Deaths Of Residents Research Articles

The Ombudsman’s Role in Probation

This article describes and analyses the involvement of the Prisons and Probation Ombudsman (PPO) with the Probation Service since 2001 when first complaints, and latterly the deaths of hostel residents, have come within its remit. The Ombudsman’s office now has two operational arms — one investigating complaints, and the other investigating fatal incidents — each with around 30 investigators. So far as probation is concerned, the fatal incidents remit only embraces the residents of approved premises, although it is possible for complaints to be made about other deaths of those subject to supervision.

PMH9 RISK OF DEATH IN DUAL ELIGIBLE NURSING HOME RESIDENTS USING ANTIPSYCHOTIC AGENTS

Antipsychotic use among dual eligible nursing home residents is a cost and safety concern. This study examined the comparative risk of death in dual eligible elderly nursing home residents using typical and atypical agents. A retrospective cohort design matched on propensity score was used to examine the risk of death due to antipsychotic use among dual eligible nursing home residents 65 years or older from four states. New typical and atypical users in nursing homes were followed for up to six month after the exposure without censoring. The risk of death was modeled using Cox proportional model and extended Cox hazard model stratified on matched pairs based on propensity score. The unadjusted mortality rate was 19.22% for atypical antipsychotic users and 24.27 % for typical antipsychotic users. Cox proportional hazard model revealed significant increased risk of death [Hazard Ratio (HR) 1.35, 95%; Confidence Interval (CI) 1.30- 1.63] among typical users when compared to atypical users. The extended Cox model, used due to the violation of proportional hazards assumption, revealed that risk of death is twice greater among typical antipsychotic users during the initial 40 days after the start of antipsychotic treatment [HR 2.06, 95%; CI 1.82-2.32] when compared to atypical users. However, no significant differences were found after 40 days of antipsychotic exposure. The use of typical antipsychotic agents was associated with increased risk of death among aged dual eligible beneficiaries when compared to atypical use, especially within 40 days of treatment, possibly due to their underlying health status.

Light Staffing Can Mean Heavy Liability

Light Staffing Can Mean Heavy Liability

Death in long-term care facilities: Attitudes and reactions of patients and staff. A qualitative study

Background Four-point-two percent of older Irish persons reside in extended-care facilities. Patients and staff in these settings frequently form close relationships, and the death of a patient can be a traumatic event. Despite this, resources and education in bereavement management have been lacking to date. Purpose We sought to investigate the effect of the death of such residents on patients and staff in a 320-bed, long-stay elderly care facility. Methods In-depth qualitative interviews were conducted within 24 hrs following the death of a resident. Seven patients and three staff took part. Patients with moderate or severe cognitive impairment were excluded. The interviews were audio-transcribed, and analysed for recurring themes. Results 9/10 interviewees were female. Patients’ age range was 70–90 years, staff 40–60 years. Participants described feelings of loss, inadequacy, and the desirability for patients and family to have privacy during the dying phase. We identified a four-stage model to describe the fellow patient grief reaction: (1) remembrance; (2) reflection; (3) religiosity and (4) relations. Conclusion Most participants in this study experienced a grief reaction following the death of a resident. This highlights the need for bereavement care programmes in elderly care units, to allow appropriate care and support to other long-stay residents and members of staff, in addition to grieving relatives.

A Case-crossover Study: The Effects of Heat Waves on Daily Mortality Caused by Respiratory Disease in Beijing

