Factors Associated With Care Trajectory Following Acute Functional Decline in Older Home Nursing Care Patients: A Prospective Observational Study

Abstract

Health policies and previous research highlight the importance of early identification and treatment of clinical deterioration in older patients to prevent frailty, higher levels of care, and mortality. This study explores older home nursing care patients’ care trajectories and factors associated with clinical response (type and level of intervention) from the health care services, final level of community care and death within 3 months after an incidence of acute functional decline. This observational study with a prospective, descriptive design includes a sample of 135 older home nursing care patients with acute functional decline. Demographic, health-related, and clinical characteristics were analyzed and prediction models for care trajectories were fitted using Bayesian generalized mixed models. Age ranged from 65 to 100, with a median age of 85. Hospital admission were registered for 13.33% (T₁) and 8.77% (T₂) of the participants. Nine patients (6.7%) were transferred to a higher level of community care, and 11 patients (8.1%) died. Frequent transitions between levels of care characterized care trajectories for patients experiencing more severe functional decline. Age, living in a private home, and increased Modified Early Warning Scores (MEWS) were associated with level of clinical responses throughout the care trajectory. Living in a private home was associated with the patients’ final level of community care. Female gender, hospital admission, and increased MEWS scores were associated with death. Health care personnel must be vigilant when MEWS scores rise even slightly, as this might be an indication of acute functional decline with possible increased risk of mortality.