Mortality and enrolment rates in end-of-life service for older adults in residential care homes

Background.Older adults in residential care homes in Hong Kong usually have multiple co-morbidities and need end-of-life (EOL) care.Repeated hospitalisations before death are common.The Hospital Admission Risk Reduction Program for the Elderly (HARRPE) score is correlated with mortality.We compared older adults identified by clinical referral with older adults identified by HARRPE score 0.4 in terms of EOL programme enrolment rate and mortality rates at 180 and 365 days.Methods.This retrospective cohort study included older adults aged 80 years residing in care homes from 1 July 2018 to 30 June 2019.We compared older adults identified by clinical referral with older adults identified by HARRPE score 0.4 in terms of EOL programme enrolment rate and mortality rates at 180 and 365 days.Results.Of 113 clinical referral patients and 735 patients with HARRPE score 0.4,102 and 96, respectively, fulfilled EOL programme criteria.Their mean age was 92 years, with female predominance (71%).Enrolment rates were similar (57% and 51%, respectively).Survival probability was higher among enrolled patients than among nonenrolled patients (p<0.001).The two groups were comparable in terms of the 180-day mortality rate and 365-day mortality rate.In both groups, survival probabilities were higher in patients who enrolled in the EOL programme, compared with patients who did not enrol (p<0.001).The median survival was longer in the HARRPE group (191 vs 155 days). Conclusions.Older adults in residential care homes requiring EOL care according to HARRPE score 0.4 have similar enrolment and mortality rates, compared with clinical referral.The HARRPE score is a feasible tool to supplement clinical referral for timely EOL care.