Death Rates Following Nursing Homes & Care Facility Placement

I have received a number of questions from relatives who, although they are not the primary caregiver, are very concerned about a loved one with dementia being moved into a nursing home. They are worried that their near relative will quickly deteriorate if they have to leave their own home.
Are their fears well founded? Do people with dementia deteriorate quickly when admitted to care homes? Is there any evidence to show that death rates are high for people with dementia who move into a care facility?

There is evidence that people with dementia admitted to psychogeriatric nursing homes and care facilities die comparatively quickly. It is known that mortality rates are high, initially, when people move from their own homes. Mortality rates are especially high in nursing homes. In many ways this seems logical. You would expect that people admitted to a nursing home need more care and attention and in all probability will be sicker.

There are many pieces of research to show that between 50%-60% of people admitted to care homes die within the first 2 years. Mortality rates are highest in the first 6 months but tend to settle thereafter. One research paper found that mortality rates settled to around 2.5% per month rising slowly to about 3.5% by 30 months.
One study looking at people with Alzheimer's disease showed mortality rates of 50% in the first year after admission to care facilities and nursing homes. It also found that certain conditions and diseases increased the incident of death.

Contributory factors to mortality following care home placement
Looking at various studies there are certain factors at admission that appear to raise subsequent rates of mortality following admission to nursing care homes.

It is suggested that age, sex, functional limitation, and malnutrition can to a certain degree be a stronger predictor of death for patients with Alzheimer's disease in nursing homes.

Dementia severity and carehome mortality rates
Research varies as to whether the severity of dementia experienced by people affects survival rates in nursing homes and care facilities.

Gambassia found the effect of severity of dementia on survival of patients with Alzheimer's disease is inconsistent. His research looking at people living in United States nursing homes found that severity of dementia had no influence on survival.

Another study of patients with Alzheimer's disease they looked at four behavioral problems to see if it influenced mortality rates. The behaviors were wandering, verbally or physically abusive and socially inappropriateness. They found wandering had a lower rate of mortality than those without such a behavior problem (44% v 53%). By contrast, mortality rate was higher among patients exhibiting severe and aggressive behaviors (53%).

The different ways in which the research was undertaken means it is difficult to make any conclusive statements linking higher mortality rates to certain behaviors exhibited by people with Alzheimer's and other dementias. More research is required before more definitive statements can be made.

Minority racial and ethnic groups, dementia and mortality risk factors in nursing homes
Some studies have found minority racial and ethnic groups have a reduced risk of death relative to white people. This association persisted after adjustment for age, sex, level of impairment in a number of studies. Why this should be so is unclear.

Research Sources
Andrew Bebbington, Pamela Brown, Robin Darton, Kathryn Miles, Ann Netten's Survey of Admissions to Residential and Nursing Home Care. 30 month follow-up April 1999
The nature of excess mortality in nursing home patients with dementia. Van Dijk PT, Van de Sande HJ, Dippel DW, Habbema JD. 1992
Survival in a cohort of social services placements in nursing and residential homes: factors associated with life expectancy and mortality. Rothera IC, Jones R, Harwood R, Avery AJ, Waite J. 2002
Predictors of mortality in patients with Alzheimer's disease living in nursing homes Giovanni Gambassia BC, Francesco Landia, Kate L Lapaneb c, Antonio Sgadaria, Vincent Morb C, Roberto Bernabeia, on behalf of the SAGE Study Group

Article Updated 04/23/2006