Scandinavian Journal of Primary Health Care
ISSN: 0281-3432 (Print) 1502-7724 (Online) Journal homepage: http://www.tandfonline.com/loi/ipri20
Risk factors for Admission to a Nursing Home: A study of elderly people receiving home nursing Harald A. Nygaard & Grethe Albrektsen To cite this article: Harald A. Nygaard & Grethe Albrektsen (1992) Risk factors for Admission to a Nursing Home: A study of elderly people receiving home nursing, Scandinavian Journal of Primary Health Care, 10:2, 128-133, DOI: 10.3109/02813439209014049 To link to this article: http://dx.doi.org/10.3109/02813439209014049
© 1992 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted Published online: 12 Jul 2009.
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Date: 16 March 2016, At: 10:10
Scand J Prim Health Care 1992; 10: 128-133
Risk factors for Admission to a Nursing Home A study of elderly people receiving home nursing HARALD A. NYGAARD’ and GRETHE ALBREKTSEN’
‘Fyllingsdalen Sykehjem, Bergen, 2Sectionf o r Medical Informatics and Statistics,
University of Bergen, Norway.
Downloaded by [198.100.148.112] at 10:10 16 March 2016
Nygaard HA, Albrektsen G. Risk factors for admission to a nursing home: a study of elderly people receiving home nursing. S a n d J Prim Health Care 1992: 1 0 128-33 Risk factors for permanent admission to a nursing home were studied in a prospective study of persons 70 years and over who received home nursing. Demographic data and use of psychotropic drugs were registered, and mental capacity, behaviour, and performance of activities of daiJy living (ADLfunction) estimated. 214 patients received home nursing. 166 patients were available for the follow-up study aher 16 months, of whom 31 had been admitted to a nursing home. Senile dementia and stroke were the most frequent diagnoses of admitted patients. Mental impairment, age, and amount of home nursing were associated with permanent admission to a nursing home. The odds for Wig admitted were 10.2 (C. I. 2.3-44.4) times higher in moderately and severely mentally impaired persons than in not mentally impaired persons. The odds for admittance for those 85 years and over, compared with those younger than 80, were 5.0 higher (C. I. 1.615.6); and those receiving home nursing three times weekly or more had 3.8 (C. I. 1.4-9.8) times higher odds than those with less help. Key words: nursing home admission, home nursing, risk factors, mental impairment. Harald A. Nygaard, MD, Fyllingsdalen Sykehjem, N-5033 Bergen-Fyllingsdalen, Norway.
Expansion of community services at home have increasingly enabled frail elderly persons to stay in their own homes, even those with severe physical disabilities. Intervention studies have drawn attention to factors that improve the possibilities of staying at home for a longer period (1, 2). Several international studies deal with risk factors for admission to long-term institutional care. However, there are considerable discrepancies between the results of different studies (3, 4). Nordic studies that concentrate on risk factors for admission to a nursing home are scarce ( 5 ) . The aim of the present prospective investigation was to study risk factors for permanent admission to a nursing home. The study lasted 16 months and concerned patients aged 70 years and over who were living in Bergen and who were receiving home nursing at the time of the initial assessment. MATERIAL AND METHODS The basic information was collected during the first two weeks of June 1987 and included all persons Scand I Prim Health Care 1992; I0
aged 70 years and over who received home nursing, and who lived within the social district of Fyllingsdalen, a region within the city of Bergen. By December 1986 the district had 22390 residents, denoting 11% of the total population of the city. 1584 persons (7.1%) were 70 years and over, of whom 214 persons received home nursing. The data collected for this study are based on the information and knowledge of the home nurse in charge of each patient. The following details were registered: demographic information, use of psychotropic drugs, mental capacity, behaviour, and performance of ADL-functions. The mental capacity was estimated by means of the Clinical Dementia Rating (CDR) (6), which is a global rating scale, consisting of six items: memory, orientation, judgement and problem solving, community affairs, home and hobbies, and personal care. Patients are given a’rating of healthy (CDR = 0), “senescent forgetsfulness” (CDR = O S ) , mild (CDR = l), moderate (CDR = 2) or severe (CDR = 3) dementia. The scale was developed as an instrument for staging Alzheimer’s disease, but has also been used for estimating mental capacity in
Risk factors for admission to a nursing home
Downloaded by [198.100.148.112] at 10:10 16 March 2016
Table I. The number of patients 70 years and over in the social district of Fyllingsdalen receiving home nursing according to age and gender. Figures in brackets denote the percentage of each cohort receiving home nursing. Age groups
Male
70-74 75-79 8&84 85-89 90t
10 (4.1) 15 (8.9) 14 (13.7) 9 (27.3)
Total
