Most readers may be surprised to learn that frail older people living in residential aged care services, often referred to as nursing homes or care facilities, die prematurely. We tend to think the deaths of older people, and especially those in care, are due to natural causes. But although confronting to contemplate, residents die prematurely due to injury and violence.
Investigations into deaths of individual residents by the Coroners Court and the recent inquiry into Oakden care facility in South Australia show vulnerable older people in care have been subjected to undue suffering and harm. The Federal Aged Care Minister Ken Wyatt has also commissioned an independent review into aged care processes.
Our research published today in the Medical Journal of Australia found 15.2% of over 20,000 deaths of nursing home residents between 2000 and 2013 resulted from external causes (that is, an injury, violence or other external event).
The study collated information from all the investigations into deaths of individual residents by the Coroners Court over the past decade. The most frequent mechanisms of death were falls (2,679 cases, 81.5%), choking (261 cases, 7.9%) and suicide (146 cases, 4.4%).
The incidents leading to death usually occurred in the nursing home (95.8%), but the death itself usually occurred elsewhere (67.1%). This was typically at an acute care hospital where residents had been transferred. Somewhat surprising was the small proportion of people (1.2%) who died from adverse events related to their clinical care (such as medication errors). And these numbers are likely to be underestimated due to some deaths being misclassified as “natural”.
Our study provides the first detailed understanding of how many deaths in nursing homes that shouldn’t be happening. Although coroners play an important role in identifying factors that may prevent death and injury, fewer than 3% of the external-cause deaths were examined by an inquest. Coroners also made no recommendations about preventing injury in 98.4% of all cases.
Establishing how people die in care
A better understanding of how, where and when older people die in nursing homes is the first step towards reducing harm, improving quality of care and improving quality of life.
The next step is understanding why these preventable deaths occur. This requires a detailed analysis of the circumstances of each death – by examining what was or was not done, and determining what other factors unrelated to the person’s underlying illnesses may have contributed to the death.
This type of analysis is common in hospitals, where the contributing factors leading to adverse events include considering the organisation’s culture, communication systems, governance arrangements, management and supervision of staff, workload, equipment and the physical environment.