title: High rates of hospital admission among older residents in assisted living facilities: opportunities for intervention and impact on acute care.
abstract: BACKGROUND
  Little is known about health or service use outcomes for residents of Canadian assisted living facilities. Our objectives were to estimate the incidence of admission to hospital over 1 year for residents of designated (i.e., publicly funded) assisted living (DAL) facilities in Alberta, to compare this rate with the rate among residents of long-term care facilities, and to identify individual and facility predictors of hospital admission for DAL residents.
  
  
  METHODS
  Participants were 1066 DAL residents (mean age ± standard deviation 84.9 ± 7.3 years) and 976 longterm care residents (85.4 ± 7.6 years) from the Alberta Continuing Care Epidemiological Studies (ACCES). Research nurses completed a standardized comprehensive assessment for each resident and interviewed family caregivers at baseline (2006 to 2008) and 1 year later. We used standardized interviews with administrators to generate facility- level data. We determined hospital admissions through linkage with the Alberta Inpatient Discharge Abstract Database. We used multivariable Cox proportional hazards models to identify predictors of hospital admission.
  
  
  RESULTS
  The cumulative annual incidence of hospital admission was 38.9% (95% confidence interval [CI] 35.9%- 41.9%) for DAL residents and 13.7% (95% CI 11.5%-15.8%) for long-term care residents. The risk of hospital admission was significantly greater for DAL residents with greater health instability, fatigue, medication use (11 or more medications), and 2 or more hospital admissions in the preceding year. The risk of hospital admission was also significantly higher for residents from DAL facilities with a smaller number of spaces, no licensed practical and/ or registered nurses on site (or on site less than 24 hours a day, 7 days a week), no chain affiliation, and from select health regions.
  
  
  CONCLUSIONS
  The incidence of hospital admission was about 3 times higher among DAL residents than among long-term care residents, and the risk of hospital admission was associated with a number of potentially modifiable factors. These findings raise questions about the complement of services and staffing required within assisted living facilities and the potential impact on acute care of the shift from long-term care to assisted living for the facility-based care of vulnerable older people.
authors.affiliation: David B. Hogan, MD, is a Professor and Brenda Strafford Foundation Chair in Geriatric Medicine, University of Calgary, Calgary, Alberta.
authors.forename: David B
authors.initials: DB
authors.lastname: Hogan
authors.affiliation: Joseph E. Amuah, PhD, is a Senior Researcher with the Health System Performance Branch, Canadian Institute for Health Information, Ottawa, Ontario.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Amuah
authors.affiliation: Laurel A. Strain, PhD, is a Professor with the Department of Sociology, University of Alberta, Edmonton, Alberta.
authors.forename: Laurel A
authors.initials: LA
authors.lastname: Strain
authors.affiliation: Walter P. Wodchis, PhD, is an Associate Professor with the Institute of Health Policy, Management and Evaluation, University of Toronto; a Research Scientist with the Toronto Rehabilitation Institute; and an Adjunct Scientist with the Institute for Clinical Evaluative Sciences, Toronto, Ontario.
authors.forename: Walter P
authors.initials: WP
authors.lastname: Wodchis
authors.affiliation: Andrea Soo, MSc, is a PhD candidate with the Department of Community Health Sciences, University of Calgary, Calgary, Alberta.
authors.forename: Andrea
authors.initials: A
authors.lastname: Soo
authors.affiliation: Misha Eliasziw, PhD, is an Associate Professor with the Department of Public Health and Community Medicine, Tufts University, Boston, Massachusetts.
authors.forename: Misha
authors.initials: M
authors.lastname: Eliasziw
authors.affiliation: Andrea Gruneir, PhD, is a Scientist with the Women's College Research Institute, Women's College Hospital, University of Toronto; an Assistant Professor in the Institute of Health Policy, Management and Evaluation, University of Toronto; and an Adjunct Scientist with the Institute for Clinical Evaluative Sciences, Toronto, Ontario.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gruneir
authors.affiliation: Brad Hagen, PhD, is an Associate Professor with the Faculty of Health Sciences, University of Lethbridge, Lethbridge, Alberta.
authors.forename: Brad
authors.initials: B
authors.lastname: Hagen
authors.affiliation: Gary Teare, PhD, is Director of Measurement and Analysis, Saskatchewan Health Quality Council, and an Adjunct Professor with the College of Medicine and School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan.
authors.forename: Gary
authors.initials: G
authors.lastname: Teare
authors.affiliation: Colleen J. Maxwell, PhD, is a Professor with the Schools of Pharmacy and of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, and an Adjunct Scientist with the Institute for Clinical Evaluative Sciences, Toronto, Ontario.
authors.forename: Colleen J
authors.initials: CJ
authors.lastname: Maxwell
mesh_terms: D000369:Aged, 80 and over; D000416:Alberta / Q000453:epidemiology; D040561:Assisted Living Facilities / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003422:Critical Care / Q000706:statistics & numerical data*; D005260:Female; D005544:Forecasting; D006760:Hospitalization / Q000706:statistics & numerical data* / Q000639:trends*; D006801:Humans; D008134:Long-Term Care / Q000706:statistics & numerical data*; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*