Mortality of nursing home residents

Almost one-fifth of the 65 and over population dies in a nursing home. However, relatively little is known is the experience of people who die in nursing homes. The goals of this thesis are to describe characteristics of nursing home residents who die in the nursing home during the two year study period, and compare their characteristics and health care utilization to residents who neither die nor are discharged from the nursing home during that time period.; This thesis uses data from the Epidemiology of Dementia in Nursing Homes database, a prospective cohort of new admissions to the nursing home from a representative random sample of all nursing homes in Maryland. Residents were followed for up to two years or until death. Decedents were subdivided into those dying within the first 30 days (termed early deaths) and those dying after 30 days but before the end of follow-up which was two years (termed late deaths).; Decedents were different from not discharged residents on demographics, health and functional status on admission and in their pattern of change over time. A smaller proportion of early deaths had a diagnosis of dementia compared to late deaths and not discharged residents (25% vs. 67% vs. 58% p = .001). Decedents were more frail and impaired compared to not discharged residents as measured by ADL and IADL impairments, continence and chronic diseases. Decedents received more labor-intensive and invasive treatments and reported more conditions such as shortness of breath and vomiting. Over one-third of early deaths reported daily pain.; The pattern of health care utilization both inside and outside the nursing home was significantly different between early deaths and late deaths and not discharged residents. Early deaths had higher rates of visits both inside and outside the nursing home. They had proportionately more visits to hospital and emergency room than the other groups. There is considerable variability in patterns of health care utilization among nursing homes.; The results show that decedents are significantly different from residents not discharged from the nursing home in both admission characteristics and type and pattern over time of health care utilization.