Predictors of a nursing home placement from a non-acute geriatric hospital.
BACKGROUND
Identifying patients who need Nursing Home (NH) care following a hospital admission is important.


OBJECTIVE
To identify the factors that predispose to an NH discharge.


METHODS
Prospective observational study with blinded end-point evaluation.


METHODS
A non-acute geriatric hospital.


METHODS
Two hundred consecutive elderly patients who were admitted for rehabilitation following treatment for an acute illness.


METHODS
Discharge to an NH or home.


RESULTS
Thirty-five out of the 150 live discharges (23.3%) were to an NH. NH discharges had a longer length of stay (38.5 versus 19.8 days; p < 0001). They were more likely to have visual impairment (p = 0.0009), confusion (p < 0.0001), wandering behaviour (p = 0.003), incontinence (p < 0.0001 or unsafe gait (p = 0.0005), to be on tranquillizers (p = 0.003), to be at risk of falls (p = 0.02) and to have sustained a fall while in hospital (p = 0.001). Multiple logistic regression identified confusion (p = 0.001), incontinence (p = 0.02), falls in hospital (p = 0.01), gait abnormalities (p < 0.001), tranquillizers (p < 0.001), impaired distant vision (p = 0.01) and living alone (p < 0.001) as independently associated with the risk of an NH discharge. This risk proportionately increased with the number of risk factors present: 4.28% for 0-2 factors, 25.8% for 3-4 factors and 81.8% for 5-6 factors (p < 0.0001).


CONCLUSIONS
These factors should be the target of specific rehabilitation in an attempt to reduce the risk of discharge to a nursing home and improve patient outcome.
Aditya
B S
BS
Ashfield Community Hospital, Portland Street, Kirkby-in-Ashfield, UK.
Sharma
J C
JC
Allen
S C
SC
Vassallo
M
M
D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006299:Health Services for the Aged; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D009735:Nursing Homes; D010343:Patient Admission; D010347:Patient Care Planning; D010351:Patient Discharge; D011446:Prospective Studies; D012307:Risk Factors; D012944:Social Support; D014149:Tranquilizing Agents / Q000627:therapeutic use; D014786:Vision Disorders
D014149:Tranquilizing Agents