Hostname: page-component-8448b6f56d-mp689 Total loading time: 0 Render date: 2024-04-19T00:36:04.868Z Has data issue: false hasContentIssue false
  • English
  • Français

Discharge Outcomes in Seniors Hospitalized for More than 30 Days

Published online by Cambridge University Press:  31 March 2010

Anita L. Kozyrskyj ,
Charlyn Black ,
Dan Chateau  and
Carmen Steinbach
Anita L. Kozyrskyj*
Affiliation:
Manitoba Centre for Health Policy, Department of Community Health Services, University of Manitoba Faculty of Pharmacy, University of Manitoba
Charlyn Black
Affiliation:
Centre for Health Services and Policy Research, University of British Columbia
Dan Chateau
Affiliation:
Manitoba Centre for Health Policy, Department of Community Health Services, University of Manitoba
Carmen Steinbach
Affiliation:
Manitoba Centre for Health Policy, Department of Community Health Services, University of Manitoba
*
Requests for offprints should be sent to: / Les demandes de tirés-à-part doivent être addressées à : Anita L. Kozyrskyj, B.Sc.Phm., Ph.D., Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, 727 McDermot Avenue, Suite 408, Winnipeg, MB R3E 3P5. (Anita_Kozyrskyj@cpe.umanitoba.ca)
Get access Rights & Permissions [Opens in a new window]

Abstract

Hospitalization is a sentinel event that leads to loss of independence for many seniors. This study of long-stay hospitalizations (more than 30 days) in seniors was undertaken to identify risk factors for not going home, to characterize patients with risk factors who did go home and to describe one year outcomes following home discharge. Using Manitoba's health care databases, the likelihood of death in hospital, discharge to a nursing home, and transfer to another hospital was determined for a set of risk factors in seniors with long-stay hospitalizations in Winnipeg's acute hospitals. Of the 17,984 long-stay hospitalizations during 1993–2000, 45 per cent were discharged home, 20 per cent died, and 30 per cent were discharged to a nursing home or another hospital. Seniors who received home care prior to hospitalization were more likely to be discharged to a nursing home or die in hospital than to go home. Stroke and cognitive impairment increased the likelihood of discharge to a nursing home. Seniors with neoplasms, multiple co-morbidities, and length-of-stay more than 120 days were more likely to die in hospital. Long-stay patients with risk factors who did go home had few co-morbidities. Within one year of home discharge, 20 per cent of seniors died, 5–15 per cent were admitted to a nursing home or long-term care institution, and 26–35 per cent of persons were re-hospitalized from home. A full 37 per cent experienced none of these outcomes. Our findings point to opportunities to improve discharge outcomes and plan support services for seniors.

Résumé

L'hospitalisation constitue un précurseur de la perte d'autonomie pour de nombreux aînés. Cette étude sur les hospitalisations de longue durée (plus de 30 jours) visait à déterminer les facteurs de risque qui incitent les personnes âgées à ne pas retourner à la maison, de déterminer les caractéristiques des patients ayant des facteurs de risque et qui ont choisi de retourner à la maison ainsi que de décrire les conséquences pouvant survenir dans l'année qui suit la sortie de l'hôpital. À l'aide des bases de données sur les soins de santé du Manitoba, les probabilités d'un déce`s à l'hôpital, d'un congé vers une maison de soins infirmiers et d'un transfert vers un autre hôpital ont été déterminées pour un ensemble de facteurs de risques chez les aînés ayant subi des hospitalisations de longue durée dans les hôpitaux de courte durée de Winnipeg. Des 17 984 personnes hospitalisées pour une longue période entre1993 et 2000, 45 p. 100 ont pu retourner chez elles, 20 p. 100 sont décédées et 30 p. 100 ont été transférées dans une maison de soins infirmiers ou un autre hôpital. Les aînés qui avaient reçu des soins à domicile avant leur hospitalisation avaient plus de chances d'obtenir un congé dans une maison de soins infirmiers ou de mourir à l'hôpital que de retourner chez elles. La probabilité d'être envoyé dans une maison de soins infirmiers augmentait dans le cas d'accidents cérébraux vasculaires et de troubles cognitifs. Les aînés atteints de tumeurs, de multiples comorbidités et qui sont restés plus de 120 jours étaient plus susceptibles de mourir à l'hôpital. Les patients de longue durée qui avaient des facteurs de risque et qui sont retournés chez eux avaient peu de comorbidités. Dans l'année qui a suivi la sortie de l'hôpital, 20 p. 100 des aînés sont décédés, 5 à 15 p. 100 d'entre eux ont été admis dans une maison de soins infirmiers ou un établissement de soins de longue durée et 26 à 35 p. 100 des personnes ont été de nouveau hospitalisées à partir de leur domicile. Enfin, 37 p. 100 des personnes n'ont subi aucune de ces conséquences. Nos conclusions mettent l'accent sur des moyens possibles de réduire les conséquences notées apre`s un séjour à l'hôpital et d'améliorer les services de soutien pour les aînés.

