Background
Methods
Sample
Data source
Measures
Variable | Sample % (n) | Rate of ERVH % (n) | p value | Unadjusted | 95% Confidence interval |
---|---|---|---|---|---|
Odds ratio | |||||
Significant variables (based on p value)
| |||||
Wish to die at home
1
| |||||
No
| 70.5 (539) | 59.7 (322) | p < .01 | 1 | |
Yes
| 29.4 (225) | 34.2 (77) | 0.35 | 0.25-0.48 | |
Advance directives
2
| |||||
No
| 47.8 (365) | 66.6 (243) | p < .01 | 1 | |
Yes
| 52.2 (399) | 39.1 (156) | 0.32 | 0.24-0.43 | |
Marital status
| |||||
Single
| 48.2 (368) | 46.1 (182) | 0.0006 | 1 | |
Married
| 51.8 (396) | 58.7 (216) | 1.65 | 1.24-2.20 | |
Age
| |||||
Aged <75
| 60.4 (465) | 56.5 (263) | 0.003 | 1 | |
Aged 75+
| 31.6 (215) | 45.5 (136) | 0.64 | 0.48-0.86 | |
Not significant variables (based on p value)
| |||||
Finds guidance in religion or spirituality
3
| |||||
No
| 51.6 (370) | 51.9 (186) | 0.29 | 1 | |
Yes
| 48.4 (394) | 54.1 (213) | 1.16 | 0.88-1.55 | |
Sex
| |||||
Male
| 52.8 (401) | 53.9 (216) | 0.45 | 1 | |
Female
| 47.2 (358) | 50.9 (182) | 0.92 | 0.69-1.22 |
Variable | Sample % (n) | Rate of ERVH % (n) | p value | Unadjusted | 95% Confidence interval |
---|---|---|---|---|---|
Odds ratio | |||||
Significant variables (based on p value)
| |||||
Person’s median cost of care
| |||||
Less than or equal to $562.90
| 49.9(360) | 59.7(215) | 0.0001 | 1 | |
Greater than $562.90
| 50.1(361) | 45.4(164) | 0.59 | 0.45-0.79 | |
Caregiver distress
1
| |||||
No
| 84.3 (644) | 54.7 (352) | 0.002 | 1 | |
Yes
| 15.7 (120) | 39.2 (47) | 0.53 | 0.36-0.79 | |
Not significant variables (based on p value)
| |||||
Access to a physician
2
| |||||
No
| 1.4 (11) | 45.4 (5) | 0.65 | 1 | |
Yes
| 98.6 (753) | 52.3 (394) | 1.32 | 0.40-4.35 | |
Rural character
| |||||
No
| 88.2 (674) | 52.1 (351) | 0.99 | 1 | |
Yes
| 11.8 (90) | 52.5 (47) | 1.00 | 0.64-1.55 |
Variable | Sample % (n) | Rate of ERVH % (n) | p value | Unadjusted | 95% Confidence interval |
---|---|---|---|---|---|
Odds ratio | |||||
Significant variables (based on p value)
| |||||
Believes physical function can improve
1
| |||||
No
| 77.6 (593) | 48.6 (256) | p < .01 | 1 | |
Yes
| 22.4 (171) | 67.8 (116) | 2.31 | 1.61-3.31 | |
Bladder/bowel incontinence
| |||||
No
| 71.9 (538) | 58.5 (315) | p < .01 | 1 | |
Yes
| 28.1 (210) | 36.4 (76) | 0.41 | 0.29-0.57 | |
Swallowing difficulties
| |||||
No
| 71.4 (527) | 57.9 (305) | p < .01 | 1 | |
Yes
