Deaths Of Residents Research Articles

A research progress on risk factors for stroke related infections

Stroke is the leading cause of death and disability in the world. It is the first disease that causes the death of Chinese residents, and hospital infection is the leading cause of death in stroke patients. This paper based on the research of the domestic and foreign articles, found that stroke predictor associated pneumonia, urinary tract infection mainly including the type, area, and the size of the brain injury, the patient′s age, sex, consciousness, swallowing and urination function, National Institute of Health Stroke Scale (NIHSS) score, trachea, invasive operation, indwelling catheter and diabetes mellitus, atrial fibrillation, cardiovascular disease, etc. Some results of the study are different, further validation and Meta-analysis are needed. This paper aims to provide a basis for nursing workers to assess the risk of infection in patients with cerebral apoplexy, so as to provide early prevention and intervention for high-risk patients. Key words: Stroke; Infection; Risk factors

Health and Care Related Risk Factors for Suicide Among Nursing Home Residents: A Data Linkage Study.

This study aimed to examine associations between health status and care needs of nursing home residents and risk of death from suicide compared to other causes through a retrospective data linkage cohort study examining nursing home resident deaths in Australia between 2000 and 2013. Data linkage was performed between aged care assessment tools-Resident Classification System and Aged Care Funding Instrument-and the National Coronial Information System. A competing risks survival analysis was performed to determine the association between care assessment variables (activities of daily living (ADL), behavior, and complex health care) and the risk of death from suicide and any other cause. Of the 146 nursing home residents who died from suicide, 130 (89%) were matched to their assessment data, with comparable information available for 95 residents (65%). Residents who required high levels of care with ADL, physical health care, and cognitive and behavioral issues had a higher risk of dying from all other causes, yet lower risk of dying from suicide. The study findings demonstrate the feasibility and value of linking these two data sets; highlight a need for improved data collection processes; and support a person-centered care approach for prevention of suicide among nursing home residents.

Acute Effect of Air Pollutant Sulfur Dioxide on Acute Myocardial Infarction Mortality from 2011 to 2017 in Jinan City

Objectives: The objective of this study is to quantitatively analyze the acute effects of atmospheric pollutant sulfur dioxide (SO2) on acute myocardial infarction (AMI) death in residents of Jinan City. Methods: A descriptive analysis of data on daily weather, air pollutants, and residents' AMI death events was collected from 2011 to 2017 in Jinan city. A generalized additive model (GAM) based on the Quasi-Poisson regression was used to analyze the associations of AMI deaths and SO2. The lag effect of current day (lag0~lag3) and cumulative lagged effect (lag01~lag03) were explored. The excess risk (ER) and 95% confidence interval (CI) of AMI deaths were calculated for every 10 μg/m3 increase in SO2. Results: A total of 40,843 AMI deaths occurred between 2011 and 2017, with a daily average of 16 deaths. During the same period, the average annual value of SO2was 65 μg/m3. An increase in SO2concentration of 10 μg/m3 was associated with an increased risk of death related to AMI at lag 1 by 0.35% (95% CI: 0.06%–0.64%). Especially in cold months, a higher increased risk of 0.49% (95% CI: 0.19%–0.79 %) for AMI death was observed with SO2a 10 μg/m3 increase. While there was a significant cumulative hysteresis effect, the maximum cumulative hysteresis effect appeared in lag 02. Conclusions: The atmospheric pollutant SO2in Jinan City has a significant acute effect on the risk of death from AMI , especially a higher increased risk was observed in cold months.

Integrating palliative care in long-term care facilities across Europe (PACE): protocol of a cluster randomized controlled trial of the \u2018PACE Steps to Success\u2019 intervention in seven countries