Female
Total
0 (0)
35 (8.6) 41 (14.3) 45 (22.7) 32 (31.4) 13 (28.6)
45 (6.9) 56 (12.3) 59 (19.8) 41 (30.4) 13 (24.0)
48 (8.5)
166 (16.0)
214 (13.4)
institutionalized and home-nursed elderly (7, 8). The scale has been translated into Norwegian and is intelligible to use, assuming a proper knowledge of the patient in question. The agreement between the judgement of the home nurses and a physician is good (8). Our patients were divided into three groups: CDR 0-0.5, CDR 1 , and CDR 2-3. ADL-functions and behaviour were measured by means of a workload scale composed by Adolfsson et al. (9) consisting of 7 items: bladder and bowel
129
function, ability to eat, behaviour, motor function. hygiene, and dressing ability. Each item is given a score between 0 (normal) and 6 (highest degree of disability). The scale has not been tested for reliability, but each step is clearly defined in terms familiar to the nursing personnel. Psychotropic drugs were classified according to the Anatomical Therapeutic Chemical Classification Code (ATC classification) (10). The groups of psychotropic drugs were antipsychotics (N 05A), anxiolytics ( N 05B), hypnoticskedatives ( N OSC), and antidepressants (N 06A). Anxiolytics and hypnotics/ sedatives consist mainly of benzodiazepines which share much the same properties (11). For our purpose they were grouped together. Of the 214 patients who received home nursing, 194 were visited on a regular basis and 20 when needed. 163 patients received additional home help. The utilization of home nursing according to age and gender is shown in Table I. The patients were followed for 16 months. During the observation period two patients left the region and were lost t o follow-up. At the end of the observation period, a further 46 persons were excluded from the analysis: 11 were in a home for old people,
Table 11. Demographic characteristics registered at the initial assessment and their association with admission to a nursing home within 16 months. Living at home n=135
Admitted to nursing home
Odds ratio
p
95% confidence
interval
n=31
Gender Male Female
23 112
22
Marital state Married Not married
33 102
10 21
Living condition With someone Alone Age groups
47 88
13 18
70-79 8C-84 85 and over
73 32 30
14
Home nursing < 3 times weekly 2 3 times weekly
109 26
14 17
Home help < 3 times weekly 2 3 times weekly
126 9
21 10
10 Primary Health Care
0.1 9
0.5
0.17-1.45
0.7
0.22-2.11
0.7
0.25-2.22
2.6 4.3
0.77-8.50 1.56-11.61
5.1
2.22-1 1.65
6.7
2.46-18.0
0.4
0.5
ISSN: 0281-3432 (Print) 1502-7724 (Online) Journal homepage: http://www.tandfonline.com/loi/ipri20
Risk factors for Admission to a Nursing Home: A study of elderly people receiving home nursing Harald A. Nygaard & Grethe Albrektsen To cite this article: Harald A. Nygaard & Grethe Albrektsen (1992) Risk factors for Admission to a Nursing Home: A study of elderly people receiving home nursing, Scandinavian Journal of Primary Health Care, 10:2, 128-133, DOI: 10.3109/02813439209014049 To link to this article: http://dx.doi.org/10.3109/02813439209014049
© 1992 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted Published online: 12 Jul 2009.
Submit your article to this journal
Article views: 170
View related articles
Citing articles: 1 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ipri20 Download by: [198.100.148.112]
Date: 16 March 2016, At: 10:10
Scand J Prim Health Care 1992; 10: 128-133
Risk factors for Admission to a Nursing Home A study of elderly people receiving home nursing HARALD A. NYGAARD’ and GRETHE ALBREKTSEN’
‘Fyllingsdalen Sykehjem, Bergen, 2Sectionf o r Medical Informatics and Statistics,
University of Bergen, Norway.
Downloaded by [198.100.148.112] at 10:10 16 March 2016
Nygaard HA, Albrektsen G. Risk factors for admission to a nursing home: a study of elderly people receiving home nursing. S a n d J Prim Health Care 1992: 1 0 128-33 Risk factors for permanent admission to a nursing home were studied in a prospective study of persons 70 years and over who received home nursing. Demographic data and use of psychotropic drugs were registered, and mental capacity, behaviour, and performance of activities of daiJy living (ADLfunction) estimated. 214 patients received home nursing. 166 patients were available for the follow-up study aher 16 months, of whom 31 had been admitted to a nursing home. Senile dementia and stroke were the most frequent diagnoses of admitted patients. Mental impairment, age, and amount of home nursing were associated with permanent admission to a nursing home. The odds for Wig admitted were 10.2 (C. I. 2.3-44.4) times higher in moderately and severely mentally impaired persons than in not mentally impaired persons. The odds for admittance for those 85 years and over, compared with those younger than 80, were 5.0 higher (C. I. 1.615.6); and those receiving home nursing three times weekly or more had 3.8 (C. I. 1.4-9.8) times higher odds than those with less help. Key words: nursing home admission, home nursing, risk factors, mental impairment. Harald A. Nygaard, MD, Fyllingsdalen Sykehjem, N-5033 Bergen-Fyllingsdalen, Norway.