Keywords

agedhospitalizationnursing homesmortalityhome care servicesco-morbiditypersonnes âgéeshospitalisationmaisons de soins infirmiersmortalitéservices de soins à domicilecomorbidite
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 24 , Issue S1: Health and Health Care Use Among Older Adults: Using Population-Based Information Systems to Inform Policy in Manitoba , Spring/Printemps 2005 , pp. 107 - 119
Copyright
Copyright © Canadian Association on Gerontology 2005

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alarcon, T., Barcena, A., Gonzalez-Montalvo, J.I., Penalosa, C., & Salgado, A. (1999). Factors predictive of outcome on admission to an acute geriatric ward. Age and Ageing, 28(5), 429–432.Google Scholar
Breeze, E., Sloggett, A., & Fletcher, A. (1999). Socioeconomic and demographic predictors of mortality and institutional residence among middle aged and older people: Results from the Longitudinal Study. Journal of Epidemiology and Community Health, 53(12), 765–774.CrossRefGoogle ScholarPubMed
Carrière, Y., & Pelletier, L. (1995). Factors underlying the institutionalization of elderly persons in Canada. Journals of Gerontology: Series B, Psychology Sciences and Social Sciences, 50(3), S164–S172.Google Scholar
D'Agostino, R.B., Belanger, A.J., Markson, E.W., Kelly-Hayes, M., & Wolf, P.A. (1995). Development of health risk appraisal functions in the presence of multiple indicators: The Framingham Study nursing home institutionalization model. Statistics in Medicine, 14(16), 1757–1770.CrossRefGoogle ScholarPubMed
De Coster, C., & Kozyrskyj, A. (2000). Long-stay patients in Winnipeg acute care hospitals. Winnipeg: Manitoba Centre for Health Policy and Evaluation.Google Scholar
Gillick, M.R., Serrell, N.A., & Gillick, L.S. (1982). Adverse consequences of hospitalization in the elderly. Social Science and Medicine, 16(10), 1033–1038.Google Scholar
Glazebrook, K., Rockwood, K., Stolee, P., Fisk, J., & Gray, J.M. (1994). A case control study of the risks for institutionalization of elderly people in Nova Scotia. Canadian Journal on Aging, 13(1), 104–117.Google Scholar
Grande, G.E., Addington-Hall, J.M., & Todd, C.J. (1998). Place of death and access to home care services: Are certain patient groups at a disadvantage? Social Science and Medicine, 47(5), 565–579.Google Scholar
Higginson, I.J., Jarman, B., Astin, P., & Dolan, S. (1999). Do social factors affect where patients die? An analysis of 10 years of cancer deaths in England. Journal of Public Health Medicine, 21(1), 22–28.Google Scholar
Inouye, S.K., Bogardus, S.T., Charpentier, P.A., Leo-Summers, L., Acampora, D., Holfrod, T.R., & Cooney, L.M. Jr. (1999). A multicomponent intervention to prevent delirium in hospitalized older patients. New England Journal of Medicine, 340(9), 669–676.CrossRefGoogle ScholarPubMed
Institute for Clinical Evaluative Sciences. (1998). Get up and go! Identifying risk factors and preventing falls in elderly patients. Informed, 4(4), 1–3.Google Scholar
Kane, R.L., Matthias, R., & Sampson, S. (1983). The risk of placement in a nursing home after acute hospitalization. Medical Care, 21(11), 1055–1061.Google Scholar
Kohn, L.T., Corrigan, J.M., & Donaldson, M.S. (Eds). (2000) To err is human. Washington, D.C.: National Academy Press.Google ScholarPubMed
Lincoln, N.B., Husbands, S., Trescoli, C., Drummond, A.E.R., Gladman, J.R.F., & Berman, P. (2000). Five year follow up of a randomised controlled trial of a stroke rehabilitation unit. British Medical Journal, 320, 549.CrossRefGoogle ScholarPubMed
Liu, K., Coughlin, T., & McBride, T. (1991). Predicting nursing-home admission and length of stay: A duration analysis. Medical Care, 29(2), 125–141.Google Scholar
Mayo, N.E., Gloutney, L., & Levy, A.R. (1994). A randomized trial of identification bracelets to prevent falls among patients in a rehabilitation hospital. Archives of Physical Medicine and Rehabilitation, 75, 1302–1308.Google Scholar
Miller, E.A., & Weissert, W.G. (2000). Predicting elderly people's risk for nursing home placement, hospitalization, functional impairment, and mortality: A synthesis. Medical Care Research and Review, 57(3), 259–297.Google Scholar
Mustard, C., Finlayson, M., Derksen, S., & Berthelot, J.M. (1999). What determines the need for nursing home admission in a universally insured population? Journal of Health Services and Research Policy, 4(4), 197–203.Google Scholar
