1
|
Moriwaki M, Hayashida K, Ogata Y. Factors associated with non-home discharge of patients hospitalized for hip fracture: A nationwide retrospective study using the Japanese diagnostic procedure combination database. Medicine (Baltimore) 2023; 102:e33138. [PMID: 36862853 PMCID: PMC9981375 DOI: 10.1097/md.0000000000033138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
In Japan, the length of stay in acute care hospitals has been shortened, home medical care has been promoted following national policy. However, many issues remain in promoting home medical care. The aim of this study was to clarify the profiles of patients with hip fractures, aged ≥ 65 years, who were hospitalized in acute care institutions at the time of discharge and the influence on nonhome discharge. This study used data from patients who satisfied all the following conditions: Patients aged ≥ 65 years who were hospitalized and discharged between April 2018 and March 2019; Patients with hip fractures, and; Patients who were admitted from home. The patients were classified into the home discharge and nonhome discharge groups. Multivariate analysis was conducted by comparing socio-demographic status, patient background factors, patient status at discharge, and hospital function. This study included 31,752 patients (73.7%) and 11,312 patients (26.3%) in the nonhome discharge group and home discharge group, respectively. Overall, the proportions of males and females were 22.2% and 77.8%, respectively. The average (standard deviation) age of the patients was 84.1 years (7.4) and 81.3 years (8.5) in the nonhome discharge and home discharge groups, respectively (P < .01). The following factors affected nonhome discharge: 75 to 84 years (odds ratio [OR] = 1.81, 95% confidence interval [CI] = 1.68-1.96), ≥85 years (OR = 2.17, 95% CI = 2.01-2.36), electrocardiography or respiratory treatment "(Factor A3) (OR = 1.44, 95% CI = 1.23-1.68), level of assistance with activities of daily living "(Factor B1)" (OR = 4.56, 95% CI = 4.22-4.92), and hospital where the patient-to-nurse ratio is 7:1 (OR = 2.12, 95% CI = 1.91-2.35). The results suggested that support from activities of daily living caregivers and implementing medical treatments such as respiratory care are required to advance home medical care. This study's method enables analysis focusing on aspiration pneumonia and cerebral infarction, which are common among older adults. Furthermore, specific measures for promoting home medical care for patients who are highly dependent on medical and long-term care may be developed.
Collapse
Affiliation(s)
- Mutsuko Moriwaki
- Quality Management Center, Tokyo Medical and Dental University Hospital (TMDU), Bunkyo-ku, Tokyo, Japan
- * Correspondence: Mutsuko Moriwaki, Quality Management Center, Tokyo Medical and Dental University Hospital (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan (e-mail: )
| | - Kenshi Hayashida
- Department of Medical Informatics and Management, University Hospital, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Yasuko Ogata
- Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), Bunkyo-ku, Tokyo, Japan
| |
Collapse
|
2
|
Falvey JR, Murphy TE, Leo-Summers L, Gill TM, Ferrante LE. Neighborhood Socioeconomic Disadvantage and Disability After Critical Illness. Crit Care Med 2022; 50:733-741. [PMID: 34636807 PMCID: PMC9001742 DOI: 10.1097/ccm.0000000000005364] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Factors common to socioeconomically disadvantaged neighborhoods, such as low availability of transportation, may limit access to restorative care services for critical illness survivors. Our primary objective was to evaluate whether neighborhood socioeconomic disadvantage was associated with an increased disability burden after critical illness. Our secondary objective was to determine if the effect differed for those discharged to the community compared with those discharged to a facility. DESIGN Longitudinal cohort study with linked Medicare claims data. SETTING United States. PATIENTS One hundred ninety-nine older adults, contributing to 239 ICU admissions, who underwent monthly assessments of disability for 12 months following hospital discharge in 13 different functional tasks from 1998 to 2017. MEASUREMENTS AND MAIN RESULTS Neighborhood disadvantage was assessed using the area deprivation index, a 1-100 ranking evaluating poverty, housing, and employment metrics. Those living in disadvantaged neighborhoods (top quartile of scores) were less likely to self-identify as non-Hispanic White compared with those in more advantaged neighborhoods. In adjusted models, older adults living in disadvantaged neighborhoods had a 9% higher disability burden over the 12 months following ICU discharge compared with those in more advantaged areas (rate ratio, 1.09; 95% Bayesian credible interval, 1.02-1.16). In the secondary analysis adjusting for discharge destination, neighborhood disadvantage was associated with a 14% increase in disability burden over 12 months of follow-up (rate ratio, 1.14; 95% credible interval, 1.07-1.21). Disability burden was 10% higher for those living in disadvantaged neighborhoods and discharged home as compared with those discharged to a facility, but this difference was not statistically significant (interaction rate ratio, 1.10; 95% credible interval, 0.98-1.25). CONCLUSIONS Neighborhood socioeconomic disadvantage is associated with a higher disability burden in the 12 months after a critical illness. Future studies should evaluate barriers to functional recovery for ICU survivors living in disadvantaged neighborhoods.
