A study from Indiana University has found that almost half of all long-stay nursing home residents experience at least one transfer to an Emergency Department over the course of a year regardless of their cognitive status. About a third of these individuals were subsequently admitted to the hospital.
Age, race, two or more chronic diseases, number of hospitalizations in the year prior to the study, and “Do Not Resuscitate” status all influenced the ED visit.
Participants in the study were 4,491 long-stay (90 or more consecutive days) nursing home residents age 65 and above.
Stressful to go to Emergency Department
“Transferring to an ED is stressful for most people, but it is especially difficult for cognitively impaired older adults from nursing homes who may not understand what is happening to them,” said IU Center for Aging Research and Regenstrief Institute investigator Michael LaMantia, M.D., MPH, first author of the study. “We — physicians, nursing home staff and all who are concerned with older adults who live in long-term care facilities — should be thinking about why individuals with advanced dementia, for whom comfort-oriented care is often more in line with preferences indicated by family members, have ED utilization patterns similar to those patients with early to moderate dementia and even those with no dementia.”
Among nursing home residents sent to the ED, persons with advanced stage dementia were significantly more likely than persons with early to moderate stage or no dementia to receive a diagnosis of a urinary tract infection, a condition potentially treatable in the nursing home.
The researchers encourage nursing home providers to employ the findings of the new study to develop strategies that meet their residents’ care goals and avoids unnecessary transfers from the nursing home to the ED, which in addition to being stressful for the individual are costly to the health care system.
“Identifying unnecessary transfers of nursing home patients to the hospital continues to be a high priority for policymakers, researchers and clinicians,” said IU Center for Aging Research and Regenstrief Institute investigator Kathleen Unroe, M.D., MHA, senior author of the study. “We need to deliver patient-centered and directed care in the most appropriate setting. 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.”
I often call this the rinse, lather and repeat syndrome. Mom is admitted to the hospital, gets an infection, is weak from 10 days in bed so goes to the nursing home for rehab. Maybe she gets back to her apartment in good shape, maybe not. Next time she is likely to need a more intense level of care wen she goes home or she may have to go to an assisted living and then a nursing home. It’s a downward spiral. In future articles on my Senior Care site at verywell we will look at what you, the family caregiver, can do to make sure unneeded and unwarranted trips are not made to the hospital. Stay tuned for more.