WEDNESDAY, Aug. 5 (HealthDay News) -- Non-profit nursing homes provide better care than for-profit facilities, say Canadian researchers who reviewed the results of 82 studies from 1965 to 2003.

Forty studies found that non-profit nursing homes provided significantly better quality care, while three studies concluded that for-profit homes delivered better care. The remaining studies had mixed results. Most of the studies were conducted in Canada and the United States.

Further analysis by the team at McMaster University in Hamilton, Ontario, suggested that non-profit homes did better in four important quality measures: more or higher quality staffing; lower rates of pressure ulcers; less use of physical restraints; and fewer deficiencies cited by regulatory agencies.

Based on their findings, the review authors calculated that if all nursing homes were non-profit, nursing home residents in the United States would receive 500,000 more hours of nursing care per day, while those in Canada would receive 42,000 more hours of nursing care per day.

The researchers also found that of 7,000 cases of pressure ulcers in Canada, 600 were directly linked to for-profit ownership of nursing homes, as were 7,000 of 80,000 pressure ulcer cases in the United States.

The findings, published online Aug. 4 in the British Medical Journal, suggest a trend toward higher quality care in non-profit nursing homes than in for-profit homes, said the McMaster researchers. But more research is needed to learn more about the factors that affect the link between profit status and quality of care, they added.

In an accompanying editorial, one expert noted that many factors other than profit status have been connected to the quality of nursing home care. Professor Tamara Konetzka, of the University of Chicago, warned that "if differences in quality between for-profit and non-profit nursing homes stem at least in part from differences in revenues rather than mission, eliminating for-profit homes may do little to eliminate differences in quality."

More information

The U.S. National Institute on Aging has more about selecting a nursing home.

TUESDAY, Aug. 4 (HealthDay News) -- Older people who break a hip have nearly a 25 percent chance of dying in the next five years, a Canadian study has found.

The five-year death rate for those who have a spinal fracture is 16 percent, according to the study, which is reported in the Aug. 4 issue of the Canadian Medical Association Journal.

The study, which included 7,753 people aged 50 and older from all parts of Canada, found that a hip fracture increases the risk of death 3.2-fold and a spinal fracture increases the risk 2.7-fold, said study author George Ioannidis, a health research methodologist at McMaster University in Hamilton, Ontario.

A number of previous studies have outlined the dangers of fractures for older people, Ioannidis said. "The big difference between this study and the others is design," he said. "We had a random selection of the Canadian people, looking at areas with 40 percent of the Canadian population. Other studies have looked at non-randomized samples, from hospitals or specific geographic regions."

Twenty different factors that could influence mortality, and many different fracture types, were considered in the study, Ioannidis said. The most significant relationships were found for hip and spine fractures.

The research effort, called the Canadian Multicentre Osteoporosis Study, focused on the effects of the bone-weakening condition seen in one of every four women older than 50 and one in every eight men of that age.

"I don't think that individuals are completely aware of the consequences of osteoporosis," Ioannidis said. "It causes not only weakening but also death."

One of every six women over 50 will sustain a hip fracture, he said.

All estimates in the study appear to apply to U.S. residents as well as Canadians.

People should start thinking about the possible dangers of osteoporosis as early as age 50, Ioannidis said. "If you are worried about it, you definitely should consult your physician," he said. "We can act early. We have medications that are very effective, and a variety of non-medical interventions to reduce the incidence of falls that cause fractures."

Those non-medical interventions are a specialty of Maureen Ashe, co-author of a commentary accompanying the report, and an investigator at the Centre for Hip Health and Mobility at Vancouver General Hospital and an assistant professor of family practice at the University of British Columbia.

The toll taken by fractures might be greater than reported in the study, Ashe noted. Cognitive impairment and dementia are major risk factors for fall-related fractures, she said, and people with those conditions are difficult to recruit and thus might be under-represented in the study.

