Prevalence of and factors associated with prolonged length of stay in older hospitalized medical patients
Aim To characterize elderly medical patients and identify factors associated with prolonged length of stay. Methods The present prospective observational study evaluated consecutive patients aged ≥65 years admitted in acute geriatric and medical wards. A comprehensive assessment including demographi...
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| Published in | Geriatrics & gerontology international Vol. 16; no. 3; pp. 314 - 321 |
|---|---|
| Main Authors | , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Japan
Blackwell Publishing Ltd
01.03.2016
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1444-1586 1447-0594 1447-0594 |
| DOI | 10.1111/ggi.12471 |
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| Abstract | Aim
To characterize elderly medical patients and identify factors associated with prolonged length of stay.
Methods
The present prospective observational study evaluated consecutive patients aged ≥65 years admitted in acute geriatric and medical wards. A comprehensive assessment including demographic, clinical, functional and cognitive variables was carried out. Delayed discharge was defined when patients were discharged later than the date they were deemed medically ready for discharge by physicians. The analysis was initially carried out on the total sample and subsequently according to whether hospital admission had been from home, or from intermediate or long‐term facilities.
Results
Among 1568 patients (age 81.3 ± 7.3 years, 712 men), we observed a high prevalence of functional dependence, cognitive impairment, chronic immobilization and frailty (50%, 25%, 20% and 40%, respectively). Overall, delayed discharge occurred in 442 cases – resulting in 2637 days of prolonged hospital stay – and was independently associated with impairment in activities of daily living, frailty, high comorbidity and inappropriate admission. Among patients admitted from home (roughly 90% of the sample), delayed discharge occurred in 392 patients, and was independently associated with cognitive impairment, functional dependence, low severity of comorbidity and inappropriate admission (OR 3.39). Among patients admitted from intermediate or long‐term facilities, lower cognitive impairment and greater severity of functional dependence were independently associated with prolonged stay.
Conclusions
Poor health conditions and high prevalence of geriatric syndromes are extremely common among older medical inpatients. Delayed discharge was mainly observed in patients admitted from home, and associated with cognitive impairment (OR 1.12) and functional dependence (OR 1.49). Geriatr Gerontol Int 2015; 16: 314–321. |
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| AbstractList | Aim To characterize elderly medical patients and identify factors associated with prolonged length of stay. Methods The present prospective observational study evaluated consecutive patients aged ≥65 years admitted in acute geriatric and medical wards. A comprehensive assessment including demographic, clinical, functional and cognitive variables was carried out. Delayed discharge was defined when patients were discharged later than the date they were deemed medically ready for discharge by physicians. The analysis was initially carried out on the total sample and subsequently according to whether hospital admission had been from home, or from intermediate or long-term facilities. Results Among 1568 patients (age 81.3±7.3 years, 712 men), we observed a high prevalence of functional dependence, cognitive impairment, chronic immobilization and frailty (50%, 25%, 20% and 40%, respectively). Overall, delayed discharge occurred in 442 cases - resulting in 2637 days of prolonged hospital stay - and was independently associated with impairment in activities of daily living, frailty, high comorbidity and inappropriate admission. Among patients admitted from home (roughly 90% of the sample), delayed discharge occurred in 392 patients, and was independently associated with cognitive impairment, functional dependence, low severity of comorbidity and inappropriate admission (OR 3.39). Among patients admitted from intermediate or long-term facilities, lower cognitive impairment and greater severity of functional dependence were independently associated with prolonged stay. Conclusions Poor health conditions and high prevalence of geriatric syndromes are extremely common among older medical inpatients. Delayed discharge was mainly observed in patients admitted from home, and associated with cognitive impairment (OR 1.12) and functional dependence (OR 1.49). Geriatr Gerontol Int 2015; 16: 314-321. To characterize elderly medical patients and identify factors associated with prolonged length of stay.AIMTo characterize elderly medical patients and identify factors associated with prolonged length of stay.The present prospective observational study evaluated consecutive patients aged ≥65 years admitted in acute geriatric and medical wards. A comprehensive