title: Risk Factors for the Discontinuation of Home Medical Care among Low-functioning Older Patients.
abstract: OBJECTIVE
  Older patients receiving home medical care often have declining functional status and multiple disease conditions. It is important to identify the risk factors for care transition events in this population in order to avoid preventable transitions. In the present study, therefore, we investigated the factors associated with discontinuation of home medical care as a potentially preventable care transition event in older patients.
  
  
  METHODS
  Baseline data for participants in the Observational study of Nagoya Elderly with HOme MEdical (ONEHOME) study and data on the mortality, institutionalization, or hospitalisation of the study participants during a 2-year follow-up period were used. Discontinuation of home care was defined as admission to a hospital for any reason, institutionalization, or death. Univariate and multivariate Cox hazard models were used to assess the association of each of the factors with the discontinuation of home care during the observational period. The covariates included in the multivariate analysis were those significantly associated with the discontinuation of home care at the level of P<0.05 in the univariate analysis.
  
  
  RESULTS
  The univariate Cox hazard model revealed that a low hemoglobin level (< 11g/dL), low serum albumin level (< 3g/dL), higher Charlson Comorbidity Index score, and low Mini Nutritional Assessment Short Form score (< 7) were significantly associated with the discontinuation of home care. A multivariate Cox hazard model including these four factors demonstrated that all four were independently associated with home-care discontinuation.
  
  
  CONCLUSIONS
  The present results demonstrated that anemia, hypoalbuminemia, malnourishment, and the presence of serious comorbidities were associated with the discontinuation of home medical care among low-functioning older patients.
authors.affiliation: Hiroyuki Umegaki, Nagoya University Graduate School of Medicine, Department of Community Healthcare and Geriatrics, 65 Tsuruma-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan, Phone: +81-52-744-2364; Fax: +81-52-744-2371; Email address: umegaki@med.nagoya-u.ac.jp.
authors.forename: H
authors.initials: H
authors.lastname: Umegaki
authors.forename: A
authors.initials: A
authors.lastname: Asai
authors.forename: S
authors.initials: S
authors.lastname: Kanda
authors.forename: K
authors.initials: K
authors.lastname: Maeda
authors.forename: T
authors.initials: T
authors.lastname: Shimojima
authors.forename: H
authors.initials: H
authors.lastname: Nomura
authors.forename: M
authors.initials: M
authors.lastname: Kuzuya
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006454:Hemoglobins / Q000032:analysis; D006699:Home Care Services / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D015596:Nutrition Assessment; D016016:Proportional Hazards Models; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis
chemical_list: D006454:Hemoglobins; D012709:Serum Albumin