Other medical risk factors include worsening vision, decreased sense of balance and possible effects of the multiple medications taken by many older people, she said.

Bone health can be helped, she said, by adequate physical activity.

"But there are both internal and external factors" involved in fractures, she said. "A lot of preventive research has been done about improving a person's environment, such as making sure there is adequate lighting, fastening scatter rugs, providing handrails where necessary."

More information

The U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases has more on osteoporosis.

TUESDAY, Aug. 4 (HealthDay News) -- When seniors stop taking proper care of themselves, their risk for death increases nearly sixfold, a new study shows.

In addition, elderly people who are abused physically, emotionally, financially or through withdrawal of care don't fare much better. Their risk for dying more than doubles, the researchers report.

"Elder self-neglect and abuse really have severe consequences," said study author Dr. XinQi Dong, an associate professor of medicine at Rush University Medical Center in Chicago.

Though people often associate dementia or Alzheimer's disease with self-neglect, the researchers found that "it's not just the cognitively impaired" who are affected, Dong said. "Even more capable seniors face a higher risk of premature death from self-neglect."

The findings are reported in the Aug. 5 issue of the Journal of the American Medical Association.

Elder self-neglect is the most common reason that someone is referred to adult protective services, according to Dr. Thomas Gill, author of an accompanying editorial in the same issue of the journal. The inability to care for oneself, which characterizes self-neglect, can include failing to provide adequate food, water, clothing, shelter and necessary medications and not following basic hygiene practices, according to the study and editorial.

Abuse can include physical or sexual abuse, confinement, emotional abuse, caregiver neglect, deprivation or financial exploitation, the study reported.

Dong and his colleagues followed a group of 9,318 Chicago residents, all older than 65, who were participating in the Chicago Health and Aging Project. During the study period, from 1993 to 2005, social service agencies received reports of self-neglect on 1,544 of the participants, and 113 were reported as being abused. During about seven years of follow-up, 4,306 of the participants died.

The researchers found that elder self-neglect was associated with a 5.82 times increased risk for mortality in the year after a report of self-neglect. For abused seniors, the chance that they would die in the year after the abuse was reported was more than twice as great as it was for seniors who were not abused.

Dong said the researchers controlled the data to account for numerous factors -- such as medical conditions, socioeconomic status, health habits and memory -- but still found a strong association between abuse and self-neglect and the risk for premature death.

That suggests, he said, that it's the abuse and self-neglect that lead to the physical decline that ends in death.

"This degree of mortality risk is usually reserved for acute conditions, like an acute heart attack or stroke, and these findings really emphasize the importance of reporting abuse and self-neglect as well as the need to respond promptly with social service and medical intervention and prevention," Dong said.

The study points to an imminent problem, according to Dr. Karin Ouchida, medical director of the Montefiore Medical Center Home Health Agency in New York City.

"The situation is kind of grim right now," Ouchida said. "The population is going to get larger, and the population of people armed to care for them is getting smaller. I think this study really raises a red flag."

"Whether it was some decline in medical function that led to self-neglecting behavior, or the other way around, these people are in crisis, and social services and medical services need to have more communication and interaction," she said.

Anyone who suspects that an older family member, neighbor or friend is being abused or might be self-neglecting need to report those suspicions, both Ouchida and Dong said. A sudden change in weight, hygiene, or worsening medical conditions, such as being more short of breath, are clues that people might be neglecting themselves. Abuse can be harder to detect, but any unexplained bruises or sudden change in doctors could be clues.

Financial abuse and exploitation are probably getting worse in the recession, they said. Possible signs of this can include more telephone, mail and even in-person solicitations. Or, if older people start running out of money when they never did before or things are suddenly missing from their home, they could be in trouble.

"The tragedies of elder abuse are a reflection on all of us," Don said. "It can be a difficult topic to talk about, but this study demonstrated the adverse health outcomes that can result."

More information

The American Psychological Association has more on elder abuse and neglect  .