Factors associated with prolonged length of stay in older patients.
BACKGROUND
Prolonged stay in acute hospitals increases the risk of hospital-acquired infections in older patients, and disrupts patient flow and access to care due to bed shortages. We aimed to investigate the factors associated with prolonged length of stay (pLOS) among older patients (aged ≥ 78 years) in a tertiary hospital, to identify the potentially modifiable risk factors that could direct interventions to reduce length of stay (LOS).


METHODS
During a three-month period from January 2013 to March 2013, we identified 72 patients with pLOS (LOS ≥ 21 days) and compared their demographic and clinical variables with that of 281 randomly selected control patients (LOS < 21 days) using univariate and multivariate logistic regression analyses.


RESULTS
The mean age of the patients was 85.30 ± 5.34 years; 54% of them were female and 72% were of Chinese ethnicity. Logistic regression revealed the following significant factors for increased LOS: discharge to intermediate and long-term care services (odds ratio [OR] 9.22, 95% confidence interval [CI] 3.56-23.89; p < 0.001); increased severity of illness (OR 2.41, 95% CI 1.12-5.21; p = 0.025); and presence of caregiver stress (OR 3.85, 95% CI 1.67-8.91; p = 0.002).


CONCLUSIONS
Presence of caregiver stress and nursing home placement are potential modifiable risk factors of pLOS among older patients. Early identification and management of caregiver stress, as well as expediting discharge planning, may help to reduce the length of stay for this cohort.
Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore.
Hui Jin
HJ
Toh
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Zhen Yu
ZY
Lim
Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore.
Philip
P
Yap
Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore.
Terence
T
Tang
D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers; D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007902:Length of Stay; D008297:Male; D011897:Random Allocation; D012044:Regression Analysis; D012307:Risk Factors; D012720:Severity of Illness Index; D012846:Singapore; D012923:Social Class; D013315:Stress, Psychological; D062606:Tertiary Care Centers
caregiver stress; elderly; prolonged length of stay