Collapse
Affiliation(s)
- Jason R. Falvey
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
- Yale School of Medicine, Section of Geriatrics, Department of Internal Medicine, New Haven, CT
| | - Terrence E. Murphy
- Yale School of Medicine, Section of Geriatrics, Department of Internal Medicine, New Haven, CT
| | - Linda Leo-Summers
- Yale School of Medicine, Section of Geriatrics, Department of Internal Medicine, New Haven, CT
| | - Thomas M. Gill
- Yale School of Medicine, Section of Geriatrics, Department of Internal Medicine, New Haven, CT
| | - Lauren E. Ferrante
- Yale School of Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine
| |
Collapse
|
3
|
Older People's Perception of Changes in Their Living Environment after Relocation: A Case Study in Beijing, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17062021. [PMID: 32204323 PMCID: PMC7143045 DOI: 10.3390/ijerph17062021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/12/2020] [Accepted: 03/16/2020] [Indexed: 11/16/2022]
Abstract
Beijing has been experiencing population ageing and rapid urbanization processes. Older people’s living environment has changed dramatically. This research aims to understand the older people’s perception of the changes in their living environment, the determinants of age-friendly living environment, and the impact path before and after their relocation in Beijing. The quantitative analysis is based on 353 valid questionnaires collected in four sample communities in Beijing. By using descriptive analysis and structure equation modeling (SEM), the results show that the living environment gets improved after relocation except accessibility to health care facilities. The cultural environment of the communities has significant impacts on the age-friendliness of the living environment. The physical environment of communities is able to improve the living environment indirectly through promoting the community cultural environment. This study sheds light on future research on age-friendly living environment for the ageing population in Beijing.
Collapse
|
4
|
Park S, Park K, Hancox J, Castaneda-Gameros D, Koo KC. Physical Activity and Subjective Vitality in Older Adults From Community-and Assisted-Living Settings. Asian Nurs Res (Korean Soc Nurs Sci) 2019; 13:313-317. [PMID: 31778826 DOI: 10.1016/j.anr.2019.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 11/06/2019] [Accepted: 11/19/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE There is a growing number of older adults moving into assisted-living facilities to maintain their independence while being assisted with certain tasks and having convenient access to services. Physical activity (PA) and vitality play an important role in independence, as well as in mental health, of older adults. However, no research has examined the difference in older adults' levels of vitality (defined as the state of feeling alive and alert) between those living in assisted-living facilities and those from community-living settings. This study also explored sociodemographic predictors of PA and vitality among older adults living in two different types of housing. METHODS This cross-sectional study examined differences in PA levels and vitality between older adults (aged ≥ 60 years; n = 148, mean age = 74.70 years) living in assisted-living facilities (n = 85, mean age = 77.46 years) and those in community-living settings (n = 63, mean age = 70.98 years). PA was assessed by accelerometry, and vitality was measured using the subjective vitality scale. RESULTS Engagement in light PA and moderate to vigorous PA was higher in individuals living in community-living settings after controlling for sociodemographic variables. However, vitality was not significantly different between the two types of housing after controlling for sociodemographic variables. Marital status, education, and number of diagnosed diseases were associated with vitality. CONCLUSION The support is needed for designing strategies to increase PA in older adults living in assisted-living facilities. More attention should be paid to increasing subjective vitality of older adults in both types of housing to promote healthy aging.
