The residents had high levels of dependency, were predominantly
cognitively impaired, manifested frequent mild behavioural
symptoms and multiple morbidity. Less than half used
NHS secondary care resources during the study period but
those who did used them intensively. When primary and secondary
care services were considered together, participants
used NHS services on average once a month.
The study was detailed, prospective and had high recruitment
rates. The sample was broadly representative in terms
of age, gender distribution and home registration status when
compared with a national care home market survey [17].
Based on the local NHS trust’s reported admission rate of 2
per home per month—which would have resulted in 132
admissions—the homes sampled were potentially lower than
average users of secondary care resources. An important
limitation was the low response rate for GHQ-12 and
EQ-5D which, although explained by the high prevalence of
cognitive impairment, meant that measurements of psychological
wellbeing and health-related quality of life were inadequate.
The study did not collect data on some important
care problems in older patients, such as falls and pressure
ulcers which might be useful in designing or commissioning
services.
The prevalence of cognitive impairment was considerably
higher than previously reported in UK care homes—75% of
residents had an MMSE ≤22, compared with a 50% dementia
prevalence reported in 2004 [9]. This may represent an increasing
tendency for care homes to be used predominantly
for the growing number of people with dementia rather than
physical disability alone. Behavioural disturbance was less
prevalent than expected, affecting two-thirds of residents in
this cohort by comparison with 75–79% of US and
Norwegian nursing home residents [18, 19]. Antipsychotic
prescribing was also less prevalent than in overseas studies:
12% of participants were receiving antipsychotics, compared
with 58% in US nursing home cohorts [18]. These differences
might suggest differing patterns of psychopathology as
well as its management in UK care home residents.
Changing patterns of antipsychotic prescribing among GPs
might also be an important contributor.
In our study, there were significant differences between
dependency, cognitive function, behaviour, nutrition, medication
and use of services between nursing and residential