Comorbidity and dependence jointly indicate the need for palliative care in nursing home residents

The purpose was to investigate the association between mortality in nursing home residents (NHR) and multimorbidity, dependence and their interaction. This study was an 18-month prospective, observational study, that included a subgroup of 5527 NHR residing in 163 nursing homes located in France between May and July 2011. A Cox proportional hazard model was used to perform multivariate survival analysis. Independent variables of interest were baseline multimorbidity, baseline dependence, and the interaction between multimorbidity and dependence. NHR were very dependent at baseline and the median Charlson Index score was 2. In multivariate survival analysis, multimorbidity and dependence were both significantly associated with an increased 18-month mortality (HR=1.10; CI 95% [1.04 -1.17] and HR=1.30; CI 95% [1.22 -1.38], respectively). Higher multimorbidity and higher dependence were both independently associated with a higher 18-month mortality in NHR. Clinicians could use these two simple indicators to identify NHR requiring palliative care.