Improving end of life care for nursing home residents: an analysis of hospital mortality and readmission rates.

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.