Predictive Factors of Mortality in Older Adult Residents of Long-Term Care Facilities

SeolHwa MOON ； Gwi-Ryung Son HONG

《The Journal of Nursing Research》 28卷2期 (2020/04) Pp. 1-8-011

https://doi.org/10.1097/jnr.0000000000000356

摘要

Background: Various factors affect the mortality of older adult residents of long-term care facilities. To provide adequate nursing care for older adults, it is necessary to understand the factors that affect their risk of mortality. Purpose: This study was designed to (a) evaluate the 24-month survival rate and (b) identify the underlying cause of death in various dimensions, including cognitive, psychological, and physical function; nutritional status; and chronic disease. Methods: A longitudinal study was carried out between 2011 and 2013 at seven long-term care facilities. The participants comprised 276 residents who were all older than 65 years old. Baseline measurements included cognitive function (Mini-Mental State Examination for Dementia Screening), psychological function (Cornell Scale for Depression in Dementia), physical function (Barthel Index), nutritional status (Mini Nutritional Assessment, mid-arm circumference, and calf circumference), and chronic disease status (hypertension, diabetes mellitus, chronic respiratory disease, heart disease, and urinary incontinence). Data analysis included univariate and multivariate logistic regression to identify the main factors affecting mortality. Results: In 2011 (baseline), the mean age of the participants was 80.46 years (SD = 7.08) and most were female (73.6%). At the 24-month follow-up, 94 (34.1%) of the participants had died. The major factors affecting mortality were as follows: cognitive dysfunction (OR = 3.12, 95% CI [1.41, 6.90]), mid-arm circumference (＜ 22.5 cm; OR = 2.32, 95% CI [1.35, 3.96]), and urinary incontinence (OR = 2.04, 95% CI [1.16, 3.61]). Conclusions: According to the findings, special attention is needed at the end of life to improve the quality of life of older adults with cognitive dysfunction, malnutrition (low mid-arm circumference), and urinary incontinence who reside in long-term care facilities.

關鍵字

death ； longitudinal study ； long-term care ； older adults

參考文獻

Benetos, A., Labat, C., Rossignol, P., Fay, R., Rolland, Y., Valbusa, F., … Gautier, S. (2015). Treatment with multiple blood pressure medications, achieved blood pressure, and mortality in older nursing home residents: The PARTAGE study. JAMA Internal Medicine, 175(6), 989–995. https://doi.org/10.1001/jamainternmed.2014.8012

Berardelli, M., De Rango, F., Morelli, M., Corsonello, A., Mazzei, B., Mari, V., … Passarino, G. (2013). Urinary incontinence in the elderly and in the oldest old: Correlation with frailty and mortality. Rejuvenation Research, 16(3), 206–211. https://doi.org/10.1089/rej.2013.1417

Cereda, E., Pedrolli, C., Zagami, A., Vanotti, A., Piffer, S., Opizzi, A., … Caccialanza, R. (2011). Nutritional screening and mortality in newly institutionalised elderly: A comparison between the Geriatric Nutritional Risk Index and the Mini Nutritional Assessment. Clinical Nutrition, 30(6), 793–798. https://doi.org/10.1016/j.clnu.2011.04.006

Chan, T. C., Shea, Y. F., Luk, K. H., Chu, L. W., & Chan, H. W. (2013). Association between functional status of Chinese nursing home older adults and long term mortality. Journal of the American Medical Directors Association, 14(2), 147.e1-147.e5. https://doi.org/10.1016/j.jamda.2012.10.016

Damián, J., Pastor-Barriuso, R., García López, F. J., & de PedroCuesta, J. (2017). Urinary incontinence and mortality among older adults residing in care homes. Journal of Advanced Nursing, 73(3), 688–699. https://doi.org/10.1111/jan.13170