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Predicting mortality and length of stay in long term care facilities – a systematic review.

Research output: Contribution to conference - Without ISBN/ISSN Posterpeer-review

Publication date2018
<mark>Original language</mark>English
EventNursing Home Research International Working Group - Barcelona , Spain
Duration: 9/11/201610/11/2016


ConferenceNursing Home Research International Working Group


In England, the number of older adults residing in long-term care facilities, or care homes, is expected to rise from the current level of around 350,000 to almost 600,000 by 2030. As majority of older adults admitted to care homes will reside there until death, it is unsurprising that mortality rates are higher compared to the general population. Little routine, individual level data are collected in care homes, and there is ongoing debate regarding whether it is appropriate to incorporate mortality rates or length of stay as predictors of care quality. Less is known of how mortality and length of stay vary within and between care homes. Previous studies have used a range of methods to extract and analyse data on these outcomes, including linked administrative records, census data and longitudinal studies. To date, there has been no international review of these studies. This study aims to collate factors associated with variation in mortality rates and length of stay in care homes for the elderly, at an individual and institutional level.

A systematic literature search of health related databases was conducted to identify relevant research papers. The databases included MEDLINE, EMBASE, CINAHL and the Cochrane Library. Papers were sourced if they included adults aged over 65 years residing in long-term care settings; and measured mortality or length of stay as one of the outcomes. Studies using observational designs, either retrospective or prospective, were included for data extraction. Data were extracted on individual and institutional characteristics, study design, and primary outcomes.

The review will identify the predictive power of individual and institutional characteristics associated with mortality and length of stay. It is anticipated that this will include age, sex and self-reported health, co-morbidities and the use of health services leading up to death. Comparisons between the types of care provided by care homes, such as nursing and residential, will also be reviewed.

Mortality and length of stay in care home residents varies between individuals and between care homes. The findings on characteristics associated with length of stay could be used by health care professionals to facilitate training staff on end of life care, inform treatment choices and support service development. The use of mortality rates as indicators of quality of care or quality of dying is contentious, however the variation in mortality across care homes warrants further research, especially in countries where care is financially supported.