Health status of UK care home residents: a cohort study

Background: UK care home residents are often poorly served by existing healthcare arrangements. Published descriptions of residents ’ health status have been limited by lack of detail and use of data derived from surveys drawn from social, rather than health, care records. Aim: to describe in detail the health status and healthcare resource use of UK care home residents Design and setting: a 180-day longitudinal cohort study of 227 residents across 11 UK care homes, 5 nursing and 6 residential, selected to be representative for nursing/residential status and dementia registration. Method: Barthel index (BI), Mini-mental state examination (MMSE), Neuropsychiatric index (NPI), Mini-nutritional index (MNA), EuroQoL-5D (EQ-5D), 12-item General Health Questionnaire (GHQ-12), diagnoses and medications were recorded at baseline and BI, NPI, GHQ-12 and EQ-5D at follow-up after 180 days. National Health Service (NHS) resource use data were collected from databases of local healthcare providers. Results: out of a total of 323, 227 residents were recruited. The median BI was 9 (IQR: 2.5 – 15.5), MMSE 13 (4 – 22) and number of medications 8 (5.5 – 10.5). The mean number of diagnoses per resident was 6.2 (SD: behavioural symptoms, multimorbidity, polypharmacy and frequently use NHS resources. Effective care for such a cohort requires broad expertise from multiple disciplines delivered in a co-ordinated and managed way. Abstract Background: small, retrospective studies suggest that major life events and/or sudden emotional stress may increase fall and fracture risk. The current study examines these associations prospectively. Methods: a total of 5,152 men aged ≥ 65 years in the Osteoporotic Fractures in Men study self-reported data on stressful life events for 1 year prior to study Visit 2. Incident falls and fractures were ascertained for 1 year after Visit 2. Fractures were cen-trally con ﬁ rmed. Results: a total of 2,932 (56.9%) men reported ≥ 1 type of stressful life event. In men with complete stressful life event, fall and covariate data ( n = 3,949), any stressful life event was associated with a 33% increased risk of incident fall [relative risk (RR) 1.33, 95% con ﬁ dence interval (CI) 1.19 – 1.49] and 68% increased risk of multiple falls (RR = 1.68, 95% CI = 1.40 – 2.01) in the year following Visit 2 after adjustment for age, education, Parkinson ’ s disease, diabetes, stroke, instrumental activities of daily living (IADL) impairment, chair stand time, walk speed, multiple past falls, depressive symptoms and antidepressant use. Risk increased with the number of types of stressful life events. Though any stressful life event was associated with a 58% increased age-adjusted risk for incident fracture, this association was attenuated and no longer statistically signi ﬁ cant after additional adjustment for total hip bone mineral density, fracture after age 50, Parkinson ’ s disease, stroke and IADL impairment. Conclusions: in this cohort of older men, stressful life events signi ﬁ cantly increased risk of incident falls independent of other explanatory variables, but did not independently increase incident fracture risk.