PP-31-083 Background/Aims: To explore the effects of heat wave on daily mortality caused by respiratory disease in Beijing from 1 January, 1999 to 30 June, 2000, and to analyze the effect on death of chronic obstructive pulmonary disease (COPD). Methods: Symmetrical bi-directional control case-crossover design was used to study the impact. The seventh day before and after death were chosen as its own self-control. Results: There were significant effects on daily death counts on people suffering from the first, second, and third heat waves. The lag phase was 2–5 days. The OR values of daily death from respiratory disease for 5 heat wave events were 2.124 (95% CI: 1.643–2.746), 2.143 (95% CI: 1.034–4.439), 3.733 (95% CI: 2.890–4.823), 1.067 (95% CI: 0.452–2.516), and 1.091 (95% CI: 0.401–2.950), respectively. The OR values for COPD were 1.620 (95% CI: 1.165–2.253), 2.222 (95% CI: 0.903–5.469), 2.947 (95% CI: 2.106–4.126), 1.000 (95% CI: 0.342–2.926), and 1.500 (95% CI: 0.632–3.560), respectively. The OR values of women's daily death counts caused by respiratory disease were 3.300 (95% CI: 2.001–5.442) and 4.326 (95% CI: 3.013–6.209) for the first and the third heat wave events, respectively, which were higher than that of men's 2.080 (95% CI: 1.291–3.351) and 3.149 (95% CI: 2.185–4.539), respectively. The OR values of daily death counts for individuals aged ≥65 years were 2.846 (95% CI: 1.976–4.099) and 3.753 (95% CI: 2.866–4.915), whereas the OR values of those aged <65 years were 1.167 (95% CI: 0.392–3.471) and 3.333 (95% CI: 1.459–7.617), respectively. The results indicated that the impact of heat wave event on elderly women (≥65 years) was greater than other subpopulation. The OR values were 2.909 (95% CI: 1.982–4.270) for the first and 4.474 (95% CI: 3.052–6.558) for the third heat wave. Conclusion: (1) There was a significant increase in daily death counts as a result of respiratory disease, including COPD, in Beijing, in individuals suffering from the heat wave. The lag phase was 2–5 days. (2) In women, the risk of daily death for women caused by respiratory disease was greater than in men during heat wave. (3) The risk of respiratory disease death for elderly residents was greater, and the effect of heat wave on elderly females was the maximum.

Protecting Lives and Property in the Wildland–Urban Interface: Communities in Montana and Southern California Adopt Australian Paradigm

Threats to people and property in the wildland–urban interface have taken on global proportions. It is becoming increasingly rare to have a wildland fire incident that does not involve people and their homes. In addition to Australia and North America, people have died in interface fires in Europe, Africa, and Asia, including 212 people who died in the devastating forest fires in northeastern China in May 1987. The prevailing interface model is one that attempts to evacuate people away from fire areas to get them out of harm’s way. This traditional approach in the U.S. has been preferred by law enforcement agencies and fire services. The problem with this model is that evacuation warnings are often late to non-existent, leading to the deaths of interface residents entrapped by fires on highways as they try to escape. For example, 16 people suffered lethal burns when the 2003 Cedar and Paradise Fires in California overran them as they were trying to evacuate. Two communities in the United States have adopted variations of the Australian model of Prepare, Go Early, or Stay and Defend (P/GE/SD). Officials in the Painted Rocks Fire District, Montana, and Rancho Santa Fe, California, were interviewed to determine how the Australian model was being implemented. Two of the authors have firsthand experience with these two case examples. P/GE/SD has been tested successfully at both locations. The Australian model, however, is under review following the Black Saturday fires of February 2009 in Victoria, Australia. The objective of this paper is to present specific ideas that can be used to reform and improve fire policy, planning, and performance in the Wildland–Urban Interface in the United States.

Care Provider Perspectives on End-Of-Life Care in Long-Term-Care Homes: Implications for Whole-Person and Palliative Care

This study holistically explores the experience of dying and end-of-life care for older persons with dementia in long-term care (LTC) from the perspective of care providers. Using a focused ethnography methodology, seven researchers interviewed LTC staff, residents' families, volunteers, management staff, and spiritual advisers/clergy over a five-day period. Research was guided by two key questions: What is the dying experience of people living in LTC from the perspective of different care providers? and, What are the salient issues in providing palliative care for elderly people dying in LTC? Based on a thematic analysis of verbatim data, three common themes were identified: tension between completing job tasks on time and "being there" for residents; the importance of family-like bonds between front-line staff and residents; and the importance of communication among staff and between staff and residents and their families at the end of life. Findings are discussed in relation to their implications for policies and practices that can support whole-person care and ultimately a good death for residents of LTC facilities.