assessment including demographic, clinical, functional and cognitive variables was carried out. Delayed discharge was defined when patients were discharged later than the date they were deemed medically ready for discharge by physicians. The analysis was initially carried out on the total sample and subsequently according to whether hospital admission had been from home, or from intermediate or long-term facilities.METHODSThe present prospective observational study evaluated consecutive patients aged ≥65 years admitted in acute geriatric and medical wards. A comprehensive assessment including demographic, clinical, functional and cognitive variables was carried out. Delayed discharge was defined when patients were discharged later than the date they were deemed medically ready for discharge by physicians. The analysis was initially carried out on the total sample and subsequently according to whether hospital admission had been from home, or from intermediate or long-term facilities.Among 1568 patients (age 81.3 ± 7.3 years, 712 men), we observed a high prevalence of functional dependence, cognitive impairment, chronic immobilization and frailty (50%, 25%, 20% and 40%, respectively). Overall, delayed discharge occurred in 442 cases - resulting in 2637 days of prolonged hospital stay - and was independently associated with impairment in activities of daily living, frailty, high comorbidity and inappropriate admission. Among patients admitted from home (roughly 90% of the sample), delayed discharge occurred in 392 patients, and was independently associated with cognitive impairment, functional dependence, low severity of comorbidity and inappropriate admission (OR 3.39). Among patients admitted from intermediate or long-term facilities, lower cognitive impairment and greater severity of functional dependence were independently associated with prolonged stay.RESULTSAmong 1568 patients (age 81.3 ± 7.3 years, 712 men), we observed a high prevalence of functional dependence, cognitive impairment, chronic immobilization and frailty (50%, 25%, 20% and 40%, respectively). Overall, delayed discharge occurred in 442 cases - resulting in 2637 days of prolonged hospital stay - and was independently associated with impairment in activities of daily living, frailty, high comorbidity and inappropriate admission. Among patients admitted from home (roughly 90% of the sample), delayed discharge occurred in 392 patients, and was independently associated with cognitive impairment, functional dependence, low severity of comorbidity and inappropriate admission (OR 3.39). Among patients admitted from intermediate or long-term facilities, lower cognitive impairment and greater severity of functional dependence were independently associated with prolonged stay.Poor health conditions and high prevalence of geriatric syndromes are extremely common among older medical inpatients. Delayed discharge was mainly observed in patients admitted from home, and associated with cognitive impairment (OR 1.12) and functional dependence (OR 1.49).CONCLUSIONSPoor health conditions and high prevalence of geriatric syndromes are extremely common among older medical inpatients. Delayed discharge was mainly observed in patients admitted from home, and associated with cognitive impairment (OR 1.12) and functional dependence (OR 1.49). Aim To characterize elderly medical patients and identify factors associated with prolonged length of stay. Methods The present prospective observational study evaluated consecutive patients aged ≥65 years admitted in acute geriatric and medical wards. A comprehensive assessment including demographic, clinical, functional and cognitive variables was carried out. Delayed discharge was defined when patients were discharged later than the date they were deemed medically ready for discharge by physicians. The analysis was initially carried out on the total sample and subsequently according to whether hospital admission had been from home, or from intermediate or long‐term facilities. Results Among 1568 patients (age 81.3 ± 7.3 years, 712 men), we observed a high prevalence of functional dependence, cognitive impairment, chronic immobilization and frailty (50%, 25%, 20% and 40%, respectively). Overall, delayed discharge occurred in 442 cases – resulting in 2637 days of prolonged hospital stay – and was independently associated with impairment in activities of daily living, frailty, high comorbidity and inappropriate admission. Among patients admitted from home (roughly 90% of the sample), delayed discharge occurred in 392 patients, and was independently associated with cognitive impairment, functional dependence, low severity of comorbidity and inappropriate admission (OR 3.39). Among patients admitted from intermediate or long‐term facilities, lower cognitive impairment and greater severity of functional dependence were independently associated with prolonged stay. Conclusions Poor health conditions and high prevalence of geriatric syndromes are extremely common among older medical inpatients. Delayed discharge was mainly observed in