Age and Ageing Advance Access originally published online on July 25, 2005
Age and Ageing 2005 34(5):467-475; doi:10.1093/ageing/afi141
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Research Paper |
A multi-centre European study of factors affecting the discharge destination of older people admitted to hospital: analysis of in-hospital data from the ACMEplus project
1 Medicine for the Elderly, Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen, UK
2 Department of Geriatric Medicine, University Hospital Birmingham NHS Trust, Birmingham, UK
3 The Catalan Agency for Health Technology Assessment and Research, Barcelona, Spain
4 Istituto Nazionale di Riposo e Cura Anziani (INRCA), Ancona, Italy
5 Sheffield Institute for Studies on Ageing, University of Sheffield & Northern General Hospital, Sheffield, UK
6 Sextant Research Group, National School for Public Health, Athens, Greece
7 The University of Bialystok, Bialystok, Poland
8 Health office, Turku, Finland
Address correspondence to: D. G. Seymour, Care of the Elderly, Department of Medicine and Therapeutics, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK. Fax (+44) 01224 554761. Email: d.g.seymour{at}abdn.ac.uk
Abstract
Objectives: to examine the relationship between seven predictor variables (recorded on Day 3 of hospital admission) and discharge destination in non-elective medical patients aged 65+ years.
Design: prospective cohort.
Setting: eight centres in six European countries.
Predictor variables: age, gender, living alone, physical function (three categories based on Barthel Index), cognition (Katzman’s orientation–memory–concentration test), main body system affected (based on International Classification of Diseases), number of geriatric giants (GGs) involved in the referral (a GG being a problem with falling, mobility, continence or cognition).
Main outcome measures: discharge destination (by Day 90) in three categories: ‘HOMESAME’ (return to previous residence), ‘INSTIN90’ (discharge to alternative residence or still in hospital at 90 days), ‘DEADINHO’ (death in hospital),
Results: in 1,626 patients, discharge destination was HOMESAME in 84.7%, DEADINHO in 8.9% and INSTIN90 in 6.4%. Mean duration of stay was 17.7 days, median 12. Univariate analyses showed a statistically significant relationship between all seven predictor variables and discharge destination. Physical function was the best single predictor with a seven-fold difference in adverse outcome rates between the best and worst categories. On multiple logistic regression, significant predictor variables were as follows. (i) For DEADINHO: physical function, cognition, gender; (ii) for INSTIN90: physical function, living alone, GGs, age, gender. Multiple linear regression identified physical function, GGs and living alone as predictors of loge length of stay.
Conclusion: case-mix systems to compare risk-adjusted hospital outcome in older medical patients need to incorporate information about physical function, cognition and presenting problems in addition to diagnosis.
Keywords: activities of daily living, aged, 80 and over, hospitals, outcome assessment (health care), risk-adjustment, elderly
Received January 20, 2005; accepted in revised form June 6, 2005.
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