Acute hospital admissions among nursing home residents: a population-based observational study

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Abstract

Background

Nursing home residents are prone to acute illness due to their high age, underlying illnesses and immobility. We examined the incidence of acute hospital admissions among nursing home residents versus the age-matched community dwelling population in a geographically defined area during a two years period. The hospital stays of the nursing home population are described according to diagnosis, length of stay and mortality. Similar studies have previously not been reported in Scandinavia.

Methods

The acute hospitalisations of the nursing home residents were identified through ambulance records. These were linked to hospital patient records for inclusion of demographics, diagnosis at discharge, length of stay and mortality. Incidence of hospitalisation was calculated based on patient-time at risk.

Results

The annual hospital admission incidence was 0.62 admissions per person-year among the nursing home residents and 0.26 among the community dwellers. In the nursing home population we found that dominant diagnoses were respiratory diseases, falls-related and circulatory diseases, accounting for 55% of the cases. The median length of stay was 3 days (interquartile range = 4). The in-hospital mortality rate was 16% and 30 day mortality after discharge 30%.

Conclusion

Acute hospital admission rate among nursing home residents was high in this Scandinavian setting. The pattern of diagnoses causing the admissions appears to be consistent with previous research. The in-hospital and 30 day mortality rates are high.

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Most cited references 12

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The natural history of functional morbidity in hospitalized older patients.

Connie L. Sommers, Jeppe A. Olsen, Etienne Hirsch … (1990)

This study provides data on changes in the functional status of older patients that are associated with acute hospitalization. Seventy-one patients over the age of 74 admitted to the medical service of Stanford University Hospital between February and May 1987 received functional assessments covering seven domains: mobility, transfer, toileting, incontinence, feeding, grooming, and mental status. Assessments were obtained by report from the patient's caregiver (or the patient when he or she lived alone) for 2 weeks before admission; from the patient's nurse on day 2 of hospitalization and on the day before discharge; and again from the caregiver (or patient) 1 week after discharge. The sample had a mean age of 84, covered 37 Diagnostic Related Groups, and had a median length of stay of 8 days. Between baseline and day 2, statistically significant deteriorations occurred for the overall functional score and for the individual scores for mobility, transfer, toileting, feeding, and grooming. None of these scores improved significantly by discharge. In the case of mobility, 65% of the patients experienced a decline in score between baseline and day 2. Between day 2 and discharge, 67% showed no improvement, and another 10% deteriorated further. These data suggest that older patients may experience a burden of new and worsened functional impairment during hospitalization that improves at a much slower rate than the acute illness. An awareness of delayed functional recovery should influence discharge planning for older patients. Greater efforts to prevent functional decline in the hospitalized older patient may be warranted.

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Predictors of nursing home hospitalization: a review of the literature.

David Grabowski, Kate A Stewart, Suzanne Broderick … (2008)

Hospitalization of nursing home residents is costly and potentially exposes residents to iatrogenic disease and psychological harm. This article critically reviews the association between the decision to hospitalize and factors related to the residents' welfare and preferences, the providers' attitudes, and the financial implications of hospitalization. Regarding the resident's welfare, factors associated with hospitalization included sociodemographics, health characteristics, nurse staffing, the presence of ancillary services, and the use of hospices. Patient preferences (e.g., advance directives) and provider attitudes (e.g., overburdening of staff) were also associated with increased hospitalization. Finally, financial variables related to hospitalization included nursing home ownership status and state Medicaid policies, such as nursing home payment rates and bed-hold requirements. Most studies relied on potentially confounded research designs, which leave open the issue of selection bias. Nevertheless, the existing literature asserts that nursing home hospitalizations are frequent, often preventable, and related to facility practices and state Medicaid policies.

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Frequency and pattern of emergency department visits by long-term care residents--a population-based study.

Rhonda C. Bell, Paula Rochon, David Anderson … (2010)

To obtain population-based estimates of emergency department (ED) visits by long-term care (LTC) residents. Retrospective cohort study using administrative data. All LTC facilities in Ontario, Canada. All LTC residents who visited an ED at least once during a 6-month period. All ED visits were described using the National Ambulatory Care Reporting System. Two distinct visit types were defined. Potentially preventable visits were defined as those for any ambulatory care sensitive condition; these are conditions for which exacerbations that result in hospital use suggest lack of access to adequate primary care. Low-acuity visits were defined as those triaged as non-urgent at ED registration and ended with return to the LTC facility without hospital admission. Nearly one-quarter of LTC residents visited the ED at least once in 6 months. Of all visits, 24.6% were for a potentially preventable reason, most commonly pneumonia, urinary tract infection, and congestive heart failure. These visits had a high frequency of ambulance transport (90.4%), emergent triage (35.3%), hospital admission (62.4%), and death within 30 days (23.6%). Of all visits, 11.0% were low acuity. Fall-related injury was the most common cause. Low-acuity visits were the shortest (mean length 4.5 +/- 4.0 hours) and had the lowest frequency of death within 30 days (4.3%). LTC residents made frequent visits to the ED. The visit types showed distinct patterns that suggest a need for better access to medical care for common conditions and a greater emphasis on fall prevention in LTC.

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Author and article information

Journal

Journal ID (nlm-ta): BMC Health Serv Res

Title: BMC Health Services Research

Publisher: BioMed Central

ISSN (Electronic): 1472-6963

Publication date Collection: 2011

Publication date (Electronic): 26 May 2011

Volume: 11

Page: 126

Affiliations

[1 ]Centre for Evidence-Based Practice, Bergen University College, Post box 7030, N-5020 Bergen, Norway

[2 ]Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway

[3 ]Norwegian Knowledge Centre for the Health Services, Oslo, Norway

[4 ]Kavli's Research Centre for Ageing and Dementia, Haraldsplass Hospital, Bergen, Norway and Institute of Medicine, University of Bergen, Bergen, Norway

[5 ]Løvåsen Teaching Nursing Home, Municipality of Bergen, Bergen, Norway

Article

Publisher ID: 1472-6963-11-126

DOI: 10.1186/1472-6963-11-126

PMC ID: 3112397

PubMed ID: 21615911

SO-VID: 8365528f-59c3-441b-b29d-1ba0acf6ab58

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Acute hospital admissions among nursing home residents: a population-based observational study

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Abstract

Background

Methods

Results

Conclusion

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Most cited references 12

The natural history of functional morbidity in hospitalized older patients.

Predictors of nursing home hospitalization: a review of the literature.

Frequency and pattern of emergency department visits by long-term care residents--a population-based study.

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