patients admitted from home, and associated with cognitive impairment (OR 1.12) and functional dependence (OR 1.49). Geriatr Gerontol Int 2015; 16: 314–321. To characterize elderly medical patients and identify factors associated with prolonged length of stay. The present prospective observational study evaluated consecutive patients aged ≥65 years admitted in acute geriatric and medical wards. A comprehensive assessment including demographic, clinical, functional and cognitive variables was carried out. Delayed discharge was defined when patients were discharged later than the date they were deemed medically ready for discharge by physicians. The analysis was initially carried out on the total sample and subsequently according to whether hospital admission had been from home, or from intermediate or long-term facilities. Among 1568 patients (age 81.3 ± 7.3 years, 712 men), we observed a high prevalence of functional dependence, cognitive impairment, chronic immobilization and frailty (50%, 25%, 20% and 40%, respectively). Overall, delayed discharge occurred in 442 cases - resulting in 2637 days of prolonged hospital stay - and was independently associated with impairment in activities of daily living, frailty, high comorbidity and inappropriate admission. Among patients admitted from home (roughly 90% of the sample), delayed discharge occurred in 392 patients, and was independently associated with cognitive impairment, functional dependence, low severity of comorbidity and inappropriate admission (OR 3.39). Among patients admitted from intermediate or long-term facilities, lower cognitive impairment and greater severity of functional dependence were independently associated with prolonged stay. Poor health conditions and high prevalence of geriatric syndromes are extremely common among older medical inpatients. Delayed discharge was mainly observed in patients admitted from home, and associated with cognitive impairment (OR 1.12) and functional dependence (OR 1.49). |
| Author | Comi, Chiara Maggiani, Guido Isaia, Giovanni Carlo Fonte, Gianfranco Marchese, Lorenzo Bonetto, Martina Isaia, Gianluca Bo, Mario Furno, Elisabetta Falcone, Yolanda Pivaro, Federica Giorgis, Veronica |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/25752922$$D View this record in MEDLINE/PubMed |
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Does family make a difference for elderly patients? publication-title: Can Fam Physician – volume: 23 start-page: 433 year: 1975 end-page: 441 article-title: A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients publication-title: J Am Geriatr Soc – volume: 10 start-page: 20 year: 1970 end-page: 30 article-title: Progress in development of the index of ADL publication-title: Gerontologist – volume: 39 start-page: 142 year: 1991 end-page: 147 article-title: The timed “Up and Go”: a test of basic functional mobility for frail elderly persons publication-title: J Am Geriatr Soc – volume: 9 start-page: 4 year: 2009 article-title: Delayed transfer of care from NHS secondary care to primary care in England: its determinants, effect on hospital bed days, prevalence of acute medical conditions and deaths during delay, in older adults aged 65 years and over publication-title: BMC Geriatr – volume: 12 start-page: 172 year: 2012 article-title: Acute care inpatients with long‐term delayed‐discharge: evidence from a Canadian health region publication-title: BMC Health Serv Res – volume: 2 start-page: 292 year: 2007 end-page: 301 article-title: The elderly in the emergency department: a critical review of problems and solutions publication-title: Intern Emerg Med – volume: 39 start-page: 238 year: 2002 end-page: 247 article-title: Older adults in the emergency department: a systematic review of patterns of use, adverse outcomes and effectiveness of interventions publication-title: Ann Emerg Med – volume: 29 start-page: 122 year: 2003 end-page: 126 article-title: Patterns of ED use and perceptions of the elderly regarding their emergency care: a synthesis of recent research publication-title: J Emerg Nurs – volume: 30 start-page: 3 issue: Suppl. 3 year: 2001 end-page: 6 article-title: Older people in accident and emergency departments publication-title: Age Ageing – volume: 345 start-page: e6137 year: 2012 article-title: Pressure on hospitals has led to worse care for older patients publication-title: BMJ – volume: 27 start-page: 697 year: 1998 end-page: 702 article-title: Risk of admission within 4 weeks of discharge of elderly patients from the emergency department –the DEED study. Discharge of elderly from emergency department publication-title: Age Ageing – volume: 12 start-page: 430 year: 2000 end-page: 438 article-title: Characteristics associated with inappropriate hospital use in elderly patients admitted to a general internal medicine service publication-title: Aging – volume: 95 start-page: 1851 year: 2003 end-page: 1860 article-title: Age‐associated changes in skeletal muscles and their effect on mobility: an operational diagnosis of sarcopenia publication-title: J Appl Physiol – volume: 10 