Impact of long term care and mortality risk in community care and nursing homes populations

• Published in: Archives of gerontology and geriatrics 2018-05, Vol.76, p.160-168
• Main Authors: Lopes, Hugo, Mateus, Céu, Rosati, Nicoletta
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Female; Home and community-based services; Humans; Logistic Models; Long-Term Care; Male; Mortality; Mortality risk; Nursing Homes; Outcomes assessment; Portugal
• ISSN: 0167-4943; 1872-6976
• DOI: 10.1016/j.archger.2018.02.009

•The Portuguese National Network for Long-Term Care was created in 2006.•Individuals receiving home care have a higher mortality rate.•Most individuals present no changes in their cognitive and physical status.•Quality and safety may improve if patient-reported outcomes measures are implemented. 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. Home-and-Community-Based Services (HCBS) and three types of Nursing Homes (NH). 20,984 individuals admitted and discharged in 2015. 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 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. 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.