We also evaluated the proportion of residents requiring assistance in their activities of daily living (ADLs) according to the KATZ scale. Within our cohort of residents ≥65 years old, the majority of residents with CHD needed assistance with 3-4 ADLs (p=0.18) (Figure 1). However, this was found this to not be statistically significant.
Excluding the presence of CHD, persons within the CHD cohort were found to have a greater number of chronic conditions on average than those without CDH (CHD: 3.2 ± 1.7 non CHD 2.5 ± 1.4, p<0.0001) (Figure 2).
Over the past 12 months, more residents with CHD had ER visits or overnight hospital stays after their arrival to the RCF than those without CHD ...view middle of the document...
RCFs provide an alternative to nursing homes for people who do not require 24 hour nursing care, but are unable to live fully independently. These facilities may provide assistance with medication, personal care, and activities of daily living (ADL). According to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the objectives of RCFs include (1) minimizing the need to move as needs increase (2) accommodating individual residents’ changing needs and preferences (3) maximizing residents’ dignity, autonomy, privacy, independence, choice and safety and (4) encouraging family and community involvement4.
As a chronic and often life-limiting condition, coronary heart disease results in substantial morbidity affecting the healthcare needs and residential options of its sufferers. Within this study, we sought to describe the differences among RCF residents ages ≥65 years old with and without CHD.
Using the 2010 National Survey of Residential Care Facilities, we observed that 14% of persons ≥65yo living in Residential Care Facilities have coronary heart disease. However, persons within the CHD cohort appear to be more medically complex than RCF residents without CHD. Despite similar lengths of stay, residents with CHD have a greater number of health conditions on average than those without CHD. Not surprisingly, persons with CHD had higher rates of hypertension, stroke, congestive heart failure, and heart attack than those without CHD. Additionally, persons with CHD have increased odds of overnight hospitalizations after admission to RCF than those without CHD, even after adjusting for key demographics and health conditions.
The results of this study fill a gap in the literature and they may be used to inform ways to better understand and serve the aging population diagnosed with CHD as their need for RCF increase. Further studies should address whether there are interventions that could be implemented to treat these medically complex patients with CHD in their residential care settings with less escalation to hospital level care.
As with all cross-sectional surveys, we are unable to assess causal inferences with the results of the 2010 National Survey of Residential Care Facilities. Therefore, a majority of the analysis in this capstone project is only able to report on associations between CHD status and resident demographics or health conditions. Use of longitudinal survey design can address many of these limitations in future studies, as longitudinal study design would allow policymakers and healthcare workers to assess causal relationships to inform evidence based decisions to improve and support different long-term care options for the aging population.
Within the study design of the 2010 NSRCF, there is the potential for recall bias based on proxy interviews. Additionally, the nature of the dataset prohibits deeper analysis of the...