BackgroundSeveral studies have highlighted the need for improvement in palliative care delivered to older people long-term care facilities. However, the available evidence on how to improve palliative care in these settings is weak, especially in Europe. We describe the protocol of the PACE trial aimed to 1) evaluate the effectiveness and cost-effectiveness of the ‘PACE Steps to Success’ palliative care intervention for older people in long-term care facilities, and 2) assess the implementation process and identify facilitators and barriers for implementation in different countries.MethodsWe will conduct a multi-facility cluster randomised controlled trial in Belgium, Finland, Italy, the Netherlands, Poland, Switzerland and England. In total, 72 facilities will be randomized to receive the ‘Pace Steps to Success intervention’ or to ‘care as usual’. Primary outcome at resident level: quality of dying (CAD-EOLD); and at staff level: staff knowledge of palliative care (Palliative Care Survey). Secondary outcomes: resident’s quality of end-of-life care, staff self-efficacy, self-perceived educational needs, and opinions on palliative care. Economic outcomes: direct costs and quality-adjusted life years (QALYs).Measurements are performed at baseline and after the intervention. For the resident-level outcomes, facilities report all deaths of residents in and outside the facilities over a previous four-month period and structured questionnaires are sent to (1) the administrator, (2) staff member most involved in care (3) treating general practitioner, and (4) a relative. For the staff-level outcomes, all staff who are working in the facilities are asked to complete a structured questionnaire. A process evaluation will run alongside the effectiveness evaluation in the intervention group using the RE-AIM framework.DiscussionThe lack of high quality trials in palliative care has been recognized throughout the field of palliative care research. This cross-national cluster RCT designed to evaluate the impact of the palliative care intervention for long-term care facilities ‘PACE Steps to Success’ in seven countries, will provide important evidence concerning the effectiveness as well as the preconditions for optimal implementation of palliative care in nursing homes, and this within different health care systems.Trial registrationThe study is registered at www.isrctn.com – ISRCTN14741671 (FP7-HEALTH-2013-INNOVATION-1 603111) Registration date: July 30, 2015.

“To a better place”: The role of religious belief for staff in residential aged care in coping with resident deaths

IntroductionStaff in residential aged care (RAC) face increasing exposure to death and dying provoking coping-related responses. This study reports on research exploring the role of religious/spiritual belief in staff coping with death and dying in RAC homes. MethodUtilising a mixed methods, concurrent triangulation design, data from interviews and questionnaires with 113 RAC staff were analysed to explore the relationship between staff members’ religious/spiritual beliefs and coping with resident deaths within the context of 50 RAC facilities. ResultsParticipants appeared to have distinctly different experiences of the role of religious/spiritual beliefs in their attitudes toward death and dying – as reflected linguistically in how they described it. Strong religious/spiritual influence and religious affiliation were associated with lower scores for burnout. Level of religious/spiritual influence does make a difference in the strategies employed by staff in coping with death and dying. ConclusionGiven the potential benefits associated with religious/spiritual beliefs, RAC facility management would be well advised to foster a workplace culture that supports and encourages spiritual/religious expression among facility staff. Greater understanding of the role of religious/spiritual beliefs in helping staff to make sense of the end-of-life experience can provide the basis for the development of staff supports enabling both improved staff well-being and resident end-of-life care.

Minimum Data Set Changes in Health, End-Stage Disease and Symptoms and Signs Scale: A Revised Measure to Predict Mortality in Nursing Home Residents.

To revise the Minimum Data Set (MDS) Changes in Health, End-stage disease and Symptoms and Signs (CHESS) scale, an MDS 2.0-based measure widely used to predict mortality in institutional settings, in response to the release of MDS 3.0. Development of a predictive scale using observational data from the MDS and Medicare Master Beneficiary Summary File. All Centers for Medicare and Medicaid Services (CMS)-certified nursing homes in the United States. Development cohort of 1.3 million Medicare beneficiaries newly admitted to a CMS-certified nursing home during 2012. Primary validation cohort of 1.2 million Medicare recipients who were newly admitted to a CMS-certified nursing home during 2013. Items from the MDS 3.0 assessments identified as likely to predict mortality. Death information was obtained from the Medicare Master Beneficiary Summary File. MDS-CHESS 3.0 scores ranges from 0 (most stable) to 5 (least stable). Ninety-two percent of the primary validation sample with a CHESS scale score of 5 and 15% with a CHESS scale of 0 died within 1 year. The risk of dying was 1.63 times as great (95% CI=1.628-1.638) for each unit increase in CHESS scale score. The MDS-CHESS 3.0 is also strongly related to hospitalization within 30 days and successful discharge to the community. The scale predicted death in long-stay residents at 30 days (C=0.759, 95% confidence interval (CI)=0.756-0.761), 60 days (C=0.716, 95% CI=0.714-0.718) and 1 year (C=0.655, 95% CI=0.654-0.657). The MDS-CHESS 3.0 predicts mortality in newly admitted and long-stay nursing home populations. The additional relationship to hospitalizations and successful discharges to community increases the utility of this scale as a potential risk adjustment tool.

