Recent research conducted by the Bruyère Health Research Institute and ICES highlights concerning trends in the outcomes of individuals admitted to long-term care (LTC) facilities. Many residents, particularly those above the age of 65, experience severe impairments that substantially diminish their quality of life within a short span of five years post-admission.

Understanding the Severity of Impairments in Long-Term Care

The study published in JAMA Network Open reveals that approximately 20% of residents newly admitted to LTC facilities lose the ability to make everyday decisions for themselves within five years. The implications of such impairments are profound, as many individuals find themselves confined to a state of severe cognitive and physical limitations.

Key Findings

  • Decision-Making Impairment: 20% of residents permanently unable to make everyday decisions within five years; half of these individuals lived with this level of disability for more than 262 days.
  • Total Care Dependence: 13% became completely dependent on caregivers for all basic activities, such as bathing and eating, with half of this group enduring this state for over 45 days.
  • Age and Cognitive Status: Residents under 80 years and those with dementia showed a tendency to survive longer after reaching total care dependence.
  • Impact of Advance Care Directives: Residents with do-not-resuscitate (DNR) or do-not-hospitalize orders experienced shorter durations of severe disability compared to those without these directives.

Implications for Quality of Life

The findings shed light on critical aspects of what it means to live well in LTC settings. Many residents have expressed that the loss of independence, often described as 'worse than death', is more distressing than facing mortality itself. Lead author Ramtin Hakimjavadi emphasizes the significance of discussing residents' quality of life and recognizing the potential for severe disability.

“We should be talking more about what a meaningful, high-quality end of life looks like, given most residents at this stage prioritize quality of life.” – Ramtin Hakimjavadi

Demographics and Their Influence

In the study, around 65% of participants had a DNR order, and 25% had do-not-hospitalize orders, which played a role in reducing time spent in severe disabilities. The data suggest that having advance care directives aligns care with the residents' preferences and helps in making informed decisions regarding end-of-life care.

Summary of Findings

Finding Percentage Duration of Disability
Permanently unable to make decisions 20% More than 262 days
Total care dependence 13% More than 45 days
Residents under 80 with dementia Increased likelihood Longer life in total dependence
Residents with DNR orders 65% Shorter severe disability duration

Conclusions and Future Directions

The current study highlights the critical need for ongoing conversations among LTC residents, their families, and healthcare teams about what constitutes quality of life. Dr. Daniel Kobewka, a senior author, advocates for proactive discussions regarding residents’ preferences in care, especially concerning campaigns for dignity and comfort over mere life-prolonging interventions.

Additional Recommendations

  • Incorporating resident-centered approaches in care planning.
  • Establishing support systems for discussing end-of-life preferences.
  • Educating care teams about the emotional and psychological ramifications of severe disabilities.

In summary, addressing the implications of severe, lasting impairments in LTC sets a foundation for improving care practices and enhancing the quality of life for residents.

More information: For further details on the study, visit the article in the JAMA Network Open. [Link to the Study]

Literature Cited

[1] Hakimjavadi, R., et al. (2025). Cognitive and Functional Decline Among Long-Term Care Residents. JAMA Network Open.

[2] Bruyère Health Research Institute.

[3] ICES.