Prevalence of and factors associated with prolonged length of stay in older hospitalized medical patients.
OBJECTIVE
To characterize elderly medical patients and identify factors associated with prolonged length of stay.


METHODS
The present prospective observational study evaluated consecutive patients aged ≥65 years admitted in acute geriatric and medical wards. A comprehensive assessment including demographic, clinical, functional and cognitive variables was carried out. Delayed discharge was defined when patients were discharged later than the date they were deemed medically ready for discharge by physicians. The analysis was initially carried out on the total sample and subsequently according to whether hospital admission had been from home, or from intermediate or long-term facilities.


RESULTS
Among 1568 patients (age 81.3 ± 7.3 years, 712 men), we observed a high prevalence of functional dependence, cognitive impairment, chronic immobilization and frailty (50%, 25%, 20% and 40%, respectively). Overall, delayed discharge occurred in 442 cases - resulting in 2637 days of prolonged hospital stay - and was independently associated with impairment in activities of daily living, frailty, high comorbidity and inappropriate admission. Among patients admitted from home (roughly 90% of the sample), delayed discharge occurred in 392 patients, and was independently associated with cognitive impairment, functional dependence, low severity of comorbidity and inappropriate admission (OR 3.39). Among patients admitted from intermediate or long-term facilities, lower cognitive impairment and greater severity of functional dependence were independently associated with prolonged stay.


CONCLUSIONS
Poor health conditions and high prevalence of geriatric syndromes are extremely common among older medical inpatients. Delayed discharge was mainly observed in patients admitted from home, and associated with cognitive impairment (OR 1.12) and functional dependence (OR 1.49).
Department of Medical and Surgical Disciplines, Section of Geriatrics, University of Turin, Turin, Italy.
Mario
M
Bo
Department of Medical and Surgical Disciplines, Section of Geriatrics, University of Turin, Turin, Italy.
Gianfranco
G
Fonte
Department of Medical and Surgical Disciplines, Section of Geriatrics, University of Turin, Turin, Italy.
Federica
F
Pivaro
Department of Medical and Surgical Disciplines, Section of Geriatrics, University of Turin, Turin, Italy.
Martina
M
Bonetto
Department of Medical and Surgical Disciplines, Section of Geriatrics, University of Turin, Turin, Italy.
Chiara
C
Comi
Department of Medical and Surgical Disciplines, Section of Geriatrics, University of Turin, Turin, Italy.
Veronica
V
Giorgis
Department of Medical and Surgical Disciplines, Section of Geriatrics, University of Turin, Turin, Italy.
Lorenzo
L
Marchese
Department of Medical and Surgical Disciplines, Section of Geriatrics, University of Turin, Turin, Italy.
Gianluca
G
Isaia
Department of Medical and Surgical Disciplines, Section of Geriatrics, University of Turin, Turin, Italy.
Guido
G
Maggiani
Department of Medical and Surgical Disciplines, Section of Geriatrics, University of Turin, Turin, Italy.
Elisabetta
E
Furno
Department of Medical and Surgical Disciplines, Section of Geriatrics, University of Turin, Turin, Italy.
Yolanda
Y
Falcone
Department of Medical and Surgical Disciplines, Section of Geriatrics, University of Turin, Turin, Italy.
Giovanni Carlo
GC
Isaia
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015577:Geriatric Assessment; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D011446:Prospective Studies
cognitive impairment; functional decline; geriatric medicine; inappropriate admission; length of stay