start-page: 1362 year: 2003 end-page: 1370 article-title: Determinants of emergency department visits by older adults: a systematic review publication-title: Acad Emerg Med – volume: 22 start-page: 1527 year: 2007 end-page: 1531 article-title: Adverse health outcomes after discharge from emergency department‐incidence and risk factor in a veteran population publication-title: J Gen Intern Med – volume: 53 start-page: 157 year: 2000 end-page: 184 article-title: Measuring appropriate use of acute beds. A systematic review of methods and results publication-title: Health Policy – volume: 22 start-page: 306 year: 2008 end-page: 313 article-title: The hospital appropriateness evaluation protocol in elderly patients: a technique to evaluate admission and hospital stay publication-title: Scand J Caring Sci – volume: 41 start-page: 38 year: 1993 end-page: 41 article-title: Validation of a measure of physical illness burden at autopsy: the Cumulative Illness Rating Scale (CIRS) publication-title: J Am Geriatr Soc – volume: 39 start-page: 412 year: 2010 end-page: 423 article-title: Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on sarcopenia in older people publication-title: Age Ageing – volume: 13 start-page: 818 year: 1985 end-page: 829 article-title: APACHE II: a severity of disease classification system publication-title: Crit Care Med – volume: 26 start-page: 339 year: 1991 end-page: 374 article-title: Waiting for placement: an exploratory analysis of determinants of delayed discharges of elderly hospital patients publication-title: Health Serv Res – volume: 43 start-page: 130 year: 1995 end-page: 137 article-title: Validation of the Cumulative Illness Rating Scale in a geriatric residential population publication-title: J Am Geriatr Soc – volume: 43 start-page: 328 year: 1995 end-page: 336 article-title: Appropriateness of admissions and hospitalization days in an acute care teaching hospital publication-title: Rev Epidemiol Sante Publique – volume: 9 start-page: 179 year: 1969 end-page: 186 article-title: Assessment of older people: self‐maintaining and instrumental activities of daily living publication-title: Gerontologist – volume: 27 start-page: 112 year: 1989 end-page: 129 article-title: The epidemiology of delays in a teaching hospital. The development and use of a tool that detects unnecessary hospital days publication-title: Med Care – volume: 56 start-page: M146 year: 2001 end-page: M156 article-title: Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype publication-title: J Gerontol A Biol Sci Med Sci – volume: 22 start-page: 76 year: 2012 end-page: 80 article-title: Determinants of recourse to hospital treatment in the elderly publication-title: Eur J Public Health – ident: e_1_2_7_6_1 doi: 10.1007/s11739-007-0081-3 – ident: e_1_2_7_7_1 doi: 10.1093/ageing/27.6.697 – ident: e_1_2_7_8_1 doi: 10.1007/s11606-007-0343-9 – ident: e_1_2_7_29_1 doi: 10.1016/S0168-8510(00)00092-0 – ident: e_1_2_7_13_1 doi: 10.1111/j.1532-5415.2007.01590.x – ident: e_1_2_7_18_1 doi: 10.1097/00003246-198510000-00009 – ident: e_1_2_7_15_1 doi: 10.1111/j.1532-5415.1975.tb00927.x – volume: 26 start-page: 339 year: 1991 ident: e_1_2_7_23_1 article-title: Waiting for placement: an exploratory analysis of determinants of delayed discharges of elderly hospital patients publication-title: Health Serv Res – ident: e_1_2_7_16_1 doi: 10.1111/j.1532-5415.1993.tb05945.x – ident: e_1_2_7_5_1 doi: 10.1197/S1069-6563(03)00539-6 – ident: e_1_2_7_27_1 doi: 10.1097/00005650-198902000-00003 – volume: 31 start-page: 527 year: 1997 ident: e_1_2_7_25_1 article-title: Appropriateness of acute medical admissions and length of stay publication-title: J R Coll Physicians Lond – volume: 42 start-page: 449 year: 1996 ident: e_1_2_7_28_1 article-title: Long hospital stays and need for alternate level of care at discharge. 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| Snippet | Aim
To characterize elderly medical patients and identify factors associated with prolonged length of stay.
Methods
The present prospective observational study... To characterize elderly medical patients and identify factors associated with prolonged length of stay. The present prospective observational study evaluated... Aim To characterize elderly medical patients and identify factors associated with prolonged length of stay. Methods The present prospective observational study... To characterize elderly medical patients and identify factors associated with prolonged length of stay.AIMTo characterize elderly medical patients and identify... |
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| SubjectTerms | Aged Aged, 80 and over Cognitive ability cognitive impairment Comorbidity Female functional decline Geriatric Assessment geriatric medicine Geriatric psychology Geriatrics Hospitalization Humans inappropriate admission length of stay Length of Stay - statistics & numerical data Male Prospective Studies |
| Title | Prevalence of and factors associated with prolonged length of stay in older hospitalized medical patients |
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