| 28.6 (211) | 38.1 (80) | 0.46 | 0.33-0.64 | |
Potential delirium
2
| |||||
No
| 84.2 (624) | 57.0 (355) | p < .01 | 1 | |
Yes
| 15.8 (117) | 30.8 (36) | 0.35 | 0.23-0.53 | |
Activities of daily living Hierarchy scale
3
| |||||
(0) Independent
| 48.4 (335) | 67.2 (225) | p < .01 | 1 | |
(1,2,3,4,5,6) Dependent
| 51.6 (357) | 41.3 (147) | 0.44 | 0.33-0.59 | |
Cognitive skills for daily decision making
4
| |||||
(0) Intact
| 78.0 (574) | 58.2 (334) | p < .01 | 1 | |
(1,2,3,4,5) Impaired
| 22.0 (162) | 32.7 (53) | 0.36 | 0.25-0.52 | |
Chess scale
5
| |||||
(0,1,2) Stable Health
| 34.4 (239) | 66.1 (158) | p < .01 | 1 | |
(3,4,5)Unstable Health
| 65.6 (455) | 44.8 (204) | 0.47 | 0.35-0.64 | |
Weight loss
6
| |||||
No
| 49.3 (377) | 57.3 (216) | 0.005 | 1 | |
Yes
| 50.6 (387) | 47.3 (183) | 0.67 | 0.50-0.89 | |
Pressure ulcer
| |||||
No
| 85.5 (645) | 55.2 (348) | 0.01 | 1 | |
Yes
| 14.5 (109) | 46.7 (45) | 0.60 | 0.40-0.90 | |
Peripheral edema
| |||||
No
| 67.1 (501) | 55.2 (276) | 0.03 | 1 | |
Yes
| 32.9 (246) | 46.7 (115) | 0.72 | 0.53-0.98 | |
Previous hospitalization (last 90 days)
| |||||
No hospitalization within 90 days
| 32.5 (248) | 58.9 (146) | 0.03 | 1 | |
31 to 90 days ago
| 36.4 (278) | 50.4 (140) | 0.63 | 0.44-0.90 | |
In the last 30 days
| 31.1 (238) | 47.5 (113) | 0.71 | 0.50-1.0 | |
Not significant variables (based on p value)
| |||||
Cancer
| |||||
No
| 12.0 (92) | 42.9 (39) | 0.07 | 1 | |
Yes
| 88.0 (672) | 53.4 (359) | 1.49 | 0.96-2.31 | |
Dizziness
| |||||
No
| 68.1 (505) | 54.4 (274) | 0.09 | 1 | |
Yes
| 31.9 (237) | 47.7 (113) | 0.77 | 0.56-1.04 | |
Falls in the last 90 days
| |||||
No
| 74.4 (549) | 54.6 (299) | 0.10 | 1 | |
Yes
| 25.6 (189) | 47.6 (90) | 0.78 | 0.56-1.09 | |
Instrumental activities of Daily living
7
| |||||
(0) Independent
| 4.0 (30) | 66.7 (20) | 0.10 | 1 | |
(1,2,3,4,5,6,8) Dependent
| 96.0 (718) | 51.2 (370) | 0.62 | 0.34-1.15 | |
Diabetes
| |||||
No
| 92.8 (709) | 51.5 (365) | 0.23 | 1 | |
Yes
| 7.2 (55) | 60.0 (33) | 1.41 | 0.80-2.46 | |
Prior urinary tract infection
| |||||
No
| 95.5 (730) | 94.74 (378) | 0.26 | 1 | |
Yes
| 4.4 (34) | 5.26 (21) | 1.50 | 0.74-3.05 | |
Prior pneumonia
| |||||
No
| 93.2 (712) | 92.7 (370) | 0.60 | 1 | |
Yes
| 6.8 (52) | 7.3 (29) | 1.16 | 0.66-2.05 | |
Fatigue
| |||||
No
| 0.7 (5) | 60.0 (3) | 0.71 | 1 | |
Yes
| 99.3 (730) | 51.7 (377) | 0.66 | 0.33-1.34 | |
Dyspnea
| |||||
No
| 30.8 (226) | 53.1 (120) | 0.85 | 1 | |
Yes
