Life Expectancy and Quality of Life of Residents in Long-Term Care

Significant improvements in public health, prevention, and the treatment of disease, such as the introduction of antibiotics in the mid-1940s, have contributed to significant increases in health span and life expectancy. Centenarians have become an important part of the rapidly increasing oldest population, and long-term care (LTC) facilities will increasingly be caring for this oldest old population. Even as life expectancy for adults is increasing, consideration of older persons’ quality of life remains a priority. Longevity of life is not synonymous with quality of life; indeed, living longer often means living longer with the natural effects of aging, such as frailty and chronic illness. The feature articles in this digital issue of Annals of Long-Term Care: Clinical Care and Aging discuss common challenges facing the oldest residents in LTC in order to help improve their quality of life. 

Frailty among LTC residents is a complex health and functional state that, over time, can translate into higher rates of falls, weight loss, functional decline, hospitalization, and death. A need exists for a comprehensive scale to identify LTC residents who are frail, with the goal of improving residents’ recovery. Elizabeth P Howard, PhD, RN, ACNP, ANP-BC, FAAN, and John N Morris, PhD, discuss their project that developed and tested a scale to meet this need. The interRAI Nursing Home (NH) Frailty Scale is based on data from a national cohort of US NH residents collected as part of the Centers for Medicare and Medicaid Services Minimum Data Set (MDS) NH assessment instrument. The authors designated death, hospitalization, and clinical judgment of proximity of death as dependent measures. The resulting 21-item frailty scale represents an efficient and cost-effective approach to monitoring frailty in LTC facilities.

While in the early 19th century only a small proportion of people lived to old age, in modern societies most people live well past middle age, and deaths are highly concentrated at older ages. To date, no study has described veteran centenarians residing in institutional LTC settings. Raya Elfadel Kheirbek, MD, MPH, and coauthors present a case series of 8 veteran centenarians who between 2005 and 2015 resided at the Washington, DC, Veterans Affairs Medical Center, a 120-bed, 24-hour, hospital-based skilled nursing care facility. This facility provides long-term, restorative, and short-term rehabilitative services in addition to inpatient palliative and hospice services. Basic demographic, mental, medical, and functional characteristics are discussed for each centenarian, qualitatively describing the lives of the oldest old residing in LTC. he plan of care for individuals in the study was found to be person-centered and encouraged choice, purpose, and meaning. Treatment was targeted to lessen burden of disease and improve quality of life through social engagement and psychological support.