The Nursing Home Effect: A Case Study of Residents With Potential Dementia and Emergency Department Visits

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• 作者：Philipe de Souto Barreto ; Maryse Lapeyre-Mestre ; C茅line Mathieu ; Christine Piau ; Catherine Bouget ; Fran莽oise Cayla ; Bruno Vellas ; Yves Roll
• 关键词：Dementia ; elderly ; nursing home ; emergency department
• 刊名：Journal of the American Medical Directors Association
• 出版年：December, 2013
• 年：2013
• 卷：14
• 期：12
• 页码：901-905
• 全文大小：208 K

文摘

Objectives

The burden of potential dementia cases without formal diagnosis on the health care system is almost unknown. This study examined the impact of potential dementia without formal diagnosis on the rate of visits to hospital emergency department (ED) of nursing home (NH) residents.

Design

Cross-sectional study.

Setting

NHs (175) located in France.

Participants

A total of 5684 subjects who were living in the NH for at least 1 year.

Measurements

Information on NHs' characteristics and on NH residents' health was recorded by NH staff. Participants were divided in 3 groups according to their dementia status: diagnosed dementia, potential dementia without formal diagnosis, and nondementia. The outcome measure was a binary variable: ED visits in the last 12 months (yes vs no). A mixed-effects logistic regression was performed on ED visits accounting for the random effects of living in a particular NH.

Results

From the 5684 participants, 1036 had been seen in the ED. Adjusted odds ratio (AOR) showed that having a potential dementia without formal diagnosis, compared with a diagnosed dementia, was associated with an increased probability of ED visits (AOR聽= 1.25, 95% confidence interval: 0.99-1.59, P聽= .061); however, when a random NH effect was entered into the model, the association between potential dementia without formal diagnosis and ED visits disappeared (AOR聽= 1.22, 95% confidence interval: 0.95-1.57, P聽= .11).

Conclusion

The association of potential dementia without formal diagnosis with ED visits varies across NHs. This intra-NH aspect (eg, organization and care habits) should be taken into account when examining the rates of hospitalization and possibly the use of health care services in general among NH residents.