Association of clinical indicators of acute deterioration and morbidity and mortality in the residential aged care population: a retrospective cohort study of routinely collected health data (interRAI-LTCF New Zealand)

Abstract

Abstract Background: The timely identification of acute deterioration in people living in residential aged care is critical to avoiding or reducing rates of adverse events such as Emergency Department (ED) presentation or hospitalisation or death. This task is difficult as advanced age, multiple morbidity and frailty cause atypical or non-specific presentations of ill health. This study aimed to quantify the association between clinical indicators of acute deterioration reported in the literature and adverse events in his population. Method: A retrospective cohort study using routinely collected health data. The cohort (n=5238) were aged 65 years or older in their last year of life and had an interRAI-LTCF assessment completed (I January to 31 December 2015). InterRAI-LTCF variables were matched with clinical indicators of acute deterioration reported in the literature. Univariate and multivariate logistic regression tested the association between those variables and ED presentation, hospitalisation or death 7 days or less from last completed interRAI-LTCF assessment. Results: Nine clinical indicators, from four health domains were independently associated with acute deterioration. Cognitive indicators were being ‘largely asleep or unresponsive’odds ratio (OR) 7.95 95% CI 4.72-13.39, p<.001 and being ‘easily distracted; different to usual’ (OR 1.78 95% CI 1.28-2.49, p<.001). In the behavioural domain, eating ‘one or fewer meals a day’ (OR 2.13 95% CI 1.67-2.73, p<.001) and functional domain, a decline in activities of daily living status (OR 2.06 95% CI 1.11-3.82, p = .02) and not transferring to the toilet in the last three days (OR 1.95 95% CI 1.24-3.03, p = .004) were significant. Physical domain indicators were ‘dyspnoea; at rest’ (OR 1.81 5% CI 1.32-2.49, p<.001), ‘two or more falls in last 30 days’ (OR 1.53 95% CI 1.15-2.03, p = .003), daily peripheral oedema (OR 1.37 95 CI 1.07-1.77, p = .014) and daily pain (OR 1.37 95% CI 1.05-1.77, p = .019). Conclusion and implication: Clinical indicators of acute deterioration reported in the literature are significantly associated with adverse events. This evidence is a first step towards the future development of tools to support residential aged care staff with the identification of acute deterioration.