Collapse
Affiliation(s)
- Saengryeol Park
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Kyoungyun Park
- Department of Golf, Yong In University, Yongin, Republic of Korea
| | - Jennie Hancox
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Diana Castaneda-Gameros
- Research and Evaluation Division, Knowledge Directorate, Public Health Wales, Cardiff, United Kingdom
| | - Kyo Chul Koo
- Department of Urology, Yonsei University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
5
|
Roy N, Dubé R, Després C, Freitas A, Légaré F. Choosing between staying at home or moving: A systematic review of factors influencing housing decisions among frail older adults. PLoS One 2018; 13:e0189266. [PMID: 29293511 PMCID: PMC5749707 DOI: 10.1371/journal.pone.0189266] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 11/23/2017] [Indexed: 11/18/2022] Open
Abstract
Background Most older adults wish to stay at home during their late life years, but physical disabilities and cognitive impairment may force them to face a housing decision. However, they lack relevant information to make informed value-based housing decisions. Consequently, we sought to identify the sets of factors influencing the housing decision-making of older adults. Methods We performed a systematic literature search for studies evaluating any factors influencing the housing decisions among older adults over 65 years old without cognitive disabilities. Primary research from any study design reported after 1990 in a peer-reviewed journal, a book chapter or an evaluated doctoral thesis and written in English, French or Spanish were eligible. We extracted the main study characteristics, the participant characteristics and any factors reported as associated with the housing decision. We conducted a qualitative thematic analysis from the perspective of the meaning and experience of home. Results The search resulted in 660 titles (after duplicate removal) from which 86 studies were kept for analysis. One study out of five reported exclusively on frail older adults (n = 17) and two on adults over 75 years old. Overall, a total of 88 factors were identified, of which 71 seem to have an influence on the housing decision-making of older adults, although the influence of 19 of them remains uncertain due to discrepancies between research methodologies. No conclusion was made regarding 12 additional factors due to lack of evidence. Conclusion A wealth of factors were found to influence housing decisions among older adults. However, very few of them have been studied extensively. Our results highlight the importance of interdisciplinary teamwork to study the influence of a broader range of factors as a whole. These results will help older adults make the best possible housing decision based on their unique situation and values.
Collapse
Affiliation(s)
- Noémie Roy
- Interdisciplinary Research Group on Suburbs (GIRBa), Laval University, Quebec, Qc, Canada
- School of Architecture, Laval University, Quebec, Qc, Canada
- Laval University Primary Care Research Centre (CERSSPL-UL), Quebec, Qc, Canada
| | - Roxanne Dubé
- Interdisciplinary Research Group on Suburbs (GIRBa), Laval University, Quebec, Qc, Canada
- School of Architecture, Laval University, Quebec, Qc, Canada
| | - Carole Després
- Interdisciplinary Research Group on Suburbs (GIRBa), Laval University, Quebec, Qc, Canada
- School of Architecture, Laval University, Quebec, Qc, Canada
| | - Adriana Freitas
- Laval University Primary Care Research Centre (CERSSPL-UL), Quebec, Qc, Canada
| | - France Légaré
- Laval University Primary Care Research Centre (CERSSPL-UL), Quebec, Qc, Canada
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Qc, Canada
- * E-mail:
| |
Collapse
|
6
|
Forder P, Byles J, Vo K, Curryer C, Loxton D. Cumulative incidence of admission to permanent residential aged care for Australian women - A competing risk analysis. Aust N Z J Public Health 2017; 42:166-171. [PMID: 28898496 DOI: 10.1111/1753-6405.12713] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 02/01/2017] [Accepted: 07/01/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To provide a direct estimate of the risk of admission to permanent residential aged care among older women while accounting for death, according to housing type and other variables. METHODS A competing risk analysis from 8,867 Australian women born 1921-26, using linked data from the Australian Longitudinal Study on Women's Health (ALSWH), Residential Aged Care (RAC), and the Australian National Death Index. RESULTS After accounting for deaths, around 35% of women will be admitted to RAC between ages 73 and 90. The conditional cumulative incidence of admission to RAC was 26.9% if living in a house, compared to 36.0% from an apartment, 43.6% within a retirement village, and 37.1% if living in a mobile home. Each one-year increase in age was associated with a relative 17% increased risk of RAC. CONCLUSIONS Around one-third of women will enter RAC between age 73 and 90. Living in a house had the lowest risk of entering residential aged care over time. Implications for public health: These findings have important implications for planning for aged care services, including the role of housing in delaying admission to residential aged care, and the need for residential care by a high proportion of women towards the end of life.
Collapse
Affiliation(s)
- Peta Forder
- Research Centre for Generational Health & Ageing, HMRI Building, University of Newcastle, New South Wales
| | - Julie Byles
- Research Centre for Generational Health & Ageing, HMRI Building, University of Newcastle, New South Wales
| | - Kha Vo
- Bureau of Health Information, Ministry of Health, New South Wales
| | - Cassie Curryer
- Research Centre for Generational Health & Ageing, HMRI Building, University of Newcastle, New South Wales
| | - Deborah Loxton
- Research Centre for Generational Health & Ageing, HMRI Building, University of Newcastle, New South Wales
| |
Collapse
|