Associations Among Bullying Victimization, Executive Functions, and Adolescent Internalizing and Externalizing Symptoms: A Random-Intercept Cross-Lagged Panel Model.

The condition of multimorbid older adults living in a nursing home can deteriorate, for example, due to infections, changes in medication, traumas and exacerbations of chronic diseases, as well as acute medical emergencies [, ]. Nursing home staffs’ ability and guidelines for handling different situations vary greatly [], and not all units have their own physician or registered nurses constantly available [–]. In these situations, advice is often asked from the emergency department (ED) or by alerting emergency medical service (EMS) []. In recent years, there has been a significant increase in the number of EMS missions alerted to care facilities [], and EMS are also alerted to care for less acute situations []. A previous study found that EMSs are alerted up to four times more often for older adults living in nursing homes than for older adults living at home [], and older adults are also about twice as likely to require EMS physician care compared with individuals aged 18 to 65 []. However, previous research findings have not been entirely consistent. Surprisingly, Hancock et al. [] found that emergency calls were more likely to be made from nursing homes with higher quality and suitability of management, as well as from nursing homes with specialization in dementia patients. According to Lofthouse-Jones et al. [], the presence of dementia as a condition did not increase the likelihood of transfers, but patients living in care facilities were more likely to be transferred to a hospital, whereas in the study by Suzuki et al. [], nursing home residence was not identified as an independent predictor of hospital admission. In previous studies, the majority (78–90%) of the EMS missions of nursing homes ended up with patients being transferred to a hospital [, –]. However, it has been suggested that some of the transfers may be unnecessary [, ], and that unjustified transfers could be prevented if the patient’s Do Not Resuscitate (DNR)-decisions and treatment limitations were available []. Unnecessary transfers burden older adults and add avoidable complications [, , ], while also burdening the health care system. Therefore, the necessity and potential benefits of hospital transfers should be carefully evaluated in each case.