[Analysis of placement in public nursing homes after hospital admission in the fragile elderly].
BACKGROUND
To analyze placement in public nursing homes in elderly inpatients referred by the social work unit.


METHODS
We performed a cohort study in an acute geriatric unit of a tertiary hospital. The sociodemographic, clinical, functional and socioeconomic data registered on admission (inclusion period: 4 years) were analyzed. The patients were followed-up for 6 months after discharge. The percentage gaining places in public nursing homes, the waiting time (monthly incidence rate) and the reasons for not gaining a place were evaluated. The variables associated with gaining a place were introduced into a multivariate logistic regression model.


RESULTS
A total of 415 elders were referred to public nursing homes. The mean age was 85.1 years (SD=6.7), and 61.9% were women. During the follow-up period, 72 elders were granted a place (17.3%; monthly incidence rate 3.14%). In the multivariate analysis, the factors independently associated with gaining a place at a public nursing home were living alone (OR 2.788; p=0.005), having a lower income (OR 0.807; p=0.018), having a social work report from the hospital (OR 2.132; p=0.037), having previously requested a place at a public nursing home (OR 3.298; p=0.002) and discharge destination other than the home (OR 5.792; p<0.001). The main causes associated with not gaining a place were death while on the waiting list (41.4%) and not completing the paperwork (32.9%).


CONCLUSIONS
Hospitalization in the frail elderly frequently leads to requests for public nursing home admission, although few places are granted in the short term to patients in the acute unit. Certain socioeconomic factors and referral by social workers were positively associated with gaining a place. However, the waiting time leads to a substantial proportion of deaths and incomplete paperwork, largely due to the complexity of the process.
Mora Fernández
Jesús
J
Servicio de Geriatría, Hospital Clínico San Carlos, Madrid, España.
Silveira Guijarro
Luis José
LJ
Calcerrada Díaz-Santos
Nieves
N
Maganto Villamiel
María Antonia
MA
Merino Cáceres
Concepción
C
Ribera Casado
José Manuel
JM
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D016330:Frail Elderly; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010343:Patient Admission