Abstract
BACKGROUND
Identifying patients who need Nursing Home (NH) care following a hospital admission is important.
OBJECTIVE
To identify the factors that predispose to an NH discharge.
DESIGN
Prospective observational study with blinded end-point evaluation.
SETTING
A non-acute geriatric hospital.
SUBJECTS
Two hundred consecutive elderly patients who were admitted for rehabilitation following treatment for an acute illness.
MAIN OUTCOME MEASURES
Discharge to an NH or home.
RESULTS
Thirty-five out of the 150 live discharges (23.3%) were to an NH. NH discharges had a longer length of stay (38.5 versus 19.8 days; p < 0001). They were more likely to have visual impairment (p = 0.0009), confusion (p < 0.0001), wandering behaviour (p = 0.003), incontinence (p < 0.0001 or unsafe gait (p = 0.0005), to be on tranquillizers (p = 0.003), to be at risk of falls (p = 0.02) and to have sustained a fall while in hospital (p = 0.001). Multiple logistic regression identified confusion (p = 0.001), incontinence (p = 0.02), falls in hospital (p = 0.01), gait abnormalities (p < 0.001), tranquillizers (p < 0.001), impaired distant vision (p = 0.01) and living alone (p < 0.001) as independently associated with the risk of an NH discharge. This risk proportionately increased with the number of risk factors present: 4.28% for 0-2 factors, 25.8% for 3-4 factors and 81.8% for 5-6 factors (p < 0.0001).
CONCLUSION
These factors should be the target of specific rehabilitation in an attempt to reduce the risk of discharge to a nursing home and improve patient outcome.
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