Rural/urban differences in health care utilization and place of death for persons with respiratory illness in the last year of life

Respiratory illness is a leading cause of death worldwide, with rates that will continue to escalate into the foreseeable future. Rural residents have an increased risk of dying from some forms of respiratory disease, although little is known about the healthcare utilization or location of death for persons with advanced respiratory illness in rural settings. The purpose of this study was to examine rural-urban differences in healthcare utilization and location of death for residents of Saskatchewan, Canada, with chronic obstructive pulmonary disease (COPD) or lung cancer in the last 12 months of life. A retrospective cohort study was undertaken of 1098 patients who died in 2004 with a cause of death recorded as COPD or lung cancer in administrative health data from Saskatchewan Health. Decedents were classified as residents of rural/remote (< or =9,999 population size), small urban (10 000-99 999) or urban (> or =100 000) locations and analysis conducted using this primary variable of interest. Comparisons were made between the three groups in terms of demographic characteristics, healthcare utilization (physician visits, length of stay, hospitalizations, institutional care, home care, transitions between care settings) and location of death (hospital, long-term care [LTC] or home). The study population was 57% male with a mean age of 77 years (SD=11). Demographic characteristics, underlying cause of death and number of comorbid conditions were similar between urban, small urban and rural/remote groups. After adjustment for area of residence, underlying cause of death (UCOD), age group, sex, marital status, and comorbidity, urban, small urban and rural/remote residents were comparable in terms of the likelihood of: any hospitalizations, having had 5 or more transfers between settings, and dying in hospital. The proportion of home deaths in rural settings was 15.4%, and was comparable to the rate in urban settings (16.3%). Urban residents were more likely to have had 24 or more physician visits in the last year of life compared with small urban (OR=0.52, 95% CI=.37-.74) or rural/remote residents (OR=0.52, 95% CI=.40-.69), while rural/remote residents were more likely to have received any institutional LTC (OR=1.40, 95% CI=1.03-1.90) than the other groups. Hospital as a location of death was more likely for those with a UCOD of cardiovascular disease (OR=1.84, 95% CI=1.24-2.71), but was less likely for those aged 80-85 years (OR=0.46, 95% CI=.31-.69), those aged more than 85 years (OR=0.28, 95% CI=.19-.42) and those who had never married (OR=0.48, 95% CI=.29-.78). Residents of rural/remote areas were significantly less likely than those in urban or small urban settings to receive any home care (OR=0.74, 95% CI=.56-.97), any home palliative care (OR=0.29, 95% CI=.19-.45) or home physiotherapy services (OR=0.09, 95% CI=.03-.25). Rural/remote residents were, however, much more likely to receive home supportive care (OR=1.60, 95% CI=1.17-2.19) and home meal preparation (OR=2.51, 95% CI=1.44-4.39). While the healthcare needs of persons with respiratory illness in the last year of life were likely to be similar between locations, rural-urban differences were apparent in the number of primary care physician visits and in access to and the nature of home care services provided. Significantly fewer physician visits were made by residents of small urban or rural remote locations compared with those in urban settings, although additional research is needed to determine the reasons for this discrepancy. The likelihood of receiving home care services and professional home care services such as palliative care and physiotherapy was significantly lower for persons in rural/remote locations. The challenges experienced by rural remote regions with supporting patients in the community may have led to the increased likelihood of admission to institutional LTC noted for this group compared with residents of urban and small urban settings. The low home death rates is both urban and rural settings may pose particular hardship for rural families who may need to travel extensively or temporarily relocate to be closer to the hospital where their loved one is dying. Further investigation of issues related to differences in quality of care and unmet health care needs between rural and non-rural settings will strengthen the evidence base to allow equitable care at the end of life.

Functionality and Mortality in Obese Nursing Home Residents: An Example of ‘Risk Factor Paradox’?

