Abstract
BackgroundThe aim of this study was to compare disease status and health care use 1 year before and 1 year after skilled nursing home (SNH) admission.MethodsPeople over the age of 65 years admitted to SNH during the first quarter of 2013, covered by the national health insurance general scheme (69% of the population of this age), and still alive 1 year after admission were identified (n = 14,487, mean age: 86 years, women: 76%). Their reimbursed health care was extracted from the Système National d’Information Interrégimes de l’Assurance Maladie (SNIIRAM) [National Health Insurance Information System].ResultsOne year after nursing home admission, the most prevalent diseases were cardiovascular/neurovascular diseases and neurodegenerative diseases (affecting 45% and 40% of people before admission vs 51% and 53% after admission, respectively). Physical therapy use increased (43% vs 64% of people had at least one physical therapy session during the year, with an average of 47 vs 84 sessions/person during the year), while specialist consultations decreased (29% of people consulted an ophthalmologist at least once during the year before admission vs 25% after admission; 27% vs 21% consulted a cardiologist). Hospitalization rates were lower during the year following institutionalization (75% vs 40% of people were hospitalized at least once during the year), together with a lower emergency admission rate and a higher day admission rate.ConclusionsAnalysis of the new French reimbursement database specific to SNH shows that nursing home admission is associated with a reduction of some forms of outpatient care and hospitalizations.
Highlights
The aim of this study was to compare disease status and health care use 1 year before and 1 year after skilled nursing home (SNH) admission
Almost 700,000 elderly people were living in a nursing home at the end of 2011, i.e. 10% of the population 75 years and older and almost 23% of the population 85 years and older, and 573,600 (83%) of these people lived in specific Établissements d’Hébergement pour Personnes Âgées Dépendantes (EHPAD) [Skilled nursing homes (SNH)] [6]
Detailed information on health care use and disease status of institutionalized elderly people are usually derived from specific crosssectional surveys conducted among physicians, administrative personnel and residents of a sample of institutions, based on relatively small sample sizes with or without comparisons with elderly people living at home
Summary
The aim of this study was to compare disease status and health care use 1 year before and 1 year after skilled nursing home (SNH) admission. The number of dependent elderly people is increasing: 1.2 million people (7.8% of people 60 years and older) received the Allocation Personnalisée d’Autonomie (APA) (dependent person’s pension) in metropolitan France in 2012, with a predicted 2.3 million in 2060 [3]. In this context, a cross-sectional survey conducted every 4 years (2007, 2011, 2015) by the French Ministry of Health among Établissements d’Hébergement pour Personnes Âgées skilled nursing homes (EHPA survey) provides the main data on the numbers and clinical characteristics of institutionalized elderly people [4,5,6]. Analysis of trends before and after nursing home admission would require specific prospective studies, which would be more difficult and expensive to perform
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