A review of more than 21,000 deaths of people in nursing homes over a 13-year period has found the incidence of premature and potentially preventable deaths of nursing home residents has increased, prompting calls for a national policy framework for reducing harm in aged care facilities.
The study by Professor Joseph E Ibrahim and his team at the Department of Forensic Medicine, which is part of Monash University, was published today in the latest edition of MJA.
The research, which looked at deaths reported to Coroners across Australia between 1 July 2000 and 30 June 2013, found the most common mechanisms of death were falls (81.5 per cent), choking (7.9 per cent) and suicide (4.4 per cent).
While the incidents leading to death usually occurred in the nursing home (95.8 per cent), it was more common for death to occur outside the nursing home (67.1 per cent), which the researchers said “reﬂects the large number of deaths in hospital, usually from the complications of falls”.
“In contrast, the number of deaths attributed to complications of clinical care was small (1.2 per cent),” they wrote.
The research also found that less than three per cent of formal coroners’ inquests examined the external cause deaths.
In 98.4 per cent of all cases coroners made no recommendations about injury prevention, with substantial variations between jurisdictions in the number of cases for which recommendations were delivered (0-21%).
The researchers believe the full extent of the burden of external cause deaths in people living in nursing homes is “likely under-reported due to misclassification of natural cause deaths because of diagnostic minimisation of the background trauma”.
“The multiple comorbidities and frailty of nursing home residents make it difficult to demarcate disease progression from other causes of death, including complications of care and non-recent trauma,” they said.
“It follows that coroners have an important role in identifying factors that may prevent death and injury.”
Another barrier is that no single entity is responsible for reducing harm by improving practice, despite the regulation of aged care through several mechanisms, they noted.
“Interventions for preventing some of these premature deaths are contentious, and there has been little empirical investigation of their effectiveness.”
“For general health care, in contrast, there is a leading national agency, the Australian Commission on Safety and Quality in Health Care and preventable harm is monitored, investigated and acted upon by providing resources, training, education and research to rectify problems and improve care.”
“A national policy framework and implementation plan for reducing harm in nursing homes is needed.”
“Primary prevention should be a top priority, and professionals from governments and the nursing home sector should be involved in developing evidence-based strategies in consultation with residents and their families.”
An editorial about the issue of premature deaths in aged care has also been published in the print edition of MJA.