Although the percentage of obese nursing home residents is increasing, few longitudinal studies have reported on functionality and mortality in this subpopulation. The aim of the present study was to explore functionality and mortality in obese nursing home residents during a 1-year follow-up and to compare these results with those of residents within the normal and low BMI range. Two hundred residents (147 female, 53 male, mean age 85.6 +/- 7.8 years) from 2 Nuremberg nursing homes were included. Body weight and height were measured in all participants. BMI was calculated and categorized as low (<20 kg/m(2)), normal (20-30 kg/m(2)), and high (>30 kg/m(2)). Handgrip strength, timed "up and go" test, and Barthel's Activities of Daily Living were applied as functional parameters. All measurements were done at baseline and after a 1-year follow-up. At baseline, the prevalence of obesity was 23.5%, whereas low BMI values were present in 8.5% of the residents. After 1 year, there was no significant decline of functionality in the obese group, whereas functional parameters deteriorated significantly in study participants with normal BMI. One-year mortality was lowest in the obese (12.8%), with no deaths in residents with BMI of 35 kg/m(2) or higher. Mortality was highest in residents with low BMI (58.8%). In nursing home residents, obesity is associated with increased survival and stable functionality. These observations may therefore be regarded as an expression of "risk factor paradox" in this specific population of older individuals.

Análise espacial dos riscos à saúde associados à incineração de resíduos sólidos: avaliação preliminar

to examine if emissions from the Vergueiro solid waste incinerator are associated with an increased risk of cancer in the population in its vicinity. the area under influence of this incinerator was delimited by a 7 km radius from its geocoded centroid. Deaths of city residents in administrative districts inside this area due to cancer of lung, liver, larynx, non-Hodgkin's lymphoma in adults, leukemia, and all sites combined in children, in the 1998 to 2002 period, were selected and geocoded. The studied area was divided into 7 concentric rings delimited by a radius of 1 to 7 km from the incinerator. The analysis of the relationship between residential proximity to the incinerator and mortality due to cancer was based on the comparison of observed and expected cases, using the Stone test for decline in risk with distance from the incinerator. the area studied comprised 1,599,532 inhabitants, of which 92,894 were children less than 5 years old and 634,993 were adults over 40 years old. No spatial gradient in risk was observed for any outcome in relation to distance from the incinerator. although no excess risk for the selected cancers were observed, emissions of incinerators still operating and their possible health effects should be monitored. The study of the spatial distribution of health events in areas around point sources of air pollution can become a methodological option for surveillance activities.

Engaging Palliative Specialty Advanced Practice Nursing Students in the Online Environment (737)

II. Research Objectives. To determine the impact of opening an inpatient hospice center on place of death for elderly residents in Cheyenne, WY. III. Methods. The Davis Hospice Center is a 12bed inpatient hospice center in Cheyenne, WY, which opened in November 2006. Cheyenne has one public hospital, one hospice program, and three nursing homes, and is the county seat for Laramie County. There are no other medical facilities within an approximately 50 mile radius of Cheyenne. Mortality data for 2004e2008 for Laramie County, WY, was obtained from the Wyoming Department of Heath for non-traumatic deaths for people over age 65. The data was analyzed using chi-square analysis to determine if there were significant changes in place of death for county residents after opening the hospice center. IV. Results. There was a significant decrease in the number of deaths in the hospital but not in the nursing homes after opening the hospice center. The changes appear to be the result of a shift in place of death from the hospital to the hospice center. V. Conclusion. Opening a hospice center results in a significant shift in place of death from the hospital to the inpatient hospice unit. No significant shift was noted from the nursing homes to the inpatient hospice center. VI. Implications for Research, Policy, and Practice. Hospital mortality rates are a key quality indicator for hospitals. Hospital executives may be motivated to help support an inpatient hospice unit if it favorably impacts their mortality rates.

Compiling mortality statistics from civil registration systems in Viet Nam: the long road ahead.

