Description of early deaths of nursing home residents hospitalized after admission in emergency department

A quarter of nursing home residents dies in hospital. Few data are available about early in-hospital deaths of nursing home residents. The aim of the study was to describe the characteristics of early in-hospital deaths of nursing home residents after an admission in emergency department and to identify factors associated with a decision of limitation of care in emergency department. This retrospective monocentric descriptive study included all nursing home residents hospitalized and who died early (less than 3 days) after being admitted to the emergency department between 2017 and 2019. Patients' characteristics were collected in the medical record. These characteristics were compared by a logistic regression according to the existence or not of a limitation of care. 12,440 admissions of nursing home residents were identified and 332 patients died early in hospital. Half of them died in the emergency department. The first reason for admission was dyspnea (57.4%) and the main cause of death was pneumonia (41.7%). A limitation of care at emergency department was reported in 66.7% of cases. The factors independently associated with a limitation of care were the existence of active cancer (OR=5.34 [1.35-39.2], p=0.041) and severe dependence (OR=16.1 [1.60-415], p=0.034). Early in-hospital deaths of nursing home residents are common and most often related to pneumonia, dyspnea motivating the transfer. The anticipation of the care project and especially of end of life is mandatory in these patients.