Mortality in long-term care residents: retrospective national cohort study

Mortality trends among people living in long-term care settings have been poorly understood. Linking data offers the potential to provide real-world, long-term national follow-up. Our aim was to describe patterns and associations with mortality among people moving-in to care homes in Scotland.

A retrospective cohort study was undertaken using routinely collected national social care data from the Scottish Care Home Census. These data were indexed and linked to national health data and mortality records for individuals moving- in to care homes in Scotland between 1 April 2013 and 31 March 2016. Location of death, underlying causes and time to death are reported. Survival analysis was undertaken using the Gompertz model for human mortality adjusted for key variables.

Of 23 892 individuals moving-in to care homes, 20 250 (84.8%) died by 31 May 2020. Most deaths occurred in the care home setting (77.5%), with a fifth (20.5%) occurring in the hospital. 0.1% died the day they moved-in, 3.2% within a month, 24.2% within a year and 85% by 7 years. Dementia codes account for more than a third of all deaths (35.1%). Median survival time was shorter (701 vs 951 days; 23 vs 32 months) for those moving-in from the hospital, compared with the community. The adjusted HR for moving-in from the hospital was 1.19 (95% CI 1.15 to 1.22).

Mortality is common in Scotland's care homes but varies in timing. Dementia is the most common cause. Those moving-in from the hospital are more likely to die sooner, and this evidence provides opportunities to improve support for all involved.