Abstract
Objectives
To understand how the odds of both adverse and positive transitions vary over the
course of episodes of care in nursing homes.
Design
Retrospective cohort study of individuals admitted to nursing homes using clinical
and administrative Canadian Resident Assessment Instrument version 2 data linked to
emergency department and hospital records.
Setting and participants
Adults aged 65 years and older, admitted to nursing homes in Ontario, Alberta, British
Columbia, and Yukon Territories in Canada, from 2010 to 2015. The sample involved
163,176 individuals with 1,088,336 RAI 2.0 assessments.
Measures
Data on mortality and hospitalization were obtained from nursing home and hospital
records. Multistate Markov models were employed to estimate odds ratios characterizing
covariate effects on transitions to different states of health, hospitalization, and
death, stratified by day of stay beginning with the initial 90-day period after admission
to a nursing home.
Results
The first 90 days of stay after admission were characterized by higher odds of both
adverse and positive outcomes after adjusting for numerous covariates. Newly admitted
residents had greater odds of becoming worse in health instability, being hospitalized,
or dying. However, they also had greater odds of being discharged home or improving
in health compared with later stages of the episode of care. These associations varied
by the resident's Changes in Health, End-Stage Disease, Signs, and Symptoms (CHESS)
scores at the start of each 90-day follow-up period, and CHESS was associated with
differential rates of death, hospitalization, and discharge home.
Conclusions/Implications
The initial 90-day period after nursing home placement is one in which the likelihood
of both adverse and positive changes is elevated for nursing home residents. Special
efforts must be taken after admission to identify and respond to risk factors that
may increase the resident's odds of negative outcomes. At the same time, there may
be a window of opportunity for the person's transition back to the community after
a brief nursing home stay.
Keywords
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Article info
Publication history
Published online: April 04, 2019
Footnotes
This study was funded by a Strategic Impact Grant from the Canadian Frailty Network (SIG2014F-31).
George Heckman is supported by the Schlegel Chair in Geriatric Medicine. Andrew Costa is supported by the Schlegel Chair in Clinical Epidemiology and Aging.
The authors declare no conflicts of interest.
Identification
Copyright
Crown Copyright © 2019 Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
