Mortality and adverse health events in newly admitted nursing home residents with and without dementia

Jay Magaziner, Sheryl Zimmerman, Ann L. Gruber-Baldini, Carol Van Doorn, J. Richard Hebel, Pearl German, Lynda Burton, George Taler, Conrad May, Charlene C. Quinn, Cynthia L. Port, Mona Baumgarten

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: To evaluate the association between dementia and mortality, adverse health events, and discharge disposition of newly admitted nursing home residents. It was hypothesized that residents with dementia would die at a higher rate and develop more adverse health events (e.g., infections, fevers, pressure ulcers, falls) than residents without dementia because of communication and self-care difficulties. DESIGN: An expert clinician panel diagnosed an admission cohort from a stratified random sample of 59 Maryland nursing homes, between 1992 and 1995. The cohort was followed for up to 2 years or until discharge. SETTING: Fifty-nine Maryland nursing homes. PARTICIPANTS: Two thousand one hundred fifty-three newly admitted residents aged 65 and older not having resided in a nursing home for 8 or more days in the previous year. MEASUREMENTS: Mortality, infection, fever, pressure ulcers, fractures, and discharge home. RESULTS: Residents with dementia had significantly lower overall rates of infection (relative risk (RR) = 0.77, 95% confidence interval (CI) = 0.70-0.85) and mortality (RR = 0.61, 95% CI = 0.53-0.71) than those without dementia, whereas rates of fever, pressure ulcers, and fractures were similar for the two groups. These results persisted when rates were adjusted for demographic characteristics, comorbid conditions, and functional status. During the first 90 days of the nursing home stay, residents with dementia had significantly lower rates of mortality if not admitted for rehabilitative care under a Medicare qualifying stay (RR = 0.25, 95% CI = 0.14-0.45), were less often discharged home (RR = 0.33, 95% CI = 0.28-0.38), and tended to have lower fever rates (RR = 0.78, 95% CI = 0.63-0.96) than residents without dementia. CONCLUSION: Newly admitted nursing home residents with dementia have a profile of health events that is distinct from that of residents without dementia, indicating that the two groups have different long-term care needs. Results suggest that further investigation of whether residents with dementia can be well managed in alternative residential settings would be valuable.

Original languageEnglish (US)
Pages (from-to)1858-1866
Number of pages9
JournalJournal of the American Geriatrics Society
Volume53
Issue number11
DOIs
StatePublished - Nov 2005

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Nursing Homes
Dementia
Mortality
Health
Confidence Intervals
Pressure Ulcer
Fever
Infection
Long-Term Care
Self Care
Medicare
Communication
Demography

Keywords

  • Dementia
  • Nursing home
  • Outcomes

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Magaziner, J., Zimmerman, S., Gruber-Baldini, A. L., Van Doorn, C., Hebel, J. R., German, P., ... Baumgarten, M. (2005). Mortality and adverse health events in newly admitted nursing home residents with and without dementia. Journal of the American Geriatrics Society, 53(11), 1858-1866. https://doi.org/10.1111/j.1532-5415.2005.53551.x

Mortality and adverse health events in newly admitted nursing home residents with and without dementia. / Magaziner, Jay; Zimmerman, Sheryl; Gruber-Baldini, Ann L.; Van Doorn, Carol; Hebel, J. Richard; German, Pearl; Burton, Lynda; Taler, George; May, Conrad; Quinn, Charlene C.; Port, Cynthia L.; Baumgarten, Mona.

In: Journal of the American Geriatrics Society, Vol. 53, No. 11, 11.2005, p. 1858-1866.

