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Cognitive and Functional Decline Among Long-Term Care Residents.
Ramtin Hakimjavadi1, Christina Y Yin2,3, Mary Scott2,4
1Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
JAMA Network Open
|April 23, 2025
Summary
Severe impairments like inability to make decisions or communicate are common in long-term care (LTC) residents, impacting survival. Understanding frailty trajectories can improve person-centered care decisions for residents.
Area of Science:
- Gerontology
- Public Health
- Health Services Research
Background:
- Care decisions for long-term care (LTC) residents require frailty-informed approaches to enhance well-being and align with patient wishes.
- Understanding the incidence and duration of severe impairment is crucial for person-centered decision-making in LTC.
Purpose of the Study:
- To investigate the incidence and time spent living with severe impairment among long-term care residents.
- To inform person-centered medical decision-making by characterizing frailty trajectories.
Main Methods:
- A retrospective cohort study using administrative health data from Ontario, Canada, included residents aged 65+ admitted to LTC between 2013 and 2018.
- Follow-up extended until April 2023, with data analysis conducted from October 2023 to March 2024.
- Outcomes included incidence of total care dependence, inability to make decisions, inability to communicate, and incontinence, along with survival analyses.
Main Results:
- Among 120,238 LTC residents, significant proportions developed severe impairments: 20.0% inability to make decisions, 7.7% inability to communicate, 13.4% total care dependence, and 32.8% incontinence.
- Median survival varied by impairment, with total care dependence having the shortest survival (45 days) and incontinence the longest (356 days).
- Younger residents and those with dementia at admission generally experienced longer survival after developing severe impairments.
Conclusions:
- Severe permanent impairments are common in LTC residents, often occurring near end-of-life, though some live with these conditions for years.
- These findings underscore the importance of shared understanding and open communication regarding frailty trajectories.
- Facilitating discussions about the natural course of frailty can better support resident-centered medical decision-making in long-term care settings.
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