More than a quarter of nursing home patients died in the hospital after emergency abdominal surgery — the kind that would treat a gall bladder infection or appendicitis — compared to just 10% of people who had that procedure but did not live in the same environment, a new study found.
Another third of nursing home patients died within a month of their hospital stays, compared to 26% of those who didn’t live in nursing homes, according to a report recently published in the American Journal of Surgery. The study analyzed data of more than 18,000 patients with emergency abdominal surgery between 2011 and 2015, including 905 of whom who lived in skilled nursing facilities.
“Admission from a skilled nursing facility is a predictor of mortality,” the researchers noted.
Part of the problem is frailty, said Anne Mosenthal, senior author of the study and a professor and chair of the Rutgers New Jersey Medical School. Nursing home residents are typically more frail than those who do not live in a community dwelling, which increases the risk of emergency procedures. Many nursing home residents can become frail because they are bedridden or because they suffer dementia.
“Just being bedridden as an elderly person makes you physiologically much weaker, and it’s harder to respond to the stress of emergency surgery,” she said.
Emergency abdominal surgery may be warranted because of a blockage in the intestines, an infection in the gall bladder or appendicitis, but frailty can increase the risk of numerous types of other surgeries as well, Mosenthal said.
There are cases where frailty can be prevented — with the help of proper nutrition and exercise — and there are the situations in which it is unavoidable, such as when patients have dementia and cannot participate in their own recoveries.
“There should be conversations with patients or their families about the reality before surgery, so that people can make a decision about undergoing risky procedures,” Mosenthal said. Some patients or family members may want to opt for palliative care, which monitors the comfort level of patients with serious, life-threatening illnesses, but they should also discuss these options before the possibility of an emergency procedure.
Although these discussions can be difficult, families should discuss end of life wishes — preferably before anyone is admitted to a hospital or nursing home.
Nursing homes can be a dangerous place for the elderly, who may find themselves lonely and distressed, or not taken care of properly. Two other recent studies, from the Office of the Inspector General in June, found elder abuse was common, at home as well as in nursing facilities. The OIG found nearly 31,000 Medicare claims had evidence of abuse or neglect, and more than 9,000 were not reported to law enforcement. About 2,500 of those cases were at the hands of a health care worker and 3,330 were related to a medical facility, one of the two reports found.