MacRae Jane, Ciminata Giorgio, Geue Claudia, Lynch Ellen, Shenkin Susan D, Quinn Terence J, Burton Jennifer Kirsty
Academic Geriatric Medicine, School of Cardiovascular and Metabolic Health, Collge of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK.
Health Economics and Health Technology Assessment, School of Health & Wellbeing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK.
BMJ Support Palliat Care. 2024 Oct 9. doi: 10.1136/spcare-2024-005163.
Mortality trends among people living in long-term care settings have been poorly understood. Linking data offers the potential to provide real-world, long-term national follow-up. Our aim was to describe patterns and associations with mortality among people moving-in to care homes in Scotland.
A retrospective cohort study was undertaken using routinely collected national social care data from the Scottish Care Home Census. These data were indexed and linked to national health data and mortality records for individuals moving- in to care homes in Scotland between 1 April 2013 and 31 March 2016. Location of death, underlying causes and time to death are reported. Survival analysis was undertaken using the Gompertz model for human mortality adjusted for key variables.
Of 23 892 individuals moving-in to care homes, 20 250 (84.8%) died by 31 May 2020. Most deaths occurred in the care home setting (77.5%), with a fifth (20.5%) occurring in the hospital. 0.1% died the day they moved-in, 3.2% within a month, 24.2% within a year and 85% by 7 years. Dementia codes account for more than a third of all deaths (35.1%). Median survival time was shorter (701 vs 951 days; 23 vs 32 months) for those moving-in from the hospital, compared with the community. The adjusted HR for moving-in from the hospital was 1.19 (95% CI 1.15 to 1.22).
Mortality is common in Scotland's care homes but varies in timing. Dementia is the most common cause. Those moving-in from the hospital are more likely to die sooner, and this evidence provides opportunities to improve support for all involved.
长期护理机构中居民的死亡率趋势一直未得到充分了解。关联数据为提供真实世界的长期全国随访提供了可能。我们的目的是描述入住苏格兰养老院人群的死亡模式及其与死亡率的关联。
采用回顾性队列研究，使用从苏格兰养老院普查中常规收集的全国社会护理数据。这些数据被索引并与2013年4月1日至2016年3月31日期间入住苏格兰养老院的个人的国家健康数据和死亡记录相关联。报告了死亡地点、潜在死因和死亡时间。使用针对关键变量调整后的人类死亡率Gompertz模型进行生存分析。
在23892名入住养老院的人中，到2020年5月31日有20250人（84.8%）死亡。大多数死亡发生在养老院（77.5%），五分之一（20.5%）发生在医院。0.1%的人在入住当天死亡，3.2%在一个月内死亡，24.2%在一年内死亡，85%在7年内死亡。痴呆症编码占所有死亡人数的三分之一以上（35.1%）。与从社区入住的人相比，从医院入住的人的中位生存时间较短（701天对951天；23个月对32个月）。从医院入住的调整后风险比为1.19（95%可信区间1.15至1.22）。
在苏格兰的养老院中，死亡很常见，但时间有所不同。痴呆症是最常见的死因。从医院入住的人死亡时间更早的可能性更大，这一证据为改善对所有相关人员的支持提供了机会。
