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Characteristics associated with inappropriate hospital use in elderly patients admitted to a general internal medicine service

Ingold, B. ; Yersin, B. ; Wietlisbach, V. ; Burckhardt, P. ; Burnand, B. ; Büla, C.

In: Aging Clinical and Experimental Research, 2000, vol. 12, no. 6, p. 430-438

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    Titre
    • Characteristics associated with inappropriate hospital use in elderly patients admitted to a general internal medicine service
    Auteur
    • Ingold, B.. Division of Geriatric Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
    • Yersin, B.. Department of Internal Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
    • Wietlisbach, V.. Institute of Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland
    • Burckhardt, P.. Department of Internal Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
    • Burnand, B.. Institute of Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland
    • Büla, C.. Division of Geriatric Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • Aging Clinical and Experimental Research, 2000, vol. 12, no. 6, p. 430-438. Springer International Publishing
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:321629
    Summary
    Our objective was to identify patient characteristics associated with inappropriate hospital days in a cohort of elderly medical inpatients. This prospective cohort study included a total of 196 patients aged 75 years and older, who were consecutively admitted over eight months to the internal medicine service of a regional, non-academic public hospital located in a rural area of Western Switzerland. Patients with severe cognitive impairment, terminal disease, or previously living in a nursing home were excluded. Data on demographics, medical, physical, social and mental status were collected at admission. A blinded hospitalization review was performed concurrently using a modified version of the Appropriateness Evaluation Protocol (AEP). Subjects' mean age was 82.4 years; 63.3% were women. Median length of stay was 8 days. Overall, 68 patients (34.7%) had at least one inappropriate day during their stay, including 18 patients (9.2%) whose hospital admission and entire stay were considered inappropriate. Most inappropriate days were due to discharge delays (87.1%), primarily to nursing homes (59.3%). Univariate analysis showed that subjects with inappropriate days were more likely to be living alone (69.1 vs 48.4%, p=0.006), and receiving formal in-home help (48.5 vs 32.8%, p=0.031). In addition, they were more impaired in basic and instrumental activities of daily living BADLs, and IADLs, p<0.001 and p=0.015, respectively), and more frequently had a depressed mood [29.4 vs 10.9%, p=0.001 with a score ≥ 6 at the Geriatric Depression Scale (GDS), short form]. Using multivariate analysis, independent associations remained for patients living alone (OR 2.6, 95%CI 1.2-5.8, p=0.016), those with a depressed mood (OR 2.8, 95%CI 1.1-7.3, p=0.032), with BADL dependencies (OR 1.5, 95%CI 1.2-1.8, p=0.001), and IADL dependencies (OR 1.3, 95%CI 1.0-1.6, p=0.032). Cardiovascular (OR 0.2, 95%CI 0.1-0.7, p=0.008) and pulmonary admission diagnoses (OR 0.1, 95%CI 0.0-0.7, p=0.022) were inversely associated with inappropriate hospital days. In conclusion, patients living alone, functionally impaired and showing depressive symptoms were at increased risk for inappropriate hospital days. These characteristics might permit better targeting for early discharge planning in these at-risk subjects, and contribute to avoiding premature discharge of other vulnerable elderly patients. Whether these interventions for at-risk patients will also result in prevention of hospitalization hazards, such as deconditioning and related functional decline, will require further study