Comparison of mortality and hospitalizations of older adults living in residential care facilities versus nursing homes or the community. A systematic review

Residential care facility may provide a transition between living at home and a nursing home for dependent older people or an alternative to nursing homes. The objective of this review was to compare mortality and hospitalizations of older adults living in residential care facilities with those living in nursing homes or in the community. We searched Medline, Scopus and Web of Science from inception to December 2022. Fifteen cohort studies with 6 months to 10 years of follow-up were included. The unadjusted relative risk (RR) of mortality was superior in nursing homes than in residential care facilities in 6 of 7 studies (from 1.3 to 1.68). Conversely, the unadjusted relative risk of hospitalizations was higher in residential care facilities in 6 studies (from 1.3 to 3.37). Studies conducted on persons with dementia found mixed results, the only study adjusted for co-morbidities observing no difference on these two endpoints. Compared with home, unadjusted relative risks were higher in residential care facilities for mortality in 4 studies (from 1.34 a 10.1) and hospitalizations in 3 studies (from 1.12 to 1.62). Conversely, the only study that followed older adults initially living at home over a 10-year period found a reduced risk of heavy hospital use (RR = 0.68) for those who temporarily resided in a residential care facilities. There is insufficient evidence to determine whether residential care facilities might be an alternative to nursing homes for older people with similar clinical characteristics (co-morbidities and dementia). Nevertheless, given the high rate of hospitalizations observed in residential care facilities, the medical needs of residents should be better explored.

Automated summary

Residential care facilities can provide a transition or alternative to nursing homes for dependent older people. This review compared mortality and hospitalizations between residential care facilities, nursing homes, and home settings. The findings showed that nursing homes had higher unadjusted mortality risks compared to residential care facilities, while residential care facilities had higher unadjusted hospitalization risks. Studies on individuals with dementia had mixed results, and only one study adjusted for co-morbidities found no difference between the two settings. Compared to home, there were higher unadjusted mortality risks in residential care facilities and higher unadjusted hospitalization risks. However, the only long-term study found reduced hospitalization risks for older adults temporarily residing in residential care facilities. The evidence is insufficient to determine if residential care facilities can be an alternative to nursing homes for older people with similar clinical characteristics. Considering the high rate of hospitalizations in residential care facilities, further exploration of residents' medical needs is warranted.