Serious, sustainable limitation that some regard as ‘worse than death’ affects many residents after admission in the long term care

Many residents have admitted that in the long term houses will be seriously disabled within five years and live in states where they are unable to make daily decisions for themselves.

According to new research by the Bruyère Health Research Institute and Ices, 20% of the inhabitants who are newly admitted to long -term care were permanently unable to make daily decisions for themselves within five years. A significant number of residents of long-term care (LTC) experience states of serious cognitive and physical limitations, so that they are unable to make personal decisions-such as eating something or what to do and are unable to communicate with staff or loved ones.

“Our studies intended to trace the experiences of residents who are newly admitted to long -term care, and those who lived in a state of serious disability for a year or more,” says main author Ramtin Hakimjavadi, internal medicine at the University of Ottawa. “We should talk more about what a meaningful, high -quality end of life looks like, given that most older adults at this stage prioritize the quality of life.”

Published in Jama Network OpenThe study included 120,238 adults aged 65 and older who were newly admitted to LTC facilities in Ontario, Canada, between 2013 and 2018. Participants were followed until death, dismissal from LTC or April 1, 2023.

Important findings

• 20% of the inhabitants admitted to LTC was permanently unable to make daily decisions for themselves for the next five years, and half lived with this level of disability for more than 262 days.

• 13% of the residents admitted to LTC became completely dependent on all care, including baths, toilet and food during the study period. Half of these people lived for more than 45 days with this level of disability.

• Residents under the age of 80 and those who had dementia were more likely to live longer as soon as they achieved total care dependence and were unable to make decisions for themselves.

• Residents with non-resuscitation or non-hospital assignments took that long after the development of limitations or serious disabilities compared to residents without guidelines for prior care.

“In interviews, residents of long -term care expressed that loss of independence is more painful for them than the idea of ​​dying. We do not offer living or fact -based care if we are not talking about the possibility of serious disabilities and questions about the circumstances when philosophical treatments would not be acceptable,” says Hakimjavadi.

In this population of LTC residents, 65% had a non-resuscitated (DNR) order and 25% had non-hospital orders. These guidelines for in advance have reduced time with serious disability, probably because the preferences of the residents were discussed, and care partners or providers knew how to support their decisions at the end of life.

“Residents, their family members and care teams must have open discussions about what quality of life means to the resident, given the possibility of long -term disability,” says senior author Dr. Daniel Kobewka, a researcher at Bruyère Health Research Institute and Deputy Scientist at Ices.

“Planning ahead can ensure that future care is in accordance with personal values, including the choice to give priority to comfort and dignity over life -practical interventions,” adds Kobewka.