OBJECTIVE: The care processes directed towards institutionalized older people needs to be tailored on goals and priorities that are relevant for this specific population. The aim of the present study was (a) to describe the distribution of selected health determinants in a sample of institutionalized older adults, and (b) to investigate the impact on survival of such measures. DESIGN: Multicentre longitudinal cohort-study. SETTING: 57 nursing homes (NH) in 7EU countries (Czech Republic, England, Finland, France, Germany, Italy, The Netherlands) and 1 non-EU country (Israel). PARTICIPANTS: 3036 NH residents participating in the Services and Health for Elderly in Long TERm care (SHELTER) study. MEASUREMENTS: We described the distribution of 8 health determinants (smoking habit, alcohol use, body mass index [BMI], physical activity, social participation, family visits, vaccination, and preventive visits) and their impact on 1-year mortality. RESULTS: During the one-year follow up, 611 (20%) participants died. Overweight (HR 0.79; 95% C.I. 0.64-0.97) and obesity (HR 0.64; 95% C.I. 0.48-0.87) resulted associated with lower mortality then normal weight. Similarly, physical activity (HR 0.67; 95% C.I. 0.54-0.83), social activities (HR 0.63; 95% C.I. 0.51-0.78), influenza vaccination (HR 0.66; 95% C.I. 0.55-0.80) and pneumococcal vaccination (HR 0.76 95% C.I. 0.63-0.93) were associated with lower mortality. Conversely, underweight (HR 1.28; 95% C.I. 1.03-1.60) and frequent family visits (HR 1.75; 95% C.I. 1.27-2.42) were associated with higher mortality. CONCLUSIONS: Health determinants in older NH residents depart from those usually accounted for in younger and fitter populations. Ad hoc studies are warranted in order to describe other relevant aspects of health in frail older adults, with special attention on those institutionalized, with the ultimate goal of improving the quality of care and life.

Ageing and Services Unit National Institutes of Health and Welfare Helsinki Finland

Aging Research Center Karolinska Institutet and Stockholm University Sweden

Department of General Practice and Elderly Care Medicine EMGO Institute for Health and Care Research VU University Medical Centre Amsterdam The Netherlands

Department of Geriatrics 1st Faculty of Medicine Charles University Prague Czech Republic

Department of Geriatrics Catholic University of Rome Italy

Department of Social Policy Institute of Labour and Social Studies Warsaw Poland

Faculty of Health and Social Science South Bohemian University Czech Republic

Institute of Public Health Catholic University of Rome Italy

Italian National Institute of Health Rome Italy

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$a Vetrano, Davide L $u Department of Geriatrics, Catholic University of Rome, Italy; Aging Research Center, Karolinska Institutet and Stockholm University, Sweden.

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$a Health determinants and survival in nursing home residents in Europe: Results from the SHELTER study / $c DL. Vetrano, A. Collamati, N. Magnavita, A. Sowa, E. Topinkova, H. Finne-Soveri, HG. van der Roest, B. Tobiasz-Adamczyk, S. Giovannini, W. Ricciardi, R. Bernabei, G. Onder, A. Poscia,

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$a OBJECTIVE: The care processes directed towards institutionalized older people needs to be tailored on goals and priorities that are relevant for this specific population. The aim of the present study was (a) to describe the distribution of selected health determinants in a sample of institutionalized older adults, and (b) to investigate the impact on survival of such measures. DESIGN: Multicentre longitudinal cohort-study. SETTING: 57 nursing homes (NH) in 7EU countries (Czech Republic, England, Finland, France, Germany, Italy, The Netherlands) and 1 non-EU country (Israel). PARTICIPANTS: 3036 NH residents participating in the Services and Health for Elderly in Long TERm care (SHELTER) study. MEASUREMENTS: We described the distribution of 8 health determinants (smoking habit, alcohol use, body mass index [BMI], physical activity, social participation, family visits, vaccination, and preventive visits) and their impact on 1-year mortality. RESULTS: During the one-year follow up, 611 (20%) participants died. Overweight (HR 0.79; 95% C.I. 0.64-0.97) and obesity (HR 0.64; 95% C.I. 0.48-0.87) resulted associated with lower mortality then normal weight. Similarly, physical activity (HR 0.67; 95% C.I. 0.54-0.83), social activities (HR 0.63; 95% C.I. 0.51-0.78), influenza vaccination (HR 0.66; 95% C.I. 0.55-0.80) and pneumococcal vaccination (HR 0.76 95% C.I. 0.63-0.93) were associated with lower mortality. Conversely, underweight (HR 1.28; 95% C.I. 1.03-1.60) and frequent family visits (HR 1.75; 95% C.I. 1.27-2.42) were associated with higher mortality. CONCLUSIONS: Health determinants in older NH residents depart from those usually accounted for in younger and fitter populations. Ad hoc studies are warranted in order to describe other relevant aspects of health in frail older adults, with special attention on those institutionalized, with the ultimate goal of improving the quality of care and life.

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$a Collamati, Agnese $u Institute of Public Health, Catholic University of Rome, Italy. Electronic address: agnese.collamati@gmail.com.

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$a Magnavita, Nicola $u Institute of Public Health, Catholic University of Rome, Italy.

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$a Sowa, Agnieszka $u Department of Social Policy, Institute of Labour and Social Studies, Warsaw, Poland.

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$a Topinkova, Eva $u Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic; Faculty of Health and Social Science, South Bohemian University, Czech Republic.

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$a Finne-Soveri, Harriet $u Ageing and Services Unit, National Institutes of Health and Welfare (THL), Helsinki, Finland.

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$a van der Roest, Henriëtte G $u Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.

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$a Tobiasz-Adamczyk, Beata $u Department of Social Policy, Institute of Labour and Social Studies, Warsaw, Poland.

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$a Giovannini, Silvia $u Department of Geriatrics, Catholic University of Rome, Italy.

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$a Ricciardi, Walter $u Institute of Public Health, Catholic University of Rome, Italy; Italian National Institute of Health, Rome, Italy.

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$a Bernabei, Roberto $u Department of Geriatrics, Catholic University of Rome, Italy.

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$a Onder, Graziano $u Department of Geriatrics, Catholic University of Rome, Italy.

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$a Poscia, Andrea $u Institute of Public Health, Catholic University of Rome, Italy.

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