Expansion of community services at home have increasingly enabled frail elderly persons to stay in their own homes, even those with severe physical disabilities. Intervention studies have drawn attention to factors that improve the possibilities of staying at home for a longer period (1, 2). Several international studies deal with risk factors for admission to long-term institutional care. However, there are considerable discrepancies between the results of different studies (3, 4). Nordic studies that concentrate on risk factors for admission to a nursing home are scarce ( 5 ) . The aim of the present prospective investigation was to study risk factors for permanent admission to a nursing home. The study lasted 16 months and concerned patients aged 70 years and over who were living in Bergen and who were receiving home nursing at the time of the initial assessment. MATERIAL AND METHODS The basic information was collected during the first two weeks of June 1987 and included all persons Scand I Prim Health Care 1992; I0
aged 70 years and over who received home nursing, and who lived within the social district of Fyllingsdalen, a region within the city of Bergen. By December 1986 the district had 22390 residents, denoting 11% of the total population of the city. 1584 persons (7.1%) were 70 years and over, of whom 214 persons received home nursing. The data collected for this study are based on the information and knowledge of the home nurse in charge of each patient. The following details were registered: demographic information, use of psychotropic drugs, mental capacity, behaviour, and performance of ADL-functions. The mental capacity was estimated by means of the Clinical Dementia Rating (CDR) (6), which is a global rating scale, consisting of six items: memory, orientation, judgement and problem solving, community affairs, home and hobbies, and personal care. Patients are given a’rating of healthy (CDR = 0), “senescent forgetsfulness” (CDR = O S ) , mild (CDR = l), moderate (CDR = 2) or severe (CDR = 3) dementia. The scale was developed as an instrument for staging Alzheimer’s disease, but has also been used for estimating mental capacity in
Risk factors for admission to a nursing home
Downloaded by [198.100.148.112] at 10:10 16 March 2016
Table I. The number of patients 70 years and over in the social district of Fyllingsdalen receiving home nursing according to age and gender. Figures in brackets denote the percentage of each cohort receiving home nursing. Age groups
Male
70-74 75-79 8&84 85-89 90t
10 (4.1) 15 (8.9) 14 (13.7) 9 (27.3)
Total
Female
Total
0 (0)
35 (8.6) 41 (14.3) 45 (22.7) 32 (31.4) 13 (28.6)
45 (6.9) 56 (12.3) 59 (19.8) 41 (30.4) 13 (24.0)
48 (8.5)
166 (16.0)
214 (13.4)
institutionalized and home-nursed elderly (7, 8). The scale has been translated into Norwegian and is intelligible to use, assuming a proper knowledge of the patient in question. The agreement between the judgement of the home nurses and a physician is good (8). Our patients were divided into three groups: CDR 0-0.5, CDR 1 , and CDR 2-3. ADL-functions and behaviour were measured by means of a workload scale composed by Adolfsson et al. (9) consisting of 7 items: bladder and bowel
129
function, ability to eat, behaviour, motor function. hygiene, and dressing ability. Each item is given a score between 0 (normal) and 6 (highest degree of disability). The scale has not been tested for reliability, but each step is clearly defined in terms familiar to the nursing personnel. Psychotropic drugs were classified according to the Anatomical Therapeutic Chemical Classification Code (ATC classification) (10). The groups of psychotropic drugs were antipsychotics (N 05A), anxiolytics ( N 05B), hypnoticskedatives ( N OSC), and antidepressants (N 06A). Anxiolytics and hypnotics/ sedatives consist mainly of benzodiazepines which share much the same properties (11). For our purpose they were grouped together. Of the 214 patients who received home nursing, 194 were visited on a regular basis and 20 when needed. 163 patients received additional home help. The utilization of home nursing according to age and gender is shown in Table I. The patients were followed for 16 months. During the observation period two patients left the region and were lost t o follow-up. At the end of the observation period, a further 46 persons were excluded from the analysis: 11 were in a home for old people,
Table 11. Demographic characteristics registered at the initial assessment and their association with admission to a nursing home within 16 months. Living at home n=135
Admitted to nursing home
Odds ratio
p
95% confidence
interval
n=31
Gender Male Female
23 112
22
Marital state Married Not married
33 102
10 21
Living condition With someone Alone Age groups
47 88
13 18
70-79 8C-84 85 and over
73 32 30
14
Home nursing < 3 times weekly 2 3 times weekly
109 26
14 17
Home help < 3 times weekly 2 3 times weekly
126 9
21 10
10 Primary Health Care
0.1 9
0.5
0.17-1.45
0.7
0.22-2.11
0.7
0.25-2.22
2.6 4.3
0.77-8.50 1.56-11.61
5.1
2.22-1 1.65
6.7
2.46-18.0
0.4
0.5
