Læknablaðið - 15.02.2005, Blaðsíða 13

FRÆÐIGREINAR / HEILSUFAR ALDRAÐRA
Afturvirk rannsókn á heilsufarsbreytum
heimilismanna á Droplaugarstöðum
árin 1983-2002
Ársæll Jónsson1
SÉRFRÆÐINGUR í LYF- OG
ÖLDRUNARLÆKNINGUM
Ingibjörg
Bernhöft2
HJÚKRUNARFRÆÐINGUR
Karin
Bernhardsson3
LÆKNIR í FRAMHALDSNÁMI
Pálmi V. Jónsson1
SÉRFRÆÐINGUR í LYF- OG
ÖLDRUNARLÆKNINGUM
'Öldrunarsvið Landspítala
Landakoti, 2Droplaugarstaðir,
3Svíþjóð.
Fyrirspurnir og bréfaskipti:
Ársæll Jónsson, Landspítala
Landakoti, 101 Reykjavík.
arsaellj@landspitali. is
Lykilorö: hjú/crunarheimili,
heilsufarsbreytur, mat, afdrif
Agrip
Tilgangur: A síðustu árum hafa verið gerðar miklar
skipulagsbreytingar á öldrunarþjónustu á íslandi.
Þessi afturvirka rannsókn beinist að því að meta
áhrif þessara breytinga á lýðfræði og heilsufarsbreyt-
ur heimilismanna á Droplaugarstöðum, hjúkrunar-
heimili fyrir aldraða í Reykjavík.
ENGLISH
Jónsson Á, Bernhöft I, Bernhardsson K, Jónsson PV
Retrospective analysis of health variables in a
Reykjavík nursing home 1983-2004
Læknablaðið 2005; 91:153-60
Background: A municipal nursing home with 68 beds in
Reykjavík, opened in mid-year 1982.
Objectives: To analyse changes in demographic, health
and outcome variables over 20 years.
Design: Retrospective analyses of data from medical
records of all diseased persons with cross-sectional
comparison of five four-year intervals.
Setting: Droplaugarstadir Nursing Home in Reykjavík.
The nursing home is supervised by fuily qualified nurs-
es and provides maintenance rehabilitation. Medical
services are delivered from a specialist geriatric hospital
department.
Residents: All residents who died 1983 to 2003.
Measurements: Demographic data, type of dwelling
before admission, Nursing Home Pre-admission Assess-
ment Score (NAPA) (*), mobility- and cognitive score,
drug usage and a list of medical diagnoses. All recorded
health events during stay, falls and fractures, medical and
specialist consultations. Advance directives, as recorded
and end-of-life treatment, place of death, clinical diag-
nosis of cause of death and length of stay.
Results: The total number of medical records read num-
bered 385, including 279 females and 106 males. The
mean age on admission was 85 (±7) years. During the
first 4 years the majority of residents came from their
own private homes or residential settings but in the last
four years, 60% were admitted directly from a hospital
ward. The mortality rate was 17% per year in the first
period and the majority died in a hospital. This ratio took
a sharp turn as the mortality rate increased to 40%,
and in the last period only 2 of 97 deaths took place in
a hospital. Admission mobility- and cognitive scores
showed increased disability with time. The most common
diagnosis on admission was dementia (56%), ischemic
heart disease (46%), fractures (35%) and strokes (27%).
Parkinsonism and maturity onset diabetes had a low
Efniviður og aðferðir: Lesnar voru sjúkraskrár allra
vistmanna sem látist höfðu á árunum 1983-2002.
Þessum 20 árum var skipt niður í fimm fjögurra ára
tímabil. Skráð var aldur, kyn, hvaðan fólkið kom og
stig á vistunarmati aldraðra. Metin var hreyfifærni og
vitræn geta með fjögurra stiga kvarða, lyfjanotkun
SUMMARY
prevalence rate of 6%. A mean NHPA of 57 (±17) points
confirmed a high dependency selection. The mean num-
ber of drugs per patient was 5.3 (±3), including 1.1 (±1)
for psychoactive drugs and sedatives. The most common
heaith events during residents' stay were urinary and
respiratory infections, heart failure, cardiac- and cerebral
events and pulmonary disorders. Hip fractures occurr-
ed in 45 residents (12%) and other types of fractures in
47 during their stay in the nursing home. The number of
medical visits and specialist referrals increased with time.
Palliative care was the most common form of treatment
at end of life. Pneumonia was most commonly recorded
cause of death in medical notes. The yearly mortality rate
was 29% and the mean length of stay was 3 (± 2,9) years
for the whole period.
Limitations: Retrospective analyses have many inherent
drawbacks and the information in medical records tend
to be scanty. Analyses of disabilities, as described in
the medical record, can only be descriptive and health
events are likely to be underreported. Statistical methods
have a less meaningful role for interpretation as only
diseased persons were included and survivors excluded.
However, the length of time, uniform medical care and
turnover rate of residents generate useful information on
the patterns of the nursing home service during a time of
considerable change.
Conclusions: This retrospective analysis indicates inc-
reasing frailty in nursing home patients admitted over
a period of 20 years. With time the residents are more
often admitted directly from a hospital rather than from
an individual dwelling. Most deaths took place in the
nursing home and were preceded with informal or formal
palliative care directives, which was a significant change
over time. The data indicates growing efficiency in the
nursing home selection processes due to the NHPA and
improvements in holistic geriatric care. This development
is in keeping with the lcelandic health care policy for eld-
erly people to stay longer in their own home with access
to a nursing home placement when needed.
* Jóhannesdóttir GB, Jónsson PV. Nursing Home Preadmission Assess-
ment in Reykjavik 1992. Artic Medical Research 1994; 53: 512-4.
Key words: nursing home, health varíables, assessment, outcome.
Correspondence: Ársæll Jónsson, arsaellj@landspitali.is
Læknablaðið 2005/91 153