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Nearly half of long-stay nursing home residents visit emergency department every year

  • 3 Comments

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”

Kathleen Unroe

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.

Indiana University Center for Aging Research

Half of nursing home residents visit A&E each year

Source: Regenstrief Institute

Kathleen Unroe

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.”

  • 3 Comments

Readers' comments (3)

  • Having been a care home nurse I have frequently been told to send residents to AnE /hospital despite my clinical judgement saying it could be managed in the home. We are often told to do this due to constant threats of NMC referrals and litagation if we dare make a clinical decision and complaints/investigations into the home and provider by NHS providers, regulatory bodies and local authorities. If you want nursing homes to "up their clinical skills and manage" residents health concerns in appropriate settings then start supporting the nurses rather than condemning and threatening them if they dare to think for themselves.

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  • Wouldn't it have been more helpful, as well as being more accurate, to include in the emotive headline that this study took place in the United States, where they do things differently to how we do things here ?

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  • If the government admits that 111 is not fit for purpose; and funds a GP team to visit out of hours [including weekends and bank holidays] care home staff will stop sending residents to hospital; relatives will have more faith in the care homes (as they will be offered the support from GP's OOH) and nurses won't be so frightened of the threat of litigation.
    Care home staff need to be supported; paid the same as the NHS; offered a programme of education and a career structure - only then will we see an improvement in the care home sector - after all we may need this service in the future....

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