Social and Regional Factors Predict the Likelihood of Admission to a Nursing Home After Acute Hospital Stay in Older People With Chronic Health Conditions: A Multilevel Analysis Using Routinely Collected Hospital and Census Data in Switzerland

Frailty and Long-Term Survival in Patients With Critical Illness After Nonhome Discharge: A Retrospective Cohort Study

IMPORTANCE

Patients with frailty are more frequently discharged to rehabilitation or residential aged care facility (RACF), defined as nonhome discharge, than those without frailty. An increase in nonhome discharge is considered to be one of the collateral "costs" associated with declining hospital mortality. However, it is unclear whether this association applies to patients with frailty, particularly in the long term.

OBJECTIVES

To determine the impact of frailty on long-term survival in patients who had a nonhome discharge following an ICU admission.

DESIGN

A retrospective multicenter cohort study.

SETTING AND PARTICIPANTS

All medical patients (≥ 16 yr old) admitted to Australian and Zealand ICUs, with a documented Clinical Frailty Scale (CFS) and a nonhome discharge from January 1, 2018, to March 31, 2022, were included.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Primary outcome was survival time up to 4 years. We used Cox proportional hazards regression models with robust sandwich variance estimators to assess the effect of frailty (defined as CFS = 5-8) on survival time after ICU admission between groups. We also analyzed the effect of frailty on long-term survival based on their age and nonhome discharge location. Of the 57,652 patients, 17,383 (30.2%) were frail. Overall 4-year survival was lower in patients with frailty than those without (32.5% vs. 64.3%; p < 0.001). Frailty was associated with shorter survival times (adjusted hazard ratio [aHR], 1.50; 95% CI, 1.43-1.57). Frailty was associated with a greater reduction in survival in patients younger than 65 years old (aHR, 1.73; 95% CI, 1.59-1.88), 65-80 years (aHR, 1.47; 95% CI, 1.38-1.57), or older than 80 years (aHR, 1.35; 95% CI, 1.26-1.45). Frailty was associated with greater reduction in survival in those discharged to rehabilitation (aHR, 1.52; 95% CI, 1.39-1.65) or acute hospitals (aHR, 1.56; 95% CI, 1.48-1.65) than those discharged to RACF (aHR, 0.94; 95% CI, 0.83-1.06).

CONCLUSIONS

Frailty was independently associated with shorter time to death following a nonhome discharge after an ICU admission.

RELEVANCE

There was an independent association between patients with frailty admitted to ICU and had a nonhome discharge with the shorter time to death than those without frailty.

Functional and Psychosocial Profile of Older People Living in Nursing Homes: Findings from the European Survey of Health, Ageing and Retirement in Europe (SHARE)

BACKGROUND

This paper is based on results from the Survey of Health, Ageing and Retirement in Europe (SHARE), exploring many aspects (health, economic situation and welfare) of the European population aged 50+. Differently from many other international studies, SHARE includes persons living in nursing homes or residential care facilities as part of its sample. The aim of this paper is to provide a socio-demographic, functional and psychosocial snapshot of older residents in nursing homes in Europe.

METHODS

This paper uses data from SHARE Wave 8/2020, carried out in 27 European countries. A quantitative/descriptive approach explores the prevalence of older people aged 65+ living in residential facilities as mapped by the SHARE survey across Europe, with regard to associated dimensions, i.e., socio-demographic, family relationship, perceived health/main diseases, functional and psychological status.

RESULTS

These show that older residents live mainly in Central and Northern Europe, are aged 80+, female and widowed. A small social network (SN) size is often reported. Health is perceived, above all, as being fair-poor, and the presence of long-term illness is high, with several chronic health conditions and functional limitations. The reported quality of life (QoL) is low for most respondents, with moderate-low satisfaction with life.

CONCLUSION

The analysis depicts a profile of seniors needing residential care in Europe, and provides useful insights for policymakers, to better sustain this frail population group, and to allow and improve access to high-quality long-term care (LTC) in Europe. Our findings could also be of help to train health professionals, and potentially drive the research towards the exploration of new housing solutions for seniors. This would in turn contribute to the effective implementation of European initiatives to strengthen LTC systems.

Social inequalities, length of hospital stay for chronic conditions and the mediating role of comorbidity and discharge destination: A multilevel analysis of hospital administrative data linked to the population census in Switzerland

Social factors are recognized determinants of morbidity and mortality and also have an impact on use of medical services. The objective of this study was to assess the associations of educational attainment, social and financial resources, and migration factors with length of hospital stays for chronic conditions. In addition, the study investigated the role of comorbidity and discharge destination in mediating these associations. The study made use of nationwide inpatient data that was linked with Swiss census data. The study sample included n = 141,307 records of n = 92,623 inpatients aged 25 to 84 years, hospitalized between 2010 and 2016 for a chronic condition. Cross-classified multilevel models and mediation analysis were performed. Patients with upper secondary and compulsory education stayed longer in hospital compared to those with tertiary education (β 0.24 days, 95% CI 0.14-0.33; β 0.37, 95% CI 0.27-0.47, respectively) when taking into account demographic factors, main diagnosis and clustering on patient and hospital level. However, these effects were almost fully mediated by burden of comorbidity. The effect of living alone on length of stay (β 0.60 days, 95% CI 0.50-0.70) was partially mediated by both burden of comorbidities (33%) and discharge destination (30.4%). (Semi-) private insurance was associated with prolonged stays, but an inverse effect was observed for colon and breast cancer. Allophone patients had also prolonged hospital stays (β 0.34, 95% CI 0.13-0.55). Hospital stays could be a window of opportunity to discern patients who need additional time and support to better cope with everyday life after discharge, reducing the risks of future hospital stays. However, inpatient care in Switzerland seems to take into account rather obvious individual needs due to lack of immediate support at home, but not necessarily more hidden needs of patients with low health literacy and less resources to assert their interests within the health system.