Aims of the article
Hospitalisation is a major difference in the use of health services. Hospitalisation of nursing home residents is associated with far-reaching complications (e.g. hospital-acquired infections) and leads to increased health care costs. Many of these hospitalisations are considered potentially preventable. The proportion of residents with hospitalisations varies widely between countries, including between neighbouring countries such as Germany and the Netherlands. However, there has been no systematic comparison. The aim of a systematic literature review was therefore to compare the proportions of nursing home residents with hospital admissions between the two countries. The focus was on periods when the risk of hospitalisation is particularly high, i.e. the first six months after admission to a nursing home and the last six months before death.
The main results
3 biomedical literature databases (MEDLINE via Pubmed, EMBASE and CINAHL) were searched to assess the eligibility of all observational studies up to the publication date of 3 May 2022. After reviewing 1,856 records, 9 studies were finally included, published in 14 articles (Germany: 8; Netherlands: 6). One study per country examined the first 6 months after institutionalisation. In total, 10% of Dutch and 42% of German nursing home residents were hospitalised during this period. A total of 7 studies reported on deaths in hospital, with the proportion fluctuating around 29% in Germany and between 1% and 16% in the Netherlands. The proportion of hospitalisations in the last 30 days of life ranged from 8% to 16% (Netherlands: n = 2) and from 49% to 58% (Germany: n = 3). Only the German studies analysed differences by age and sex. Although hospitalisations were less frequent in older age, they were more frequent in male residents.
Implications
The higher figures for Germany may be explained by differences in care systems. There is a lack of research, especially on the first months after admission to a nursing home. The results of this study will be included in future studies that look more closely at the care processes of nursing home residents. Unnecessary hospital transport should be avoided for the benefit of nursing home residents.
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You can find this study here: www.jamda.com/article/S1525-8610(23)00108-1/pdf
Fassmer AM, Allers K, Helbach J, Zuidema S, Freitag M, Zieschang, T, Hoffmann F. Hospitalization of German and Dutch Nursing Home Residents Depend on Different Long-Term Care Structures: A Systematic Review on Periods of Increased Vulnerability. Journal of the American Medical Directors Association 2023. Volume 24, Issue 5, P609-618.E6, May 2023
