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Assessment Tools Aid Risk Planning at Nursing Homes

Residents with heart failure have higher rates of hospitalization, death, health instability

FRIDAY, Jan. 25, 2019 (HealthDay News) — Better use of risk assessment tools, like the Changes in Health and End-stage disease Signs and Symptoms (CHESS) score, can help nursing homes identify which new residents are at risk for hospitalization or death within the first 90 days after admission, according to a study recently published in the Journal of the American Medical Directors Association.

George A. Heckman, M.D., from the University of Waterloo in Ontario, Canada, and colleagues used linked administrative data, including the Continuing Care Report System MDS 2.0 for nursing homes, the Discharge Abstract Database for hospitalized patients, and the National Ambulatory Care Reporting System, to track emergency department visits among 143,067 older adults (≥65 years) admitted to nursing homes in Canada between 2010 and 2016.

The researchers found that adverse events were most common in the first 90 days. Worsening health instability, hospitalizations, and mortality were predicted by a heart failure diagnosis. For hospitalizations and death, the effect of heart failure was strongest for low baseline health instability, as measured by the CHESS score (CHESS = 0; odds ratios [ORs], 1.63 and 1.71, respectively) versus moderate instability (CHESS = 1 to 2; ORs, 1.36 and 1.48, respectively) or versus high instability (CHESS = 3; ORs, 1.12 and 1.21, respectively). The residents most likely to die in the hospital were those with the highest degree of health instability.

“By ensuring that the entire long-term care home care team, including personal support workers, understand these risks, they can help monitor resident health and optimize their quality of life in the long-term care home,” Heckman said in a statement.

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