Research output: Contribution to journalArticle

Magaziner, J, Zimmerman, S, Gruber-Baldini, AL, Van Doorn, C, Hebel, JR, German, P, Burton, L, Taler, G, May, C, Quinn, CC, Port, CL & Baumgarten, M 2005, 'Mortality and adverse health events in newly admitted nursing home residents with and without dementia', Journal of the American Geriatrics Society, vol. 53, no. 11, pp. 1858-1866. https://doi.org/10.1111/j.1532-5415.2005.53551.x
Magaziner, Jay ; Zimmerman, Sheryl ; Gruber-Baldini, Ann L. ; Van Doorn, Carol ; Hebel, J. Richard ; German, Pearl ; Burton, Lynda ; Taler, George ; May, Conrad ; Quinn, Charlene C. ; Port, Cynthia L. ; Baumgarten, Mona. / Mortality and adverse health events in newly admitted nursing home residents with and without dementia. In: Journal of the American Geriatrics Society. 2005 ; Vol. 53, No. 11. pp. 1858-1866.
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abstract = "OBJECTIVES: To evaluate the association between dementia and mortality, adverse health events, and discharge disposition of newly admitted nursing home residents. It was hypothesized that residents with dementia would die at a higher rate and develop more adverse health events (e.g., infections, fevers, pressure ulcers, falls) than residents without dementia because of communication and self-care difficulties. DESIGN: An expert clinician panel diagnosed an admission cohort from a stratified random sample of 59 Maryland nursing homes, between 1992 and 1995. The cohort was followed for up to 2 years or until discharge. SETTING: Fifty-nine Maryland nursing homes. PARTICIPANTS: Two thousand one hundred fifty-three newly admitted residents aged 65 and older not having resided in a nursing home for 8 or more days in the previous year. MEASUREMENTS: Mortality, infection, fever, pressure ulcers, fractures, and discharge home. RESULTS: Residents with dementia had significantly lower overall rates of infection (relative risk (RR) = 0.77, 95{\%} confidence interval (CI) = 0.70-0.85) and mortality (RR = 0.61, 95{\%} CI = 0.53-0.71) than those without dementia, whereas rates of fever, pressure ulcers, and fractures were similar for the two groups. These results persisted when rates were adjusted for demographic characteristics, comorbid conditions, and functional status. During the first 90 days of the nursing home stay, residents with dementia had significantly lower rates of mortality if not admitted for rehabilitative care under a Medicare qualifying stay (RR = 0.25, 95{\%} CI = 0.14-0.45), were less often discharged home (RR = 0.33, 95{\%} CI = 0.28-0.38), and tended to have lower fever rates (RR = 0.78, 95{\%} CI = 0.63-0.96) than residents without dementia. CONCLUSION: Newly admitted nursing home residents with dementia have a profile of health events that is distinct from that of residents without dementia, indicating that the two groups have different long-term care needs. Results suggest that further investigation of whether residents with dementia can be well managed in alternative residential settings would be valuable.",
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AU - Hebel, J. Richard

AU - German, Pearl

AU - Burton, Lynda

AU - Taler, George

AU - May, Conrad

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AU - Port, Cynthia L.

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N2 - OBJECTIVES: To evaluate the association between dementia and mortality, adverse health events, and discharge disposition of newly admitted nursing home residents. It was hypothesized that residents with dementia would die at a higher rate and develop more adverse health events (e.g., infections, fevers, pressure ulcers, falls) than residents without dementia because of communication and self-care difficulties. DESIGN: An expert clinician panel diagnosed an admission cohort from a stratified random sample of 59 Maryland nursing homes, between 1992 and 1995. The cohort was followed for up to 2 years or until discharge. SETTING: Fifty-nine Maryland nursing homes. PARTICIPANTS: Two thousand one hundred fifty-three newly admitted residents aged 65 and older not having resided in a nursing home for 8 or more days in the previous year. MEASUREMENTS: Mortality, infection, fever, pressure ulcers, fractures, and discharge home. RESULTS: Residents with dementia had significantly lower overall rates of infection (relative risk (RR) = 0.77, 95% confidence interval (CI) = 0.70-0.85) and mortality (RR = 0.61, 95% CI = 0.53-0.71) than those without dementia, whereas rates of fever, pressure ulcers, and fractures were similar for the two groups. These results persisted when rates were adjusted for demographic characteristics, comorbid conditions, and functional status. During the first 90 days of the nursing home stay, residents with dementia had significantly lower rates of mortality if not admitted for rehabilitative care under a Medicare qualifying stay (RR = 0.25, 95% CI = 0.14-0.45), were less often discharged home (RR = 0.33, 95% CI = 0.28-0.38), and tended to have lower fever rates (RR = 0.78, 95% CI = 0.63-0.96) than residents without dementia. CONCLUSION: Newly admitted nursing home residents with dementia have a profile of health events that is distinct from that of residents without dementia, indicating that the two groups have different long-term care needs. Results suggest that further investigation of whether residents with dementia can be well managed in alternative residential settings would be valuable.

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