ABSTRACT
INTRODUCTION: Despite concern that many nursing home residents who become acutely unwell are admitted to hospital for often futile and distressing treatment, no previous studies analysing survival and readmission rates of this cohort were found in the literature. OBJECTIVE: To study survival and readmission rates of nursing home patients admitted acutely to general medicine. METHOD: Analysis of all admissions to the acute medical unit of a busy district general hospital over a 94 day period, comparing nursing home residents with all admitted patients aged over 70 years. RESULTS: Nursing home residents were significantly less likely to survive the admission than elderly people living in the community. 33.9% of nursing home residents did not survive the admission and 51.6% died within 6 weeks of admission. Of those discharged alive, 41.5% were readmitted or died within 6 weeks. Patients with a higher level of comorbidity were less likely to survive the admission or live to 6 weeks. DISCUSSION: These findings raise the need for careful 'advance care planning'. This should become commonplace for nursing home residents to improve end of life care and reduce hospital admissions in patients unlikely to survive. The judicious use of 'Preferred Priorities for Care' documents, 'do-not-hospitalise' orders, and the establishment of a dedicated multidisciplinary team involving primary and secondary care is proposed to help achieve these aims. CONCLUSION: Survival rates in nursing home residents admitted to an acute medical unit are low, and measures are suggested to reduce inappropriate admissions and facilitate improved end of life care.
Subject(s)
Homes for the Aged/standards , Hospital Mortality , Nursing Homes/standards , Quality of Health Care , Terminal Care/standards , Aged , Aged, 80 and over , England/epidemiology , Female , Humans , Length of Stay , Male , Middle Aged , Patient Readmission/statistics & numerical data , Unnecessary Procedures/statistics & numerical dataABSTRACT
After serum creatinine levels exceeded 10mg/100ml, median survival was 55 days (to death or dialysis) in a group of 112 patients with chronic renal disease. Renal failure was partially reversible in 29 patients, partially accounting for prolonged survival. Those with polycystic kidneys, pyelonephritis, or obstructive nephropathy survived longer,partially because of more frequent reversibility and a slower increase in serum creatinine concentration. Kiabetic nephropathy, myelomatous kidneys, and amyloidosis were associated with shorter survival, less frequent reversibility, and more rapid progression. Urinary infection and extracellular volume depletion often accounted for partially reversible renal failure and prolonged survival. Blood pressure and age were not prognostic variables, while coexistent heart failure shortened survival. Survival correlated significantly with sodium excretion.
Subject(s)
Kidney Failure, Chronic/mortality , Adult , Age Factors , Amyloidosis/complications , Blood Pressure , Creatinine/blood , Follow-Up Studies , Heart Failure/complications , Humans , Hypertension, Renal/complications , Kidney Failure, Chronic/etiology , Kidney Failure, Chronic/physiopathology , Middle Aged , Missouri , Multiple Myeloma/complications , Natriuresis , Polycystic Kidney Diseases/complications , Prognosis , Pyelonephritis/complications , Sodium/metabolismABSTRACT
Survival after serum creatinine exceeded 10.0 mg/100 ml was increased if one peritoneal dialysis was performed. After one peritoneal dialysis 'survival' of 62 patients to the present time, death or the next dialysis averaged 119 days; median survival was 28 days. Characteristics of prolonged survivors were persistent reduction of serum creatinine below the predialysis concentration, tubulointerstitial diseases, i.e. polycystic kidneys, pyelonephritis or obstructive nephropathy, potentially reversibel complications such as urinary tract infection or extracellular volume depletion, and high urine volume, and low blood pressure. Occasional pateints with survival exceeding 2 years suggest the possibility of prolonged benefit after a single dialysis at least in those wiht characteristics favoring longer survival.
