A Census-based longitudinal study of variations in survival amongst residents of nursing and residential homes in Northern Ireland.

BACKGROUND despite the intensive services provided to residents of care homes, information on death rates is not routinely available for this population in the UK. OBJECTIVE to quantify mortality rates across the care home population of Northern Ireland, and assess variation by type of care home and resident characteristics. DESIGN a prospective, Census-based cohort study, with 5-year follow-up. PARTICIPANTS all 9,072 residents of care homes for people aged 65 and over at the time of the 2001 census with a special emphasis on the 2,112 residents admitted during the year preceding census day. MEASUREMENTS age, sex, self-reported health, marital status, residence (not in care home, residential home, dual registered home, nursing home), elderly mentally infirm care provision. RESULTS the median survival among nursing home residents was 2.33 years (95% CI 2.25-2.59), for dual registered homes 2.75 (95% CI 2.42-3.17) and for residential homes 4.51 (95% CI 3.92-4.92) years. Age, sex and self-reported health showed weaker associations in the sicker populations in nursing homes compared to those in residential care or among the non-institutionalised. CONCLUSIONS the high mortality in care homes indicates that places in care homes are reserved for the most severely ill and dependent. Death rates may not be an appropriate care quality measure for this population, but may serve as a useful adjunct for clinical staff and the planning of care home provision.