title: Predictors of institution admission in the year following acute hospitalisation of elderly people.
abstract: OBJECTIVE
  The aim of the study was to identify factors related to institutionalisation within one-year follow up of subjects aged 75 or over, hospitalised via the emergency department (ED).
  
  
  METHODS
  Prospective multicentre cohort.
  
  
  METHODS
  Nine French university teaching hospitals.
  
  
  METHODS
  One thousand and forty seven (1 047) non institutionalised subjects aged 75 or over, hospitalised via ED. A sub-group analysis was performed on the 894 subjects with a caregiver.
  
  
  METHODS
  Patients were assessed using Comprehensive Geriatric Assessment (CGA) tools. Cox survival analysis was performed to identify predictors of institutionalisation at one year.
  
  
  RESULTS
  Within one year after hospital admission, 210 (20.1%) subjects were institutionalised. For the overall study population, age >85 years (HR 1.6; 95%CI 1.1-2.1; p=0.005), inability to use the toilet (HR 1.6; 95%CI 1.1-2.4; p=0.007), balance disorders (HR 1.6; 95%CI 1.1-2.1; p=0.005) and presence of dementia syndrome (HR 1.9; 95%CI 1.4-2.6; p<0.001) proved to be independent predictors of institutionalisation; while a greater number of children was inversely linked to institutionalisation (HR 0.8; 95%CI 0.7-0.9; p<0.001). Bathing was of borderline significance (p=.09). For subjects with a caregiver, initial caregiver burden was significantly linked to institutionalisation within one year, in addition to the predictors observed in the overall study population.
  
  
  CONCLUSIONS
  CGA performed at the beginning of hospitalisation in acute medical wards is useful to predict institutionalisation. Most of the predictors identified can lead to targeted therapeutic options with a view to preventing or delaying institution admission.
authors.affiliation: University of Reims Champagne-Ardenne, Faculty of Medicine, Reims, France. mdrame@chu-reims.fr
authors.forename: M
authors.initials: M
authors.lastname: Dramé
authors.forename: F
authors.initials: F
authors.lastname: Fierobe
authors.forename: P-O
authors.initials: PO
authors.lastname: Lang
authors.forename: D
authors.initials: D
authors.lastname: Jolly
authors.forename: F
authors.initials: F
authors.lastname: Boyer
authors.forename: R
authors.initials: R
authors.lastname: Mahmoudi
authors.forename: D
authors.initials: D
authors.lastname: Somme
authors.forename: I
authors.initials: I
authors.lastname: Laniece
authors.forename: D
authors.initials: D
authors.lastname: Heitz
authors.forename: J-B
authors.initials: JB
authors.lastname: Gauvain
authors.forename: T
authors.initials: T
authors.lastname: Voisin
authors.forename: B
authors.initials: B
authors.lastname: De Wazieres
authors.forename: R
authors.initials: R
authors.lastname: Gonthier
authors.forename: J
authors.initials: J
authors.lastname: Ankri
authors.forename: O
authors.initials: O
authors.lastname: Saint-Jean
authors.forename: P
authors.initials: P
authors.lastname: Couturier
authors.forename: C
authors.initials: C
authors.lastname: Jeandel
authors.forename: F
authors.initials: F
authors.lastname: Blanchard
authors.forename: J-L
authors.initials: JL
authors.lastname: Novella
mesh_terms: D000203:Activities of Daily Living; D032721:Adult Children; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers; D003704:Dementia / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000379:methods*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data*; D008297:Male; D004856:Postural Balance; D016016:Proportional Hazards Models; D012307:Risk Factors; D016019:Survival Analysis