Abstract
Introduction
Older people living in Nursing Homes (NH) are often admitted to Acute Hospitals (AH) toward their end-of-life (EOL) due to the limited capacity to manage exacerbations and symptoms within NHs. The EAGLEcare (Enhancing Advance care planning, Geriatric and End-of-Life care in NHs in the East) Programme was set up to improve in-NH care and to reduce avoidable AH admissions and their unintended consequences.
Methods
A system of proactive case-finding for residents with specific and general indicators of advanced life-limiting illnesses was developed in collaboration with NH partners, to enable early symptom recognition and timely response(s), supported by NH General Practitioners (GPs) and an interdisciplinary team from the AH, with out of hours coverage by a collaborating home palliative care service.
We retrospectively studied a cohort of residents who passed away between January 2019 and December 2023 from five NHs during their final 6 months of life. Parameters including hospital admissions, emergency department (ED) visits, length of stay (LOS), and specialist outpatient clinic (SOC) visits were compared between EAGLEcare-enrolled and non-enrolled residents. Propensity score matching (1:5 ratio) was used to balance baseline characteristics, and negative binomial regression was employed to assess programme impact
Results
Among 1088 decedents in the study period, 458 were enrolled and 630 not enrolled to the EC programme. 369 enrolled and 393 non-enrolled residents were analyzed. Residents enrolled in the EAGLEcare Programme had significantly lower rates of hospital admissions (aIRR = 0.86, 95% CI: 0.77-0.97, p=0.016), ED visits (aIRR = 0.82, 95% CI: 0.73-0.93, p=0.001), and shorter LOS (aIRR = 0.82, 95% CI: 0.69-0.97, p=0.024). However, SOC visit rates remained similar between groups.
Conclusion(s)
The EAGLEcare Programme effectively reduced hospitalizations and ED visits among NH residents at the EOL, supporting the need for integrated care models. Expanding such initiatives could improve EOL care, reduce healthcare burden, and enhance patient outcomes.
Comments
Thank You.
This is just WONDERFUL to hear. These elderly people do not need the fright of being admitted into hospital and spending their last few weeks in that dreadful environment. I am delighted that you are trying to prevent this, and had success.
I will be looking up this research ( if you could send a link, that would be amazing). I want to understand what you did.
We so need this work in Dorset ( England) where I am based. We have too many people being admitted without really good reason and after a life of 80+yrs, people don't ant to die in a hsopital ward, surrounded by strangers and noise.
Thank you for sharing your work.
Patient selection
Thank you, these are impressive results. Can you say more about how the patients were selected from the nursing home population?
Was there a difference in the time from identification to death between the two groups?
How do nursing homes in Singapore compare with those in the UK?
Selection of cohort and NH support for the programme
Hi - great results. Would really like to know your selection criteria and would also like to understand how you worked with the NHs? In my experience, even with good plans, once residents deterioriate (particularly out of hours) they are often sent to hospital - in spite of clear plans. With this in mind, I am curious what work, if any, you did with the nursing homes in order to ensure plans were used effectively?
Thank you and well done!