A multi-centre European study of factors affecting the discharge destination of older people admitted to hospital: analysis of in-hospital data from the ACMEplus project.
OBJECTIVE
to examine the relationship between seven predictor variables (recorded on Day 3 of hospital admission) and discharge destination in non-elective medical patients aged 65+ years.


METHODS
prospective cohort.


METHODS
eight centres in six European countries.


METHODS
age, gender, living alone, physical function (three categories based on Barthel Index), cognition (Katzman's orientation-memory-concentration test), main body system affected (based on International Classification of Diseases), number of geriatric giants (GGs) involved in the referral (a GG being a problem with falling, mobility, continence or cognition).


METHODS
discharge destination (by Day 90) in three categories: 'HOMESAME' (return to previous residence), 'INSTIN90' (discharge to alternative residence or still in hospital at 90 days), 'DEADINHO' (death in hospital),


RESULTS
in 1,626 patients, discharge destination was HOMESAME in 84.7%, DEADINHO in 8.9% and INSTIN90 in 6.4%. Mean duration of stay was 17.7 days, median 12. Univariate analyses showed a statistically significant relationship between all seven predictor variables and discharge destination. Physical function was the best single predictor with a seven-fold difference in adverse outcome rates between the best and worst categories. On multiple logistic regression, significant predictor variables were as follows. (i) For DEADINHO: physical function, cognition, gender; (ii) for INSTIN90: physical function, living alone, GGs, age, gender. Multiple linear regression identified physical function, GGs and living alone as predictors of loge length of stay.


CONCLUSIONS
case-mix systems to compare risk-adjusted hospital outcome in older medical patients need to incorporate information about physical function, cognition and presenting problems in addition to diagnosis.
Campbell
Susan E
SE
Medicine for the Elderly, Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen, UK.
Seymour
D Gwyn
DG
Primrose
William R
WR
Lynch
Joanna E
JE
Dunstan
Edmund
E
Espallargues
Mireia
M
Lamura
Giovanni
G
Lawson
Peter
P
Philp
Ian
I
Mestheneos
Elizabeth
E
Politynska
Barbara
B
Raiha
Ismo
I
D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition; D004194:Disease / Q000145:classification; D005060:Europe; D005190:Family; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D011446:Prospective Studies; D012044:Regression Analysis; D012737:Sex Factors