Accurate mortality statistics, needed for population health assessment, health policy and research, are best derived from data in vital registration systems. However, mortality statistics from vital registration systems are not available for several countries including Viet Nam. We used a mixed methods case study approach to assess vital registration operations in 2006 in three provinces in Viet Nam (Hòa Bình, Thùa Thiên-Hué and Bình Duong), and provide recommendations to strengthen vital registration systems in the country. For each province we developed life tables from population and mortality data compiled by sex and age group. Demographic methods were used to estimate completeness of death registration as an indicator of vital registration performance. Qualitative methods (document review, key informant interviews and focus group discussions) were used to assess administrative, technical and societal aspects of vital registration systems. Completeness of death registration was low in all three provinces. Problems were identified with the legal framework for registration of early neonatal deaths and deaths of temporary residents or migrants. The system does not conform to international standards for reporting cause of death or for recording detailed statistics by age, sex and cause of death. Capacity-building along with an intersectoral coordination committee involving the Ministries of Justice and Health and the General Statistics Office would improve the vital registration system, especially with regard to procedures for death registration. There appears to be strong political support for sentinel surveillance systems to generate reliable mortality statistics in Viet Nam.

Historical evidence that electrification caused the 20th century epidemic of “diseases of civilization”

The slow spread of residential electrification in the US in the first half of the 20th century from urban to rural areas resulted by 1940 in two large populations; urban populations, with nearly complete electrification and rural populations exposed to varying levels of electrification depending on the progress of electrification in their state. It took until 1956 for US farms to reach urban and rural non-farm electrification levels. Both populations were covered by the US vital registration system. US vital statistics tabulations and census records for 1920-1960, and historical US vital statistics documents were examined. Residential electrification data was available in the US census of population for 1930, 1940 and 1950. Crude urban and rural death rates were calculated, and death rates by state were correlated with electrification rates by state for urban and rural areas for 1940 white resident deaths. Urban death rates were much higher than rural rates for cardiovascular diseases, malignant diseases, diabetes and suicide in 1940. Rural death rates were significantly correlated with level of residential electric service by state for most causes examined. I hypothesize that the 20th century epidemic of the so called diseases of civilization including cardiovascular disease, cancer and diabetes and suicide was caused by electrification not by lifestyle. A large proportion of these diseases may therefore be preventable.

Asbestos fiber concentration in the area surrounding a former asbestos cement plant and excess mesothelioma deaths in residents

Many persons who had lived near a former asbestos cement plant (AC plant) died from mesothelioma in Amagasaki city, Japan. Asbestos fiber concentration in the area surrounding the AC plant was estimated so that the female mesothelioma death number predicted by a mathematical model was the same as the observed excess death number. We used the estimated asbestos fiber concentration to predict the excess mesothelioma deaths from 1970 to 2049. In a grid just south of the AC plant, the fiber concentration was estimated to be more than 3 f/ml for K(M) (asbestos potency factor for mesothelioma) of 7.75 x 10(-9). An uncertainty factor of five yields a K(M) range 1.55 x 10(-9) to 38.8 x 10(-9); these in turn correspond to fiber concentrations of 15 and 0.6 f/ml. For K(M) = 7.75 x 10(-9), grid units with higher fiber concentrations than 0.01 f/ml were estimated to extend 4.1 km (95% CI: 3.8-4.4 km) south-southwest of the plant. Over the 80-year study period (1970 to 2049), we predicted that the exposure under study will cause 346 excess mesothelioma deaths with range of 296 to 382 deaths. This prediction suggests that considerable medical resources will be needed through 2049 as a result of past asbestos exposure in this region.

An evaluation of the implementation of a programme to improve end-of-life care in nursing homes

The Gold Standards Framework in Care Homes programme aims to improve the quality of end-of-life care for residents. The impact of introducing phase 2 of the programme to homes in England was evaluated. A pre–post survey design was adopted, focusing on indicators identified as markers of good end-of-life care. The 95 homes in phase 2 of the programme were invited to participate in the evaluation. Homes completed a baseline survey of care provision and an audit of the five most recent resident deaths. The survey and audit were repeated post programme completion. Forty-nine homes returned completed pre- and post-surveys, 44 returned pre- and post-data on deaths. Although some staff found completion of the programme challenging, homes that returned pre- and post-data demonstrated improvements in aspects of end-of-life care. There were statistically significant increases in the proportion of residents who died in the care homes and those who had an advanced care plan. Crisis admissions to hospital were significantly reduced. This evaluation indicates that appropriately funded structured programmes have the potential to assist nursing homes improve the provision of end-of-life care to older adults, in line with government health policy.