| 69.2 (508) | 52.3 (265) | 1.02 | 0.75-1.37 | |
Pain
| |||||
(0) Not Present
| 25.9 (187) | 52.9 (99) | 0.96 | 1 | |
(1,2,3) Present
| 74.1 (536) | 53.2 (285) | 1.14 | 0.83-1.55 |
Outcomes of interest
Statistical analysis
Results
Characteristics | % (n) | |
---|---|---|
Emergency room visits or acute hospital admissions
| ||
0
| 47.8 (365) | |
1+
| 52.2 (399) | |
ED Visits
| ||
0
| 50.6 (387) | |
1
| 30.9 (236) | |
2
| 11.8 (90) | |
3+ (max of 11)
| 6.7 (51) | |
Day of week presenting to ED
| ||
Monday
| 17.8 (67) | |
Tuesday
| 11.6 (44) | |
Wednesday
| 13.5 (51) | |
Thursday
| 18.0 (68) | |
Friday
| 16.7 (63) | |
Saturday
| 11.6 (44) | |
Sunday
| 10.6 (40) | |
Time of ED visit
| ||
Midnight to 8 am
| 22.0 (83) | |
8 am to 4 pm
| 57.8 (218) | |
4 pm to Midnight
| 20.2 (76) | |
Died in ED
| ||
No
| 94.7 (357) | |
Yes
| 5.3 (20) | |
Admissions
| ||
0
| 59.9 (458) | |
1
| 29.2 (223) | |
2
| 8.5 (65) | |
3+ (max of 6)
| 2.3 (18) | |
Died during admission
| ||
No
| 39.9 (122) | |
Yes
| 60.1 (184) |
Bivariate analysis
Multivariate analysis
Independent variable | Predisposing only | Enabling only | Need only | All | ||||||
---|---|---|---|---|---|---|---|---|---|---|
Model 1 | Model 2 | |||||||||
P.E. | Odds ratio | P.E. | Odds ratio | P.E. | Odds ratio | P.E. | Odds ratio | P.E. | Odds ratio | |
(S.E.) | (95% CI) | (S.E.) | (95% CI) | (S.E.) | (95% CI) | (S.E.) | (95% CI) | (S.E.) | (95% CI) | |
Predisposing
| ||||||||||
Married | 0.47 | 1.61 | 0.55 | 1.74 | 0.55 | 1.74 | ||||
(0.15) | (1.19-2.18) | (0.17) | (1.25-2.41) | (0.17) | (1.25-2.41) | |||||
Wish to die at | −0.84 | 0.43 | −0.61 | 0.54 | −0.61 | 0.54 | ||||
Home | (0.17) | (0.31-0.61) | (0.19) | (0.37-0.79) | (0.19) | (0.37-0.79) | ||||
Any advance | −0.96 | 0.38 | −0.94 | 0.39 | −0.93 | 0.39 | ||||
Directives present | (0.15) | (0.28-0.52) | (0.17) | (0.27-0.55) | (0.17) | (0.28-0.55) | ||||
Enabling
| ||||||||||
Caregiver | −0.59 | 0.55 | −0.69 | 0.50 | −0.67 | 0.53 | ||||
Distressed | (0.20) | (0.37-0.82) | (0.23) | (0.32-0.79) | (0.23) | (0.38-0.74) | ||||
Client’s cost of | −0.50 | 0.61 | −0.60 | 0.55 | −0.64 | 0.55 | ||||
Care > Median | (0.15) | (0.45-0.81) | (0.17) | (0.39-0.76) | (0.17) | (0.39-0.76) | ||||
Need
| ||||||||||
Hospitalization in | −0.43 | 0.65 | −0.55 | 0.57 | −0.51 | 0.60 | ||||
Last 90 days | (0.21) | (0.46-0.91) | (0.18) | (0.40-0.82) | (0.18) | (0.41-0.86) | ||||
Believes physical | 0.55 | 1.73 | 0.37 | 1.45 | 0.38 | 1.46 | ||||
