Almost half of long-stay nursing home residents experience at least one transfer to an accident and emergency department over the course of a year, regardless of cognitive status, a study has found.
However, only about a third were subsequently admitted to the hospital, according to the study by the Indiana University Center for Aging Research and the Regenstrief Institute in the US.
“Identifying unnecessary transfers of nursing home patients to the hospital continues to be a high priority”
The study determined that dementia severity was not associated either with likelihood of transfer to the A&E or with having that transfer result in a hospitalization.
In contrast, age, race, two or more chronic diseases, number of admissions in the previous year and “do not resuscitate” status all influenced the time to first A&E visit.
The study involved 4,491 long-stay – 90 or more consecutive days – nursing home residents age 65 and above.
It revealed 47% of all long-stay nursing home residents experienced at least one transfer to A&E over the course of a year. At their first transfer, 36.4% of the participants were admitted, whereas 63.1% were not.
The researchers found the average time from entry into a long-term nursing facility to first A&E visit for those with advanced stage dementia was 258 days, 250 days for individuals with early to moderate cognitive impairment and 202 days for those without dementia.
Among nursing home residents sent to the A&E, those with advanced stage dementia were significantly more likely than others to receive a diagnosis of a urinary tract infection, a condition the researchers said was potentially treatable in the nursing home.
“This study confirms high rates of transfer of long-stay nursing home residents, with nearly one-half of the participants experiencing at least one emergency department visit over the course of a year, said the researchers in the Journal of Post-Acute and Long Term Care Medicine.
“Although dementia severity is not a predictor of time to emergency department use in our analyses, other factors that influence emergency department use are readily identifiable,” they added.
Half of nursing home residents visit A&E each year
Source: Regenstrief Institute
The researchers called on nursing home providers to develop strategies that met their residents’ “care goals” and avoided unnecessary, stressful and costly transfers to A&E.
Senior study author Dr Kathleen Unroe said: “Identifying unnecessary transfers of nursing home patients to the hospital continues to be a high priority for policymakers, researchers and clinicians.
“We need to deliver patient-centred and directed care in the most appropriate setting,” she said. “This study describes high rates of transfers to the hospital in a frail population; more work needs to be done to understand which of these transfers can be avoided.”