Friday, July 23, 2004
This presentation is part of : End of Life/Palliative Care
Predicting Limited Life Expectancy in Long-Term Care (LTC)
Suzanne Prevost, RN, PhD, School of Nursing, Middle Tennessee State University, Murfreesboro, TN, USA and J. Brandon Wallace, PhD, Department of Sociology, Middle Tennessee State University, Murfreesboro, TN, USA.
Learning Objective #1: Identify factors associated with rapid demise after LTC admission
Learning Objective #2: Describe the benefits of accurate identification of terminal status

Objective: To identify factors and develop a model to predict the probability of limited life expectancy (<6 months) following admission to LTC.

Design: Correlational, multiple regression

Sample: 15,050 residents admitted to LTC

Setting: 76 LTC facilities across the U.S.

Years: 2001-2003

Variables: The criterion variable was death within six months of LTC admission. Predictor variables were derived from a preliminary analysis of correlations between Minimum Data Set (MDS) admission assessment factors and death within a year. Some of the most significant predictive factors included: male sex, withdrawal from social interactions, resistance to nursing care, being bedfast, diagnoses of: dehydration, resistant infection, cancer, or the presence of an amputation.

Methods: Secondary data analysis and logistic regression of MDS admission data, linked with mortality data. Using the model derived from logistic regression, we calculated risk scores for the probability of dying within six months.

Findings: 2,210 residents died within 6 months of admission. Only 309 (14.0%) of these residents who died had been identified and coded as terminal by the facility staff. Only 188 (8.5%) of the residents who died were receiving hospice/palliative care. Using our model, 496 (22.4%) of the residents who died could have been identified on admission as being terminal. Using the highest risk category in our model (.75 - .99 probability of death), 173 patients could have been identified on admission as being at the highest risk of death; and 147 (85%) of those residents actually died within six months.

Conclusions: MDS admission data, collected by all U.S. LTC facilities, may be useful to increase the sensitivity and specificity of identifying terminal patients.

Implications: This information could be used to increase coding accuracy, trigger palliative care interventions, implement advanced directives, and improve patient and family education and preparation for end of life decisions.

Back to End of Life/Palliative Care
Back to 15th International Nursing Research Congress
Sigma Theta Tau International
July 22-24, 2004