Long-Term Care Residents Face Severe Disability and Loss of Independence
Many residents admitted to long-term care homes become severely disabled within five years, living in states where they are unable to make everyday decisions for themselves. According to new research from Bruyère Health Research Institute and ICES, 20% of residents newly admitted to long-term care became permanently unable to make everyday decisions for themselves within five years. This significant number of long-term care (LTC) residents experience states of severe cognitive and physical impairment, leaving them unable to make personal decisions or communicate with staff or loved ones.
Lead author Ramtin Hakimjavadi, an Internal Medicine Resident at the University of Ottawa, highlights the importance of discussing what a meaningful, high-quality end of life looks like for older adults in long-term care. The study, published in JAMA Network Open, followed 120,238 adults aged 65 and older who were newly admitted to LTC facilities in Ontario, Canada, between 2013 and 2018.
Key findings from the study include:
– 20% of residents admitted to LTC became permanently unable to make everyday decisions for themselves over the following five years, with half living for more than 262 days in this state.
– 13% of residents became totally dependent for all care, including bathing, toileting, and eating, with half of them living for more than 45 days with this level of disability.
– Residents under 80 years old and those with dementia were more likely to live longer once they reached total care dependence and were unable to make any decisions for themselves.
– Residents with advance care directives, such as do-not-resuscitate or do-not-hospitalize orders, did not live as long after developing impairment or severe disabilities compared to those without these directives.
Hakimjavadi emphasizes the importance of resident-centered care and discussions about quality of life and end-of-life preferences. Planning ahead and having open conversations with residents, their families, and care teams can help ensure that future care aligns with personal values, including the choice to prioritize comfort and dignity over life-prolonging interventions.
Dr. Daniel Kobewka, senior author of the study, stresses the need for discussing the possibility of prolonged disability and making decisions that honor residents’ preferences. By understanding and respecting residents’ choices, care partners and providers can offer support that prioritizes quality of life and dignity.
For more information, the study “Cognitive and Functional Decline Among Long-Term Care Residents” can be found in JAMA Network Open. This research sheds light on the challenges faced by long-term care residents and the importance of person-centered care in ensuring a high quality of life in the face of severe disability.