Health Outcomes from Assisted Living Facilities: a Cohort Study of a Primary Care Practice

The population of older adults residing in assisted living facilities (ALF) in the United States is growing, yet health data about this population is relatively sparse. We aimed to compare health outcomes of ALF residents with those of age- and sex-matched community dwelling adults in a retrospective cohort study of 808 older adults. Linear regression analyses were conducted to describe the relationship between ALF residency and our outcomes of hospitalizations within 1 year of the index date (earliest recorded date in the ALF), 30-day rehospitalization following index hospitalization, emergency department (ED) visits, and mortality at 1 year. Hospitalizations were significantly greater for ALF residents than for controls. The odds of death for ALF residents were approximately twice that of controls. Falls and ED visits were also significantly greater for ALF residents. The ALF population requires targeted geriatric and primary care models if we are to effectively meet the needs of this growing population.

Adequate working hours and skill earning.

Long working hours have caused many pediatricians to burn out and become depressed, and, as a result, many human errors have occurred, not only in outpatient clinics but also in inpatient wards. This phenomenon has also been observed in the neonatal intensive care unit, obstetrics and gynecology, and in surgical subspecialties. To prevent these human errors, the US Accreditation Council for Graduate Medical Education (ACGME) has set a cap of 80 h/week, and also a mandate on the amount of sleep/personal time for residents (10 h between shifts), as well as the maximum length of shifts (16 h with 30 h maximums), and the number of overnight calls (no more than once every 3 days). The European Union working time directive has also set 48 h as the maximum limit. These restrictions, however, generated criticisms with regard to the resulting lower volume of experience and slower acquirement of higher skills. After two resident deaths by suicide in New York City in 2014 within 1 week of each other, the ACGME called to national leaders and ran symposia on physician wellbeing in November 2015 and 2016. As a result, the American Pediatric Society National Conference ran a session named Peds21 – Pediatricians Leading Change in Physician Health and Wellness, in Chicago, September 2017, to address the relationship between burnout, job satisfaction, quality care and patient safety, and also to teach self-resilience. In the meantime, the Japan Pediatric Society has also strived to reduce pediatrician working hours by concentrating the workforce and inpatient beds into bigger regional pediatric centers, not only to prevent pediatrician exhaustion and suicide, but also to improve teamwork and achieve better patient outcomes. To ensure this, higher volumes of experience and skill earning in adequate working hours are crucial in clinical settings worldwide. The author declares no conflict of interest.

Calculating census tract-based life expectancy in New York state: a generalizable approach

BackgroundLife expectancy at birth (LE) has been calculated for states and counties. LE estimates at these levels mask health disparities in local communities. There are no nationwide estimates at the sub-county level. We present a stepwise approach for calculating LE using census tracts in New York state to identify health disparities.MethodsOur study included 2751 census tracts in New York state, but excluded New York City. We used population data from the 2010 United States Census and 2008–2010 mortality data from the state health department. Tracts were assigned to 99.97% of the deaths. We removed tracts which had a majority of people living in group quarters. Deaths in these tracts are often recorded elsewhere. Of the remaining 2679 tracts, 6.6% of the tracts had standard errors ≥ 2 years. A geographic aggregation tool was used to aggregate tracts with fewer than 60 deaths, and then aggregate areas that had standard errors of ≥ 2 years.ResultsAggregation resulted in a 9.9% reduction in the number of areas. Tracts with < 2% of population living below the poverty level had a LE of 82.8 years, while tracts with a poverty level ≥ 25% had a LE of 75.5. We observed differences in LE in border areas, of up to 10.4 years, when excluding or including deaths of study area residents that occurred outside the study area. The range and standard deviation at the county level (77.5–82.8, SD = 1.2 years) were smaller than our final sub-county areas (64.7–92.0, SD = 3.3 years). The correlation between LE and poverty were similar and statistically significant (p < 0.0001) at the county (r = − 0.58) and sub-county level (r = − 0.58). The correlations between LE and percent African-American at the county level were (r = 0.11, p = 0.43) and at the sub-county level (r = − 0.25, p < 0.0001).ConclusionThe proposed approach for geocoding and aggregation of mortality and population data provides a solution for health departments to produce stable empirically-derived LE estimates using data coded to the tract. Reliable estimates within sub-county areas are needed to aid public health officials in focusing preventive health programs in areas where health disparities would be masked by county level estimates.

