Explanatory survival model for nursing home residents- a 9-year retrospective cohort study

Anna Kańtoch; Tomasz Grodzicki; Jadwiga Wójkowska-Mach; Piotr Heczko; Barbara Gryglewska

doi:10.1016/j.archger.2021.104497

Explanatory survival model for nursing home residents- a 9-year retrospective cohort study

Arch Gerontol Geriatr. 2021 Nov-Dec:97:104497. doi: 10.1016/j.archger.2021.104497. Epub 2021 Jul 28.

Authors

Anna Kańtoch¹, Tomasz Grodzicki¹, Jadwiga Wójkowska-Mach², Piotr Heczko², Barbara Gryglewska³

Affiliations

¹ Jagiellonian University Medical College, Faculty of Medicine, Department of Internal Medicine and Gerontology, University Hospital in Kraków, 2 Jakubowskiego Str., Building I, 30-688 Kraków, Poland.
² Jagiellonian University Medical College, Faculty of Medicine, Department of Microbiology, 18 Czysta Str., 31-121 Kraków, Poland.
³ Jagiellonian University Medical College, Faculty of Medicine, Department of Internal Medicine and Gerontology, University Hospital in Kraków, 2 Jakubowskiego Str., Building I, 30-688 Kraków, Poland. Electronic address: barbara.gryglewska@uj.edu.pl.

PMID: 34411924
DOI: 10.1016/j.archger.2021.104497

Abstract

Purpose: There is a gap in the literature regarding the analysis of long-term survival and mortality risk factors among disabled and multimorbid institutionalized populations. The study aimed to analyze 9-year survival, investigate mortality factors, and develop an explanatory survival model for nursing home residents.

Materials and methods: A retrospective cohort study with a 9-year follow-up (2009-2018) was conducted among 96 residents of a nursing home with Barthel index ≤ 40. The study was based on baseline measurements performed in 2009, which included results obtained on geriatric scales: Mini Nutritional Assessment Short-Form (MNA-SF) and Abbreviated Mental Test Score (AMTS). Information on demographics, comorbidities, pharmacotherapy, transfers and deaths came from medical records. Kaplan-Meier curves were used to estimate and present survival data. Factors associated with mortality were determined using Cox proportional hazard models.

Results: The median survival was 2.9 years. Mortality during the follow-up period was 83%. Kaplan-Meier curves showed that residents with normal nutritional status (p = 0.002) and taking aspirin (p = 0.005) had a better 9-year survival. The multivariable Cox regression model revealed that the risk of mortality (Hazard Ratio, HR) increased in older age (HR=1.04), male gender (HR=2.08), with risk of malnutrition (HR=3.91), malnutrition (HR=4.84), and presence of urinary incontinence (HR=2.14). The aspirin use was the strongest protective factor against death (HR=0.40).

Conclusion: The aspirin use was associated with better long-term survival for nursing home residents. Factors associated with higher mortality among residents include older age, male gender, poor nutritional status, and urinary incontinence.

Brief summary: We are the first to report the beneficial effects of a low-dose of aspirin on the long-term survival of disabled, institutionalized populations with multimorbidity. Furthermore, this study presents an explanatory model of survival for nursing home residents and identifies the long-term mortality risk factors among disabled residents with multimorbidity.

Keywords: Aspirin; MNA-SF; Mortality factors; Nursing home; Survival; Urinary incontinence.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Geriatric Assessment*
Humans
Male
Malnutrition*
Nursing Homes
Nutrition Assessment
Retrospective Studies