title: Hospitalisation of older people before and after long-term care entry in Auckland, New Zealand.
abstract: global population projections forecast large growth in demand for long-term care (LTC) and acute hospital services for older people. Few studies report changes in hospitalisation rates before and after entry into LTC. This study compares hospitalisation rates 1 year before and after LTC entry.
  
  
  
  the Older Persons' Ability Level (OPAL) study was a 2008 census-type survey of LTC facilities in Auckland, New Zealand. OPAL resident hospital admissions and deaths were obtained from routinely collected national databases.
  
  
  
  all 2,244 residents (66% = female) who entered LTC within 12 months prior to OPAL were included. There were 3,363 hospitalisations, 2,424 in 12 months before and 939 in 12 months after entry, and 364 deaths. In the 6 to 12 months before LTC entry, the hospitalisation rate/100 person-years was 67.3 (95% confidence interval [CI] 62.5-72.1). Weekly rates then rose steeply to over 450/100 person-years in the 6 months immediately before LTC entry. In the 6 months after LTC entry, the rate fell to 49.1 (CI 44.9-53.3; RR 0.73 (CI 0.65-0.82, P < 0.0001)) and decreased further 6 to 12 months after entry to 41.1 (CI 37.1-45.1; rate ratio [RR] 0.61 (CI 0.54-0.69, P < 0.0001)).
  
  
  
  increased hospitalisations a few months before LTC entry suggest functional and medical instability precipitates LTC entry. New residents utilise hospital beds less frequently than when at home before that unstable period. Further research is needed to determine effective interventions to avoid some hospitalisations and possibly also LTC entry.
authors.affiliation: Freemasons Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand Waitemata District Health Board, Auckland, New Zealand School of Nursing, University of Auckland, Auckland, New Zealand.
authors.forename: Michal
authors.initials: M
authors.lastname: Boyd
authors.affiliation: Freemasons Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand.
authors.forename: Joanna B
authors.initials: JB
authors.lastname: Broad
authors.affiliation: Freemasons Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand.
authors.forename: Tony Xian
authors.initials: TX
authors.lastname: Zhang
authors.affiliation: School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
authors.forename: Ngaire
authors.initials: N
authors.lastname: Kerse
authors.affiliation: School of Nursing, University of Auckland, Auckland, New Zealand.
authors.forename: Merryn
authors.initials: M
authors.lastname: Gott
authors.affiliation: Freemasons Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand Waitemata District Health Board, Auckland, New Zealand.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Connolly
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006304:Health Status; D006801:Humans; D008134:Long-Term Care / Q000639:trends*; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D010343:Patient Admission / Q000639:trends*; D011379:Prognosis; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
keywords: cohort study; community; hospital admissions; long-term care; nursing home; older people