Abstract
BackgroundAs long-term nursing home care is likely to increase with the aging of the population, identifying chronic medical conditions is of particular interest. Although need factors have a strong impact on nursing home (NH) admission, the diseases causing these functional disabilities are lacking or unclear in the residents' file. We investigated the medical reason (primary diagnosis) of a nursing home admission with respect to the underlying disease.MethodsThis study is based on two independent, descriptive and comparative studies in Belgium and was conducted at two time points (1993 and 2005) to explore the evolution over twelve years. Data from the subjects were extracted from the resident's file; additional information was requested from the general practitioner, nursing home physician or the head nurse in a face-to-face interview. In 1993 we examined 1332 residents from 19 institutions, and in 2005 691 residents from 7 institutions. The diseases at the time of admission were mapped by means of the International Classification of Diseases - 9th edition (ICD-9). Longitudinal changes were assessed and compared by a chi-square test.ResultsThe main chronic medical conditions associated with NH admission were dementia and stroke. Mental disorders represent 48% of all admissions, somatic disorders 43% and social/emotional problems 8%. Of the somatic disorders most frequently are mentioned diseases of the circulatory system (35%) [2/3 sequels of stroke and 1/5 heart failure], followed by diseases of the nervous system (15%) [mainly Parkinson's disease] and the musculoskeletal system (14%) [mainly osteoarthritis]. The most striking evolution from 1993 to 2005 consisted in complicated diabetes mellitus (from 4.3 to 11.4%; p < 0.0001) especially with amputations and blindness. Symptoms (functional limitations without specific disease) like dizziness, impaired vision and frailty are of relevance as an indicator of admission.ConclusionDiseases like stroke, diabetes and mobility problems are only important for institutionalisation if they cause functional disability. Diabetes related complications as cause of admission increased almost three-fold between 1993 and 2005.
Highlights
As long-term nursing home care is likely to increase with the aging of the population, identifying chronic medical conditions is of particular interest
Andersen & Aday presume that use of a nursing home is a function of three classes of variables: personal attributes that predispose individuals to seek care; enabling factors that influence access to care and need factors as reflected by health status, disease and functional disability [1]
Medical issues surrounding nursing home care are becoming increasingly important for public health policymakers from the point of view of health education, and to primary care providers for prevention, detection and treatment of people who are at risk of chronic medical conditions
Summary
As long-term nursing home care is likely to increase with the aging of the population, identifying chronic medical conditions is of particular interest. Need factors have a strong impact on nursing home (NH) admission, the diseases causing these functional disabilities are lacking or unclear in the residents' file. We investigated the medical reason (primary diagnosis) of a nursing home admission with respect to the underlying disease. The reason for admission to long-term nursing home (NH) care is often a combination of factors. Andersen & Aday presume that use of a nursing home is a function of three classes of variables: personal attributes that predispose individuals to seek care; enabling factors that influence access to care and need factors as reflected by health status, disease and functional disability [1].
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