Travel-related risk factors for coccidioidomycosis.

Coccidioidomycosis is a regionally endemic systemic mycosis with unique risk factors. Since people travel for business or pleasure, and often in conjunction with their avocations or hobbies, the objectives of this review were to describe these and other risk factors for coccidioidomycosis; to alert travel medicine clinicians to the different presenting manifestations of coccidioidomycosis; and to recommend effective treatment, disease control and prevention strategies. To meet the objectives of this review, Internet search engines were queried with the keywords as medical subject headings over the study period, 1970-2017. The principle transmission mechanism of coccidioidomycosis is by deep inhalation of aerosolized arthroconidia with resulting symptomatic pulmonary infections ranging from febrile influenza-like illnesses to fatal disseminated mycoses. In addition to residency or travel in endemic areas, persons immunocompromised by advancing age, pregnancy, cancer, corticosteroid therapy, diabetes, organ transplantation and human immunodeficiency virus infection are at significantly increased risks of contracting coccidioidomycosis. Persons of African, Asian, Filipino and Hispanic descent are also at increased risks of contracting coccidioidomycosis. Hobbies associated with coccidioidomycosis have included armadillo hunting, model airplane flying and archaeological digging. Occupational risk factors for coccidioidomycosis include endemic exposures during military maneuvers, outdoor track and field events, road construction, solar-power and wind-power farm construction, archaeological excavation and prison work. Coccidioidomycosis is more common in endemic and non-endemic areas than previously recognized and can result in considerable morbidity and mortality. Coccidioidomycosis is increasingly imported from endemic areas in the Western Hemisphere to non-endemic areas worldwide. Increased awareness of disease risk factors among the public and the international healthcare community will improve the timely diagnosis and treatment of coccidioidomycosis and prevent disease progression, dissemination and deaths in residents in and in travellers returning from endemic regions. A vaccine for the primary prevention of coccidioidomycosis would be cost-effective.

Returning home to die or leaving home to seek health care? Location of death of urban and rural residents in Burkina Faso and Senegal

ABSTRACTBackground: In sub-Saharan Africa, the literature on end of life is limited and focuses on place of death as an indicator of access and utilization of health-care resources. Little is known about population mobility at the end of life.Objective: To document the magnitude, motivations and associated factors of short-term mobility before death among adults over 15 years of age in Burkina Faso and Senegal.Methods: The study was based on deaths of adult residents reported in three Health and Demographic Surveillance System (HDSS) sites in urban (Ouagadougou) and semi-rural areas (Kaya) of Burkina Faso, and rural areas of Senegal (Mlomp). After excluding deaths from external causes, the analysis covered, respectively, 536 and 695 deaths recorded during the period 2012–2015 in Ouagadougou and Kaya. The period was extended to 2000–2015 in Mlomp, with a sample of 708 deaths. Binary logistic regressions were used to examine the effects of socio-demographic characteristics on place of death (health facility or not) and location of death (within or outside the HDSS).Results: In Mlomp, Kaya and Ouagadougou, respectively 20.6%, 5.3% and 5.9% of adults died outside the HDSS site. In Mlomp and Kaya, these deaths were more likely to occur in a health facility than deaths that occurred within the site. The reverse situation was found in Ouagadougou. Age is the strongest determinant of mobility before death in Mlomp and Kaya. In Mlomp, young adults (15–39) were 10 times more likely to die outside the site than adults in the 60–79 age group. In Ouagadougou, non-natives were three times more likely to die outside the city than natives.Conclusions: At the end of life, some rural residents move to urban areas for medical treatment while some urban dwellers return to their village for supportive care. These movements of dying individuals may affect the estimation of urban/rural mortality differentials.

Tuberculosis mortality trend in the state of Paraná, Brazil - 1998-2012.

