Risk of Venous Thromboembolism in care home residents

Problem

Around 60,000 deaths a year in the UK are due to venous thromboembolism (VTE) with around 50% of these acquired in hospital. Care home residents and medical in-patients have a similar risk profile for hospital acquired thrombosis, and US data suggest an eight-fold risk of VTE associated with residence in a long-term care facility. However the epidemiology of VTE in care homes remains unclear and the VTE risk profile of UK care home residents has not been investigated.

Approach

We investigated the prevalence of VTE risk factors in a cohort of prospectively enrolled care home residents. Participating care homes were recruited from a randomised selection of care homes in Birmingham and Oxford. Residents of the participating care homes were enrolled consecutively; all participants provided informed consent and consultee declaration was sought for participants without capacity to consent. Temporary care home residents and residents with life expectancy < 6 months were excluded. Data was collected through case note review of participants care home and medical notes: demographics, VTE risk factors, VTE prevention strategies, medical history, and comorbidities. Mobility was measured using the rivermead mobility index (RMI).

Findings

1011 care home residents were enrolled from 45 care homes. The mean age (±SD) was 85.1 (8.6) years; 98.8% were aged > 60, with 58% aged ≥85 years. 88.8% were female and the mean BMI (±SD) was 24.4 (6.1), with 12.4% having BMI > 30. 22.2% were immobile with a RMI score of zero, and a further 28% had significantly reduced mobility with a RMI score of between 1 and 5. 11.4% had active cancer or were receiving cancer treatment, and 13.5% were on antipsychotic drugs. 9.1% had a personal history of VTE and 70% had one or more significant comorbidities (heart disease; metabolic, endocrine, respiratory pathologies; inflammatory conditions). 52.7% had dementia. Overall 99.8% had at least one risk factor that would make them eligible for VTE prophylaxis in the hospital setting when assessed with the National VTE risk assessment tool. None of the participants were on prophylactic heparin, and 5% were using compression stockings. None had been routinely risk assessed for VTE.

Consequences

The findings suggest care home residents are at high risk of VTE, yet there is very limited use of VTE prophylaxis. While there are clear guidelines and recommendations in place to reduce the risk of VTE in hospital in-patients, there are no measures in place for care home residents. There is a need for guidance in relation to care home residents, and a tailored risk stratification tool is required to routinely assess VTE risk in care home residents.