Rights statement: This is the author’s version of a work that was accepted for publication in Archives of Gerontology and Geriatrics. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Archives of Gerontology and Geriatrics, 76, 2018 DOI: 10.1016/j.archger.2018.02.009
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Research output: Contribution to Journal/Magazine › Journal article › peer-review
Research output: Contribution to Journal/Magazine › Journal article › peer-review
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TY - JOUR
T1 - Impact of long term care and mortality risk in community care and nursing homes populations
AU - Lopes, Hugo
AU - Mateus, Céu
AU - Rosati, Nicoletta
N1 - This is the author’s version of a work that was accepted for publication in Archives of Gerontology and Geriatrics. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Archives of Gerontology and Geriatrics, 76, 2018 DOI: 10.1016/j.archger.2018.02.009
PY - 2018/5
Y1 - 2018/5
N2 - Objectives To identify the survival time, the mortality risk factors and the individuals’ characteristics associated with cognitive and physical status at discharge, among the Portuguese long-term care (LTC) populations. Settings Home-and-Community-Based Services (HCBS) and three types of nursing home (NH). Participants 20,984 individuals admitted and discharged in 2015. Measurements The Kaplan-Meier survival analysis and the Cox Proportional Hazards Models were used to study the mortality risk; the Wilcoxon signed-rank test to identify the number of individuals with cognitive and physical changes between admission and discharge; two cumulative odds ordinal logistic regressions to predict the cognitive and physical dependence levels at discharge Results The mortality rate at HCBS was 30%, and 17% at the NH, with a median survival time of 173 and 200 days, respectively. The main factors associated with higher mortality were older age, male gender, family/neighbour support, neoplasms and cognitive/physical dependence at admission. In NH/HCBS, 26%/18% of individuals improve their cognitive status, while in physical status, the proportion was 38%/27%, respectively. Finally, older age, being illiterate and being classified at the lowest cognitive and physical status at admission decrease the likelihood of achieving a higher level of cognitive and physical independence at discharge. Conclusions The adoption of a robust and complete assessment tool, the definition of guidelines to enable a periodical assessment of individuals’ autonomy and the adoption of benchmark metrics allowing the comparison of results between similar units are some of the main goals to be taken into account for future developments of this care in Portugal.
AB - Objectives To identify the survival time, the mortality risk factors and the individuals’ characteristics associated with cognitive and physical status at discharge, among the Portuguese long-term care (LTC) populations. Settings Home-and-Community-Based Services (HCBS) and three types of nursing home (NH). Participants 20,984 individuals admitted and discharged in 2015. Measurements The Kaplan-Meier survival analysis and the Cox Proportional Hazards Models were used to study the mortality risk; the Wilcoxon signed-rank test to identify the number of individuals with cognitive and physical changes between admission and discharge; two cumulative odds ordinal logistic regressions to predict the cognitive and physical dependence levels at discharge Results The mortality rate at HCBS was 30%, and 17% at the NH, with a median survival time of 173 and 200 days, respectively. The main factors associated with higher mortality were older age, male gender, family/neighbour support, neoplasms and cognitive/physical dependence at admission. In NH/HCBS, 26%/18% of individuals improve their cognitive status, while in physical status, the proportion was 38%/27%, respectively. Finally, older age, being illiterate and being classified at the lowest cognitive and physical status at admission decrease the likelihood of achieving a higher level of cognitive and physical independence at discharge. Conclusions The adoption of a robust and complete assessment tool, the definition of guidelines to enable a periodical assessment of individuals’ autonomy and the adoption of benchmark metrics allowing the comparison of results between similar units are some of the main goals to be taken into account for future developments of this care in Portugal.
KW - Nursing Homes
KW - Home and Community-Based Services
KW - Mortality risk
KW - Outcomes assessment
KW - Portugal
U2 - 10.1016/j.archger.2018.02.009
DO - 10.1016/j.archger.2018.02.009
M3 - Journal article
VL - 76
SP - 160
EP - 168
JO - Archives of Gerontology and Geriatrics
JF - Archives of Gerontology and Geriatrics
SN - 0167-4943
ER -