The objective was to analyze the trend in tuberculosis mortality in Paraná from 1998 to 2012, according to healthcare macro-region-al, gender and age. Ecological study of time series data with the system of the Unified System Mortality Information Health (SIM/SUS). Trend analysis of standardized mortality rates was performed by linear regression segmented identifying the points with the change trend. There were 847 deaths of residents in Paraná in the period. The trend was initially declining to state, with subsequent significant increase only for the macro-regional East. Mortality from tuberculosis showed growing trend for the age groups 20-39 years and 40-49 years and for males. The growing trend in tuberculosis mortality was observed from 2010 is a warning to managers honing the service at different levels of health care.

What Are Staff Perceptions About Their Current Use of Emergency Departments for Long-Term Care Residents at End of Life?

The goal of this study was to examine current rates of resident deaths, Emergency Department (ED) use within the last year of life, and hospital deaths for long-term care (LTC) residents. Using a mixed-methods approach, we compared these rates across four LTC homes in Ontario, Canada, and explored potential explanations of variations across homes to stimulate staff reflections and improve performance based on a quality improvement approach. Chart audits revealed that 59% of residents across sites visited EDs during the last month of life and 26% of resident deaths occurred in hospital. Staff expressed surprise at the amount of hospital use during end of life (EOL). Reflections suggested that clinical expertise, comfort with EOL communication, clinical resources (i.e., equipment), and family availability for EOL decision making could all affect nondesirable hospital transfers at EOL. Staff appeared motivated to address these areas of practice following this reflective process.

Place of death in the Snowy Monaro region of New South Wales: A study of residents who died of a condition amenable to palliative care.

To describe the place of death of residents in a rural region of New South Wales. Cross-sectional quantitative study using death data collected from local funeral directors (in person and websites), residential aged-care facilities, one multipurpose heath service and obituary notices in the local media (newspapers/radio). Snowy Monaro region (New South Wales Australia). Residents, with advanced frailty or one of 10 conditions amenable to palliative care, who died between 1 February 2015 and 31 May 2016. Place of death. Of 224 deaths in this period, 138 were considered amenable to palliative care. Twelve per cent of these deaths occurred in a private residence, 38% in the usual place of residence and 91% within the region. Most rural residents with conditions amenable to palliative care died in the region. Most did not die in their usual place of residence. Further qualitative work is needed to determine palliative care patients' and family caregivers' preferences for, and the importance placed on, place of death. While there may be a need to support an increase in home deaths, local rural hospitals and residential aged-care facilities must not be overlooked as a substitute for inpatient hospices.

Factors associated with deaths in \u2018Elderly Housing with Care Services\u2019 in Japan: a cross-sectional study

BackgroundAlthough the Japanese government has expanded its ‘Elderly Housing with Care Services’ (EHCS) to ensure sufficient places of death for the elderly, resident deaths have occurred in less than 30% of the facilities. Our purpose was to identify the factors associated with residents’ deaths in the EHCS, especially within the areas that are expected to have a large increase in the number of deaths.MethodsOur cross-sectional study involved all EHCS (N = 412) in Japan’s Tokyo, Kanagawa prefecture and used self-administered questionnaire data that the EHCS directors completed. In addition, we accessed the national statistics related to the municipal characteristics of the cities where the EHCS were located. These sources provided information about health care provision for the residents as well as facility/resident/regional characteristics that could potentially be associated with residents’ deaths in the EHCS. Based on this information, a sequential multiple logistic regression analysis was performed. First, we included in-facility health care provision (presence of nursing staff) and facility/residents/regional characteristics in Model 1. Next, visiting nurse agency’s care provision was included in Model 2. Finally, we included community hospitals or clinical care provision in Model 3.ResultsOne hundred and fifty-four facilities answered the questionnaire (response rate: 37.4%). A total of 114 facilities were analysed. In-facility residents’ deaths occurred in more than half (54.4%) of the facilities. After adjusting for all variables (Model 3), end-of-life (EOL) care provision from community hospitals or clinics, the number of years since establishment and the number of residents were significantly associated with residents’ deaths. In Model 2, visiting nurse’s EOL care provision was significantly associated with residents’ death.ConclusionOur results suggest that in order to accommodate residents’ deaths, the government or the facility’s directors should promote the cooperation between EHCS facilities and community hospitals or clinics for in-residents’ EOL care. Furthermore, as the results suggest that community nurses contribute to the occurrences of death by collaborating with the physician, promoting cooperation with visiting nurse agencies may be also needed.

