1093/ageing/afu117

    Article  PubMed  Google Scholar 

  14. Ouslander JG, Lamb G, Perloe M et al (2010) Potentially avoidable hospitalizations of nursing home residents: frequency, causes, and costs. J Am Geriatr Soc 58:627–635. https://doi.org/10.1111/j.1532-5415.2010.02768.x

    Article  Google Scholar 

  15. Renom-Guiteras A, Uhrenfeldt L, Meyer G, Mann E (2014) Assessment tools for determining appropriateness of admission to acute care of persons transferred from long-term care facilities: a systematic review. BMC Geriatr 14:80. https://doi.org/10.1186/1471-2318-14-80

    Article  PubMed  PubMed Central  Google Scholar 

  16. Gozalo P, Teno JM, Mitchell SL et al (2011) End-of-life transitions among nursing home residents with cognitive issues. N Engl J Med 365:1212–1221. https://doi.org/10.1056/NEJMsa1100347

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  17. Ramroth H, Specht-Leible N, Brenner H (2005) Hospitalisations before and after nursing home admission: a retrospective cohort study from Germany. Age Ageing 34:291–294. https://doi.org/10.1093/ageing/afi049

    Article  PubMed  Google Scholar 

  18. Hoffmann F, Allers K (2016) Age and sex differences in hospitalisation of nursing home residents: a systematic review. BMJ Open 6:e011912. https://doi.org/10.1136/bmjopen-2016-011912

    Article  PubMed  PubMed Central  Google Scholar 

  19. Magaziner J, Zimmerman S, Gruber-Baldini AL et al (2005) Mortality and adverse health events in newly admitted nursing home residents with and without dementia. J Am Geriatr Soc 53:1858–1866. https://doi.org/10.1111/j.1532-5415.2005.53551.x

    Article  PubMed  Google Scholar 

  20. Sloane PD, Zimmerman S, Williams CS, Hanson LC (2008) Dying with dementia in long-term care. Gerontologist 48:741–751

    Article  PubMed  PubMed Central  Google Scholar 

  21. Koller D, Kaduszkiewicz H, van den Bussche H et al (2012) Survival in patients with incident dementia compared with a control group: a five-year follow-up. Int Psychogeriatrics 24:1522–1530. https://doi.org/10.1017/S1041610212000361

    Article  Google Scholar 

  22. Schulze J, van den Bussche H, Kaduszkiewicz H et al (2015) Institutionalization in incident dementia cases in comparison to age- and sex- matched controls: a 5-year follow-up from Germany. Soc Psychiatry Psychiatr Epidemiol 50:143–151. https://doi.org/10.1007/s00127-014-0911-3

    Article  PubMed  Google Scholar 

  23. Daly LE (1998) Confidence limits made easy: interval estimation using a substitution method. Am J Epidemiol 147:783–790

    Article  PubMed  CAS  Google Scholar 

  24. Hedinger D, Hämmig O, Bopp M, Swiss National Cohort Study Group (2015) Social determinants of duration of last nursing home stay at the end of life in Switzerland: a retrospective cohort study. BMC Geriatr 15:114. https://doi.org/10.1186/s12877-015-0111-3

    Article  PubMed  PubMed Central  Google Scholar 

  25. Kinley J, Hockley J, Stone L et al (2014) The provision of care for residents dying in U.K. nursing care homes. Age Ageing 43:375–379. https://doi.org/10.1093/ageing/aft158

    Article  PubMed  Google Scholar 

  26. Menec VH, Nowicki S, Blandford A, Veselyuk D (2009) Hospitalizations at the end of life among long-term care residents. J Gerontol Ser A Biol Sci Med Sci 64A:395–402. https://doi.org/10.1093/gerona/gln034

    Article  Google Scholar 

  27. Miller SC, Lima JC, Intrator O et al (2016) Palliative care consultations in nursing homes and reductions in acute care use and potentially burdensome end-of-life transitions. J Am Geriatr Soc 64:2280–2287. https://doi.org/10.1111/jgs.14469