Function can improve | (0.20) | (1.18-2.55) | (0.21) | (0.96-2.10) | (0.21) | (0.97-2.21) | ||||
Bladder/bowel | −0.63 | 0.53 | −0.39 | 0.68 | −0.46 | 0.63 | ||||
Incontinence | (0.19) | (0.37-0.77) | (0.20) | (0.46-1.01) | (0.20) | (0.43-0.94) | ||||
Swallowing | −0.58 | 0.56 | −0.50 | 0.61 | −0.52 | 0.59 | ||||
Difficulties | (0.18) | (0.39-0.80) | (0.18) | (0.41-0.89) | (0.19) | (0.40-0.86) | ||||
Dizziness | −0.33 | 0.72 | −0.45 | 0.64 | −0.41 | 0.66 | ||||
(0.17) | (0.51-1.00) | (0.18) | (0.45-0.91) | (0.18) | (0.46-0.94) | |||||
Peripheral edema | −0.31 | 0.74 | ||||||||
(0.17) | (0.51-1.03) | |||||||||
Any cognitive | −0.63 | 0.53 | −0.63 | 0.53 | −0.65 | 0.52 | ||||
Impairment (incl delirium) | (0.19) | (0.37-0.77) | (0.20) | (0.36-0.79) | (0.20) | (0.35-0.77) | ||||
Prior pneumonia | 0.57 | 1.77 | ||||||||
(0.32) | (0.94-3.33) | |||||||||
Prior urinary tract | 0.98 | 2.66 | 0.96 | 2.62 | 0.89 | 2.45 | ||||
Infection | (0.41) | (1.19-5.96) | (0.42) | (1.16-3.96) | (0.31) | (1.06-5.62) | ||||
ADLH 1+ | −0.44 | 0.66 | −0.34 | 0.71 | ||||||
(0.17) | (0.47-0.92) | (0.18) | (0.50-1.01) | |||||||
CHESS 3+ | −0.39 | 0.65 | −0.36 | 0.70 | ||||||
(0.17) | (0.47-0.91) | (0.17) | (0.50-0.99) | |||||||
C Statistic | 0.69 | 0.67 | 0.58 | 0.71 | 0.77 |
Survival analysis
Independent variable | Predisposing only | Enabling only | Need only | All | ||||
---|---|---|---|---|---|---|---|---|
P.E | Hazard rate | P.E | Hazard rate | P.E | Hazard rate | P.E | Hazard rate | |
(S.E.) | (95% CI) | (S.E.) | (95% CI) | (S.E.) | (95% CI) | (S.E.) | (95% CI) | |
Predisposing
| ||||||||
Female | −0.22 | 0.80 | ||||||
(0.10) | (0.6-0.97) | |||||||
Wish to die at home | −0.36 | 0.69 | −0.36 | 0.70 | ||||
(0.13) | (0.54-0.90) | (0.14) | (0.53-0.91) | |||||
Any advance | −0.27 | 0.78 | −0.30 | 0.74 | ||||
Directives present | (0.11) | (0.62-0.94) | (0.11) | (0.60-0.92) | ||||
Enabling
| ||||||||
Client’s Cost of Care | −0.54 | 0.58 | −0.51 | 0.60 | ||||
> Median | (0.10) | (0.47-0.71) | (0.10) | (0.49-0.74) | ||||
Need
| ||||||||
Swallowing | −0.27 | 0.76 | ||||||
Difficulties | (0.13) | (0.59-0.99) | ||||||
Dizziness | −0.24 | 0.79 | −0.27 | 0.76 | ||||
(0.11) | (0.63-0.98) | (0.11) | (0.61-0.96) | |||||
Prior pneumonia | 0.38 | 1.46 | ||||||
(0.19) | (0.98- 2.16) | |||||||
Prior urinary tract | 0.48 | 1.63 | 0.71 | 2.04 | ||||
Infection | (0.23) | (1.03-2.57) | (0.24) | (1.28-3.24) |