Study on smoking attributed death and effects of smoking cessation in residents aged 35-79 years in Tianjin, 2016

Objective: To analyze the influence of smoking on deaths in residents aged 35-79 years and the effects of smoking cessation in Tianjin. Methods: The data of 39 499 death cases aged 35-79 years in 2016 in Tianjin were collected, the risks for deaths caused by smoking related diseases and excess deaths as well as effects of smoking cessation were analyzed after adjusting 5 year old age group, education level and marital status. Results: Among the 39 499 deaths cases, 1 589 (13.56%) were caused by smoking, the percentage of the excess mortality of lung cancer caused by smoking was highest (47.60%); the risk of death due to lung cancer in smokers was 2.75 times higher than that in non-smokers (95%CI: 2.47-3.06). Among the female deaths, 183 (7.29%) were caused by smoking, the percentage of the excess mortality of lung cancer was highest (28.90%); and the risk of death of lung cancer in smokers was 4.04 times higher than that in non-smokers (95%CI: 3.49-4.68). The OR for disease in ex-smokers was 0.80 compared with 1.00 in smokers (95%CI: 0.72-0.90). The OR in males who had quitted smoking for ≥10 years was lower (0.74, 95%CI: 0.63-0.86) than that in those who had quitted smoking for 1-9 years (0.85, 95%CI: 0.74-0.98), but the difference was not significant. Conclusion: Smoking is one of the most important risk factors for deaths in residents in Tianjin. Smoking cessation can benefit people's health.

Pressure points: learning from Serious Case Reviews of failures of care and pressure ulcer problems in care homes

PurposeSerious Case Reviews (SCRs, now Safeguarding Adults Reviews (SARs)) may be held at local level in England when a vulnerable adult dies or is harmed, and abuse or neglect is suspected, and there is cause for concern about multi-agency safeguarding practice. There has been no analysis of SCRs focussing on pressure ulcers. The purpose of this paper is to present findings from a documentary analysis of SCRs/SARs to investigate what recommendations are made about pressure ulcer prevention and treatment in a care home setting in the context of safeguarding. This analysis is presented in cognisance of the prevalence and risks of pressure ulcers among care home residents; and debates about the interface of care quality and safeguarding systems.Design/methodology/approachIdentification of SCRs and SARs from England where the person who died or who was harmed had a pressure ulcer or its synonym. Narrative and textual analysis of documents summarising the reports was used to explore the Reviews’ observations and recommendations. The main themes were identified.FindingsThe authors located 18 relevant SCRs and 1 SAR covering pressure ulcer care in a care home setting. Most of these inquiries into practice, service communications and the events leading up to the death or harm of care home residents with pressure ulcers observed that there were failings in the care home, but also in the wider health and care systems. Overall, the reports reveal specific failings in multi-agency communication and in quality of care. Pressure ulcers featured in several SCRs, but it is problems and inadequacies with care and treatment that moved them to the safeguarding arena. The value of examining pressure ulcers as a key line of inquiry is that they are “visible” in the system, with consensus about what they are, how to measure them and what constitutes optimal care and treatment. In the new Care Act 2014 context they may continue to feature in safeguarding enquiries and investigations as they may be possible symptoms of system failures.Research limitations/implicationsReviews vary in content, structure and accessibility making it hard to compare their approach, findings and recommendations. There are risks in drawing too many conclusions from the corpus of Reviews since these are not published in full and contexts have subsequently changed. However, this is the first analysis of these documents to take pressure ulcers as the focus and it offers valuable insights into care home practices amid other systems and professional activity.Practical implicationsThis analysis highlights that it is not inevitably poor quality care in a care home that gives rise to pressure ulcers among residents. Several SCRs note problems in wider communications with healthcare providers and their engagement. Nonetheless, poor care quality and negligence were reported in some cases. Various policies have commented on the potential overlap between the raising of concerns about poor quality care and about safeguarding. These were highlighted prior to the Care Act 2014 although current policy views problems with pressure ulcers more as care quality and clinical concerns.Social implicationsThe value of this documentary analysis is that it rests on real case examples and scrutiny at local level. Future research could consider the findings of SARs, similar documents from the rest of the UK, and international perspectives.Originality/valueThe value of having a set of documents about adult safeguarding is that they lend themselves to analysis and comparison. This first analysis to focus on pressure ulcers addresses wider considerations related to safeguarding policy and practice.