    Article  PubMed  PubMed Central  Google Scholar 

  28. Krishnan P, Williams H, Maharaj I (2015) Patterns of end-of-life care. J Hosp Palliat Nurs 17:133–142. https://doi.org/10.1097/NJH.0000000000000136

    Article  Google Scholar 

  29. Houttekier D, Vandervoort A, Van den Block L et al (2014) Hospitalizations of nursing home residents with dementia in the last month of life: results from a nationwide survey. Palliat Med 28:1110–1117. https://doi.org/10.1177/0269216314535962

    Article  PubMed  Google Scholar 

  30. Hendriks SA, Smalbrugge M, Deliens L et al (2016) End-of-life treatment decisions in nursing home residents dying with dementia in the Netherlands. Int J Geriatr Psychiatry 32. https://doi.org/10.1002/gps.4650

    Article  PubMed  Google Scholar 

  31. Li Y, Li Q, Tang Y (2016) Associations between family ratings on experience with care and clinical quality-of-care measures for nursing home residents. Med Care Res Rev 73:62–84. https://doi.org/10.1177/1077558715596470

    Article  PubMed  Google Scholar 

  32. Badrakalimuthu V, Barclay S (2014) Do people with dementia die at their preferred location of death? A systematic literature review and narrative synthesis. Age Ageing 43:13–19. https://doi.org/10.1093/ageing/aft151

    Article  PubMed  Google Scholar 

  33. Sommer S, Marckmann G, Pentzek M et al (2012) Advance directives in nursing homes: prevalence, validity, significance, and nursing staff adherence. Dtsch Ärzteblatt Int 109:577–583. https://doi.org/10.3238/arztebl.2012.0577

    Article  Google Scholar 

  34. In der Schmitten J, Lex K, Mellert C et al (2014) Implementing an advance care planning program in German nursing homes: results of an inter-regionally controlled intervention trial. Dtsch Ärzteblatt Int 111:50–57. https://doi.org/10.3238/arztebl.2014.0050

    Article  Google Scholar 

  35. Ohlmeier C, Langner I, Garbe E, Riedel O (2016) Validating mortality in the German Pharmacoepidemiological Research Database (GePaRD) against a mortality registry. Pharmacoepidemiol Drug Saf 25:778–784. https://doi.org/10.1002/pds.4005

    Article  PubMed  Google Scholar 

  36. Brüne-Cohrs U, Juckel G, Schröder SG (2007) Qualität der Demenzdiagnostik im Seniorenheim. Zeitschrift für ärztliche Fortbildung und Qual im Gesundheitswes -. Ger J Qual Heal Care 101:611–615. https://doi.org/10.1016/J.ZGESUN.2007.09.009

    Article  Google Scholar 

  37. Bradford A, Kunik ME, Schulz P et al (2009) Missed and delayed diagnosis of dementia in primary care: prevalence and contributing factors. Alzheimer Dis Assoc Disord 23:306–314. https://doi.org/10.1097/WAD.0b013e3181a6bebc

    Article  PubMed  PubMed Central  Google Scholar 

  38. Hoffmann F, Icks A (2012) Structural differences between health insurance funds and their impact on health services research: results from the Bertelsmann Health-Care Monitor. Gesundheitswesen 74:291–297. https://doi.org/10.1055/s-0031-1275711

    Article  PubMed  CAS  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. We thank the DAK-Gesundheit for providing the data.

Author information

Authors and Affiliations

  1. Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany

    Katharina Allers & Falk Hoffmann

Authors
  1. Katharina Allers
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Falk Hoffmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

KA and FH developed the study protocol and performed the data analysis. KA wrote the manuscript. Both authors contributed to the discussion and critically reviewed the manuscript drafts.

Corresponding author

Correspondence to Katharina Allers.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Allers, K., Hoffmann, F. Mortality and hospitalization at the end of life in newly admitted nursing home residents with and without dementia. Soc Psychiatry Psychiatr Epidemiol 53, 833–839 (2018). https://doi.org/10.1007/s00127-018-1523-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-018-1523-0

Keywords

Search

Navigation