Morbidity and mortality associated with influenza exposure in long-term care facilities for dependant elderly people

The purpose of this paper is to describe the impact of exposure to influenza on hospitalizations and deaths in the elderly residents of long-term care facilities (LTCFs). An observational, longitudinal, prospective, multicenter, cohort study collected influenza and influenza-like cases, diseases, hospitalizations, and deaths of dependent elderly residents of French LTCFs during the 2004-2005 seasonal influenza epidemic. A total of 8,041 residents of 98 participating LTCFs were included. The mean age was 85 +/- 9 years; 93% were vaccinated against influenza and 64% of the residents were exposed to influenza during the epidemic. Exposure to influenza increased both the all-cause risk of hospitalization (9.2% of the residents exposed vs. 7.4% of the residents not exposed) (relative risk, RR [95% confidence interval, CI] = 1.24 [1.05; 1.47]) and the all-cause risk of death (5.8% vs. 4.3%) (RR [95% CI] = 1.36 [1.10; 1.70]). Exposure to influenza increased the risks of death and hospitalization. Additional measures should be taken to avoid influenza exposure and apply recommendations more thoroughly in the particularly susceptible population of elderly LTCF residents.

Developing a Booklet for Care Home Staff on End-of-Life Care

This article discusses the planning and implementation of a bereavement support tool to be used by care home staff members. The development of the support tool was the key outcome of the home’s participation in a training programme provided by the local hospice’s education department. As knowledge of end-of-life care expanded, it became apparent that less experienced and newer members of staff were lacking in knowledge, confidence and support in the care of dying residents and their families. This led to the development of an in-home, bereavement education and staff support booklet. This article demonstrates the reasons for the development of the booklet, including staff members’ avoidance of residents’ death and lack of subsequent contact with bereaved relatives. Such behaviour led staff members to feel distressed at the death of residents and to perceive a lack of follow-up support. The article highlights the experience of the home with the intention of providing other care homes with a view of what can be achieved. Conflicts on interest: none

Preventable avoidable mortality: Evolution of socioeconomic inequalities in urban areas in Spain, 1996–2003

This study describes the inequalities in preventable avoidable mortality in relation to socioeconomic levels and analyses their evolution during the period 1996–2003 in the cities of Alicante, Castellon and Valencia. Four causes of preventable avoidable mortality were analysed according to sex: malignant tumour of the trachea, bronchus and lung, cirrhosis and other chronic diseases of the liver, motor vehicle accidents and AIDS, which had caused the death of non-institutionalised residents in the three cities during the period 1996–2003. The different census tracts were grouped into three socioeconomic levels. In general, socioeconomic inequalities in preventable avoidable mortality remain constant in time, except the ones caused by AIDS in Valencia, where they increase for men. Some census tracts in the three cities where the study was carried out were found to have significantly higher preventable mortality rates, and therefore require intervention.

Impacto del déficit cognitivo en la supervivencia de ancianos residentes en la comunidad

To analyze cognitive deficit as a risk factor for death in elderly residents in the community and its relationship with variables related to sociodemographic factors, physical health, and functional capacity.A prospective study was carried out in the city of Santa Cruz, Brazil, in 310 randomly selected elderly individuals who were followed-up for 53 months. Predictive factors were sociodemographic and neuropsychiatric variables, physical health, and functional capacity. The statistical methods used were bivariate analysis (survival analysis), and Cox regression (multivariate analysis) with respective hazard ratios (HR). A value of P<.05 was considered statistically significant and 95% confidence intervals (CI) were calculated.A total of 60 (20.5%) elderly residents died during the study. The main cause of death was cardiovascular disease. The mean time until death was approximately 24.8 months. The main risk factors identified in Cox analysis were cognitive deficit (HR=4.22), stroke (HR=3.08) and dependency for basic activities of daily living (HR=3.55).Cognitive deficit is an independent risk factor for death. The results of the present study could be useful in formulating future health policies aiming to reduce mortality in the elderly.

The Long-Term Challenges of Advanced MS

The Long-Term Challenges of Advanced MS