Longevity: Big Data Comparison of Mortality in Older Adults Receiving Care in Nursing Homes or Their Own Home in Andalusia (Spain)

¹Andalusian School of Public Health, Granada, Spain

²Regional Ministry of Finance and Public Administration, Andalusia, Spain

³Andalusian Agency for Healthcare Quality, Seville, Spain

⁴Andalusian School of Public Health, Granada, Spain

⁵Agency for Social Services and Dependency of Andalusia, Seville, Spain

*Corresponding Author:

Sandra Arlette Pinzon
Professor, Andalusian School of Public Health
Citizenship and Social Welfare, Cuesta del Observatorio
4 Campus Universitario de Cartuja Granada
Andalusia 18080, Spain
Tel: +34 677904299
E-mail: sandra.pinzon.easp@juntadeandalucia.es

Received date September 28, 2016; Accepted date October 03, 2016; Published date October 10, 2016

Citation: Pinzon S, Rocha JL, Reyes V, Sanchez P, Martinez M, et al. (2016) Longevity: Big Data Comparison of Mortality in Older Adults Receiving Care in Nursing Homes or Their Own Home in Andalusia (Spain). J Alzheimers Dis Parkinsonism 6:268. doi: 10.4172/2161-0460.1000268

Copyright: © 2016 Pinzon S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Institutionalized dependent older adults represent a highly vulnerable group of the population, with high mortality as described in previous studies [1,2]. The Activities of Daily Living (ADL) level [3], cognitive impairment [4], hip fracture [5], cancer [6] and Chronic Obstructive Pulmonary Disease [7] are important risk factors of mortality in this population. Recent studies have also found an increased risk of death among institutionalized older adults than those that live within the community, adjusting for age, gender and clinical conditions [8,9].

The creation of a big data set allowed us to validate in our elderly population some predictors of mortality and confirm the importance of care setting as a risk of death factor. To do this, we use clinical and social data taken from the Information System for Dependence and the Electronic Health Record. The date of death is obtained from the Deaths Registry of Andalusia and the data is cross-referenced with that of the National Deaths Register. With them, we performed a survival analysis and included the following variables: sex, age, ADL level, preferences (nursing home or home-based care), support network characteristics (assessment, consistency, frailty and risk of claudication) and clinical conditions (dementia, Alzheimer’s disease, cerebrovascular disease, Chronic Obstructive Pulmonary Disease, hip fracture and cancer).

We analyzed data from 200,039 people, 71% women. The average age was 80 years. According to the results, the risk of death is lower for women (38% less than men), and increases by ADL level (1,3% higher for each additional point on ADL Scale), age (5% for each additional year of age), Chronic Obstructive Pulmonary Disease (29%) and cancer (42%). After adjusting these variables, we found that nursing home care increases 55% the risk of death compared to home-based care (Table 1).

Our results are consistent with previous studies. We found an elevated mortality of institutionalized older adults [2], and the greater risk of death in the residential care setting compared to home-based care [8,9]. The results also confirm that ADL level is a very powerful predictive mortality factor [3].

These findings highlight the importance of further understanding the mortality of the elderly in these two environments. Are there other variables that may help us explain this effect? On the one hand, it is necessary to explore whether the geriatric assessment and health care programs act as protective factors for mortality of older adults that live in their own homes [11-13]. In Andalusia, there are specific care plans for older adults in their homes such as the Telecare Service, the monitoring program after hospital discharged, the follow-up visits to chronic patients by nursing personnel, health examinations for those aged 65 and above, etc. Another point to address is the differential handling of chronic diseases in older people both within the community and in residential care. In Andalusia, the older adults living in their homes receive health care through the Primary Care professionals and in accordance with the clinical practice guidelines established for each care process. The evidence-based care takes part of the management objectives in the Andalusia Public Healthcare System. However, in residential care for dependent people, the healthcare depends on each provider, whether public or private. In accordance with the regulations established in the Public System of Social Services, each provider contracts the healthcare personnel and applies their own protocols for the care of the residents. The differential management of the chronic diseases may have a direct influence on mortality [8]. Besides, there are other clinical and health care predictive factors such as Body Mass Index [14], medications [8], use of health services [8] or preventive home visits [15], which should be analyzed.

On the other hand, not only health factors may be influencing the higher mortality in nursing homes. Variables such as relational autonomy [16], sense of coherence [17,18] or the role of the family [16] could have a protective effect when care is provided at home.

Our findings show that residential care increases the risk of death in dependent older adults compared to home-based care, controlling important variables such as sex, age, ADL level and key support network characteristics and clinical conditions. However, we must continue to study the mechanisms that result in care setting having this effect on elderly mortality.

Table 1: Mortality risk factors in dependent older adults.