Mustard, C.A., & Mayer, T. (1997). Case-control study of exposure to medication and the risk of injurious falls requiring hospitalization among nursing home residents. American Journal of Epidemiology, 145(8), 738–745.CrossRefGoogle ScholarPubMed
Palmer, R.M. (1995). Acute hospitals care of the elderly: Minimizing the risk of functional decline. Cleveland Clinic Journal of Medicine, 62(2), 117–128.Google Scholar
Patrick, L., Leber, M., Scrim, C., Gendron, I., & Eisener-Parsche, P. (1999). A standardized assessment and intervention protocol for managing risk of falls on a geriatric rehabilitation unit. Journal of Gerontology Nursing, 25(4), 40–47.Google Scholar
Potts, S., Feinglass, J., Lefevere, F., Kadah, H., Branson, C., & Webster, J. (1993). A quality-of-care analysis of cascade iatrogenesis in frail elderly hospital patients. Quality Review Bulletin, 19(6), 196–198.Google Scholar
Pritchard, R.S., Fisher, E.S., Teno, J.M., Sharp, S.M., Reding, D.J., Knaus, W.A., Wennberg, J.E., & Lynn, J. (1998). Influence of patient preferences and local health system characteristics on the place of death: SUPPORT Investigators; Study to Understand Prognoses and Preferences for Risks and Outcomes of Treatment. Journal of the American Geriatric Society, 46(10), 1242–1250.CrossRefGoogle ScholarPubMed
Rockwood, K., Stolee, P., & McDowell, I. (1996). Factors associated with institutionalization of older people in Canada: Testing a multifactorial definition of frailty. Journal of the American Geriatric Society, 44(5), 578–582.Google Scholar
Roos, L.L., Mustard, C.A., Nicol, J.P., McLerran, D.F., Malenka, D.J., Young, T.K., & Cohen, M.M. (1993). Registries and administrative data: Organization and accuracy. Medical Care, 31(3), 201–212.Google Scholar
Roos, L.L., Sharp, S.M., & Cohen, M.M. (1991). Comparing clinical information with claims data: Some similarities and differences. Journal of Clinical Epidemiology, 44(9), 881–888.Google Scholar
Rudberg, M.A., Sager, M.A., & Zhang, J. (1996). Risk factors for nursing home use after hospitalization for medical illness. Journal of Gerontology: Series A, Biological Sciences and Medical Sciences, 51(5), M189–M194.Google ScholarPubMed
Shapiro, E., & Tate., R. (1985). Predictors of long-term care facility use among the elderly. Canadian Journal on Aging, 4, 11–19.Google Scholar
Sochalski, J., & Aiken, L.H. (1999). Accounting for variation in hospital outcomes: A cross-national study. Health Affairs, 18, 256–259.CrossRefGoogle ScholarPubMed
Stroke Unit Trialists' Collaboration. (1997). Collaborative systematic review of the randomised trials of organised inpatient (stroke unit) care after stroke. British Medical Journal, 314, 1151.CrossRefGoogle Scholar
Thom, D.H., Haan, M.N., & Van Den Eeden, S.K. (1997). Medically recognized urinary incontinence and risks of hospitalization, nursing home admission and mortality. Age and Ageing, 26(5), 367–374.Google Scholar
Tomiak, M., Berthelot, J.M., Guimond, E., & Mustard, C.A. (2000). Factors associated with nursing-home entry for elders in Manitoba, Canada. Journal of Gerontology: Series A, Biological Sciences and Medical Sciences, 55(5), M279–M287.Google ScholarPubMed
Trottier, H., Martel, L., Houle, C., Berthelot, J.M., & Legare, J. (2000). Living at home or in an institution: What makes the difference for seniors? Health Report, 11(4), 49–61.Google Scholar
Wachtel, T.J., Derby, C., & Fulton, J.P. (1984). Predicting the outcome of hospitalization for elderly persons: Home versus nursing home. Southern Medical Journal, 77(10), 1283–1285, 1290.Google Scholar
Williams, J.I., & Young, W. (1996). Inventory of studies on the accuracy of Canadian health administrative databases (Pub. No. 96-03-TR). North York, ON: Institute for Clinical Evaluative Sciences.Google Scholar
Wolinsky, F.D., Callahan, C.M., Fitzgerald, J.F., & Johnson, R.J. (1992). The risk of nursing home placement and subsequent death among older adults. Journal of Gerontology, 47(4), S173–S182.Google Scholar
Zureik, M., Lang, T., Trouillet, J.L., Davido, A., Tran, B., Levy, A., & Lombrail, P. (1995). Returning home after acute hospitalization in two French teaching hospitals: Predictive value of patients' and relatives' wishes. Age and Ageing, 24(3), 227–234.Google Scholar