Premature deaths of nursing home residents: an epidemiological analysis

To the Editor:

I read with some concern the study by Ibrahim and colleagues1 published in the Journal. In their epidemiological study of deaths of nursing home residents reported to the coroner, the authors reported a more than quadrupling of the rate of deaths due to falls over the decade from 2002 to 2012, and deemed these deaths to be preventable and premature. In their discussion, Ibrahim and colleagues1 insinuate that this increased rate of deaths due to falls relates to some extent to a decline in the standard of care provided to nursing home residents.

As this study lacks a control group, fundamentally, there is a problem in making any assumptions about preventable deaths and care provided to nursing home residents. This problem is particularly pertinent in light of data published by the Australian Institute of Health and Welfare which show an almost 40% increase in the rate of injury hospitalisations for older Australians, predominantly due to falls, over a similar 10-year period.2 A subsequent publication by the Australian Institute of Health and Welfare reports that 50% of all falls in older people resulting in hospitalisation occur in or around the home and that only 22% occur in an aged care facility.3 Therefore, one could ask whether there has been a similar increase in the rate of premature and preventable deaths due to falls of older Australians who live in their own homes. Clearly, further research on falls in general is required before any conclusions about possible causes can be made.