References

1. Takahashi K, Yamanaka S (2006) Induction of pluripotent stem cells from mouse embryonic and adult fibroblast cultures by defined factors. Cell 126: 663-676.
2. Takahashi K, Tanabe K, Ohnuki M, Narita M, Ichisaka T, et al. (2007) Induction of pluripotent stem cells from adult human fibroblasts by defined factors. Cell 131: 861-872.
3. Yu J, Vodyanik MA, Smuga-Otto K, Antosiewicz-Bourget J, Frane JL, et al. (2007) Induced pluripotent stem cell lines derived from human somatic cells. Science 318:1917-1920.
4. Scudellari M (2016) How iPS cells changed the world. Nature 534:  310-312.
5. Wernig M, Meissner A, Foreman R, Brambrink T, Ku M, et al. (2007) In vitro reprogramming of fibroblasts into a pluripotent ES-cell-like state. Nature 448: 318-324.
6. Vera E, Studer L (2015) When rejuvenation is a problem: challenges of modeling late-onset neurodegenerative disease. Development 142: 3085-3099.
7. Miller JD, Ganat YM, Kishinevsky S, Bowman RL, Liu B, et al. (2013) Human iPSC-based modeling of late-onset disease via progerin-induced aging. Cell Stem Cell 13: 691-705.
8. Soria-Valles C, Lopez-Otin C (2016) iPSCs: On the Road to Reprogramming Aging. Trends Mol Med 22:  713-724.
9. Polo JM, Liu S, Figueroa ME, Kulalert W, Eminli S, et al. (2010) Cell type of origin influences the molecular and functional properties of mouse induced pluripotent stem cells. Nat Biotechnol 28: 848-855.
10. Kim K, Doi A, Wen B, Ng K, Zhao R, et al. (2010) Epigenetic memory in induced pluripotent stem cells. Nature 467: 285-290.
11. Yamanaka S (2010) Patient-specific pluripotent stem cells become even more accessible. Cell Stem Cell 7: 1-2.
12. Kaneko S, Yamanaka S (2013)To be immunogenic, or not to be: that's the iPSCquestion. Cell Stem Cell 12: 385-386.
13. Colman A, Dreesen O (2009) Pluripotent stem cells and disease modeling. Cell Stem Cell 5: 244-247.
14. Hohwieler M, Illing A, Hermann PC, Mayer T, Stockmann M, et al. (2016) Human pluripotent stem cell-derived acinar/ductal organoids generate human pancreas upon orthotopic transplantation and allow disease modelling. Gut 2016-312423.
15. Takebe T, Zhang RR, Koike H, Kimura M, Yoshizawa E, et al. (2014) Generation of a vascularized and functional human liver from an iPSC-derived organ bud transplant. Nat Protoc 9: 396-409.
16. Consortium HD IPSC (2012) Induced pluripotent stem cells from patients with Huntington's disease show CAG-repeat-expansion-associated phenotypes. Cell Stem Cell 11: 264-278.
17. Tucker BA, Solivan-Timpe F, Roos BR, Anfinson KR, Robin AL, et al. (2014) Duplication of TBK1 Stimulates Autophagy in iPSC-derived Retinal Cells from a Patient with Normal Tension Glaucoma. J Stem Cell Res Ther 3: 161.
18. 18. DeRosa BA, Van Baaren JM, Dubey GK, Lee JM, Cuccaro ML, et al. (2012) Derivation of autism spectrum disorder-specific induced pluripotent stem cells from peripheral blood mononuclear cells. NeurosciLett 516:  9-14.
19. . DeRosa BA, Van Baaren JM, Dubey GK, Lee JM, Cuccaro ML, et al. (2012) Derivation of autism spectrum disorder-specific induced pluripotent stem cells from peripheral blood mononuclear cells. NeurosciLett 516:  9-14.
20. Raab S, Klingenstein M, Liebau S, Linta LA (2014) Comparative View on Human Somatic Cell Sources for iPSC Generation. Stem Cells Int 2014: 768391.
21. Táncos Z, Varga E, Kovács E, Dinnyés A, Kobolák J (2016) Establishment of induced pluripotent stem cell (iPSC) line from a 75-year old patient with late onset Alzheimer's disease (LOAD). Stem Cell Res 17: 81-83.
22. Chandrasekaran A, Varga E, Nemes C, Táncos Z, Kobolák J, et al. (2016) Establishment of induced pluripotent stem cell (iPSC) line from a 63-year old patient with late onset Alzheimer's disease (LOAD). Stem Cell Res 17: 78-80.
23. Táncos Z, Varga E, Kovács E, Dinnyés A, Kobolák J (2016) Establishment of induced pluripotent stem cell (iPSC) line from an 84-year old patient with late onset Alzheimer's disease (LOAD). Stem Cell Res 17: 75-77.
24. Ochalek A, Nemes C, Varga E, Táncos Z, Kobolák J, et al. (2016) Establishment of induced pluripotent stem cell (iPSC) line from a 57-year old patient with sporadic Alzheimer's disease. Stem Cell Res 17: 72-74.
25. Nemes C, Varga E, Táncos Z, Bock I, Francz B, et al. (2016) Establishment of PSEN1 mutant induced pluripotent stem cell (iPSC) line from an Alzheimer's disease (AD) female patient. Stem Cell Res 17: 69-71.
26. Zhou H, Martinez H, Sun B, Li A, Zimmer M, et al. (2015) Rapid and Efficient Generation of Transgene-Free iPSC from a Small Volume of Cryopreserved Blood. Stem Cell Rev 11: 652-665.
27. Kitchens CS, Erkan D, Brandão LR, Hahn S, James AH, et al. (2011) Thrombotic storm revisited: preliminary diagnostic criteria suggested by the thrombotic storm study group. AmJ Med 124: 290-296.
28. Ortel TL, Kitchens CS, Erkan D, Brandão LR, Hahn S, et al. (2016) Clinical causes and treatment of the thrombotic storm. Expert Rev Hematol 5: 653-659.