Socioeconomic Differences and Trends in the Place of Death among Elderly People in China.

China is facing a dramatic aging of its population. Little is known about the factors that influence the place of death and the trends in the place of death for elderly people in China. The purposes of this study were: (1) to examine the impact of the socioeconomic status (SES) on place of death for elderly Chinese residents; and (2) to assess temporal trends in the place of death over the last 15 years. Data were derived from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) (1998–2012). Place-of-death as an outcome was dichotomized into either death at home or death outside the home. Logistic regression analyses were used to examine the impact of SES on place of death. The results showed that, of the 23,098 deaths during the study period, 87.78% occurred at home. The overall trend in home death has increased since 2005. SES was shown to be an important factor affecting place of death. The elderly with higher SES were more likely to die where health resources were concentrated, i.e., in a hospital or other type of institution. Our finding suggests that the trend towards a greater emphasis on death at home may call for the development of more supportive home care programs in China. Our finding also suggests that the socioeconomic differences in the place of death may be related to the availability of or access to health care services.

Moving to a Systems Approach to Safeguard Adults in Residential Care

In 2016, the Health and Social Care Institute Adult Safeguarding Collection data indicated care homes are a setting of high risk of harm to adults. This research study considers the outcomes of a sample of 11 Serious Case Reviews into the abuse of adults in the care setting. Its purpose is to help identify professional practice messages that might lead to the prevention of harm in care homes for the future. Serious Case Reviews have recognised a weakness in safeguarding practice relating to the way in which practitioners have dealt with safeguarding events. In all the reviews, the practitioner response was observed to be one that focused on the individual harmed. There was an absence of regard to the wider picture of cumulative concerns, showing a worrying pattern of provider failure leading to the death or serious injury of further residents. In response it is proposed adult social care professionals consider a systems approach to safeguarding in the care home environment. Implementing a holistic view of the home that includes a data intelligence system to signify when there are cumulative concerns that could indicate the need for actions to prevent escalation to greater harm for adults.

Mortality attributable to inadequate intake of fruits among population aged 25 and above in China, 2013

Objective: To assess the mortality attributable to low fruit intake among people over 25 years old in China, 2013, and its effect on life expectancy. Methods: Based on data collected from China Chronic Disease and Risk Factor Surveillance in 2013, the average fruit intake in different genders and areas were calculated. Potential impact fraction (PIF) was used to examine the impact on deaths, mortality and life expectancy. Results: The average daily fruit intake was (113.3±168.9) g among people over 25 years old, with (103.6±160.1) g for men and (122.7±176.6) g for women, in China in 2013. Fruit intake for urban residents was significantly higher than that in rural residents and higher in eastern regions than that in central or western regions. Scores that attributable to low fruit intake accounted for 15.21% of the total deaths and the population attributable fraction of inadequate intake of fruits to associated diseases was 35.00%. PIF for all the deaths in rural residents (16.50%) appeared higher than that of the urban residents (13.88%), and higher in the residents living in the eastern region (15.48%) than that in the central (16.27%) or western (13.75%) regions. Number of deaths that attributable to low fruit intake was 1.348 4 million. Deaths caused by related diseases appeared as: ischemic heart disease (472.5 thousands), hemorrhagic stroke (338.8 thousands), ischemic stroke (259.0 thousands), lung cancer (208.4 thousands), esophageal cancer (60.7 thousands), laryngeal cancer (5.4 thousands) and oral cancer (3.6 thousands). Numbers of all deaths and related diseases for urban residents were lower than that of the rural residents, with central regions (452.7 thousands) higher than that in the eastern (531.1 thousands) or western (364.6 thousands) regions. The average life expectancy loss caused by low fruit intake was 1.73 years, 1.80 years for men and 1.58 years for women, in this country. Loss of life expectancy in the rural residents was higher than that of the urban residents, and higher in central regions than that in the eastern or western regions. Conclusions: The intake of fruit was far lower than the recommended standard set for the Chinese people. Population attributable fraction was related to the associated diseases caused by inadequate intake of fruits which also made serious impact on life expectancy.