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• Re: Improving end of life care for nursing home residents: an analysis of hospital mortality and readmission rates
  Lynne Partington
  Published on: 4 May 2010

• Published on: 4 May 2010

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

  • Lynne Partington, Senior Lecturer/Researcher, Cheshire Hospices Education/St Luke's (Cheshire) Hospice, Cheshire
  • Other Contributors:
    • Julie Kinley, Research Practice Nurse, St Christophers Hospice, London, Jean Hennings, PhD student, Lancaster University and Katherine Froggatt, Senior Lecturer, Lancaster University

  We were very pleased to see this paper on improving end of life care for nursing home residents. Drawing upon our experience as clinicians and researchers active in nursing home work we would like to identify a number of methodological issues that the paper raises for us. Firstly, in order to better understand the implications of the findings presented here, more information about the population in general and not only the...

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  We were very pleased to see this paper on improving end of life care for nursing home residents. Drawing upon our experience as clinicians and researchers active in nursing home work we would like to identify a number of methodological issues that the paper raises for us. Firstly, in order to better understand the implications of the findings presented here, more information about the population in general and not only the local population is required. The geographical area that the study covers is known to have a high number of nursing homes, so it would be beneficial to know what percentage of the population lives in these nursing homes and how this compares with national figures. A number of choices made within the study methods needed justification: The specific time frame (94 days, April - July) chosen for the period of the study raises questions of representativeness, particularly in terms of the time of year and the impact that seasonal conditions such as pneumonia have, which might change admission patterns.Only admissions to the medical unit were included in the study. This is unlikely to have given a true picture of the admission rate from nursing homes. This study clearly aimed to audit the number of residents admitted from nursing homes to hospital, but did not consider the reason(s) for admission. This raises questions regarding how the conclusions were drawn, and on what basis. For example, the paper concludes that advance care planning should be used more widely and that this will reduce the number of hospital admissions. However, advance care planning is a method by which people are invited to state their preferences and for them to be discussed and recorded. It cannot be assumed that advance care planning will reduce admission. The choices and preferences of nursing home residents in the study were not reported, so we do not know if the presence of advance care plans influences admission rates. The authors suggest that in many cases, it would be in the best interests of these patients to stay in the nursing home, but the research evidence in support of this conclusion is not presented. Given that no reason for admission has been provided, it is impossible to suggest that all of these admissions 'inappropriate'. A more detailed study considering the background to the admission and the subsequent care pathway of the resident/patient would be necessary to provide this information. The nursing home setting is becoming an increasingly significant place of care for dying people. We need to continue to build on the knowledge provided by this and other studies to gain knowledge that will inform evidence based interventions to the benefit of older people living and dying in nursing homes.

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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