title: The Impact of Nonelective Abdominal Surgery on the Residential Status of Older Adult Patients.
abstract: OBJECTIVE
  To describe the change in residential status at discharge and 6 months after hospitalization among older adults who have undergone nonelective abdominal surgery and to identify risk factors associated with discharge to institution.
  
  
  BACKGROUND
  Surgery in older adults may lead to a loss of independence that prevents them from returning to their preadmission residential status. Understanding the impact of surgery on residential status and risk factors for institutionalization is important for patient counseling, discharge planning, and resource allocation.
  
  
  METHODS
  Community-dwelling patients aged 70 years and older who underwent nonelective abdominal surgery over a 15-month period were prospectively enrolled. Residential status before admission, at discharge, and 6 months after admission was assessed. Multiple logistic regression was used to identify factors associated with discharge to institution.
  
  
  RESULTS
  Of the 197 patients who underwent surgery and survived to discharge, 30% were living alone before admission and 70% were living with others. At discharge, 72% of patients returned to their preadmission residential status and 22% were institutionalized. Six months after hospitalization, 55% of institutionalized patients had returned to community-living, and 79% of all patients had returned to their preadmission residential status. Change in residential status was associated with decreased quality of life. Increasing American Society of Anesthesiologists score, frailty, surgery for malignancy, and postoperative complications were associated with discharge to institution.
  
  
  CONCLUSIONS
  The majority of older patients, including those who were discharged to an institution, returned to their preadmission residential status 6 months after nonelective abdominal surgery.
authors.affiliation: *Department of Surgery, Division of General Surgery, Dalhousie University, Halifax, Nova Scotia †Faculty of Medicine, Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia.
authors.forename: Philip J B
authors.initials: PJ
authors.lastname: Davis
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Bailey
authors.forename: Michele
authors.initials: M
authors.lastname: Molinari
authors.forename: Jill
authors.initials: J
authors.lastname: Hayden
authors.forename: Paul M
authors.initials: PM
authors.lastname: Johnson
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly; D006801:Humans; D057187:Independent Living / Q000706:statistics & numerical data*; D007326:Institutionalization / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011788:Quality of Life