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Discharge Outcomes in Seniors Hospitalized for More than 30 Days

Published online by Cambridge University Press:  31 March 2010

Anita L. Kozyrskyj ,
Charlyn Black ,
Dan Chateau  and
Carmen Steinbach
Anita L. Kozyrskyj*
Affiliation:
Manitoba Centre for Health Policy, Department of Community Health Services, University of Manitoba Faculty of Pharmacy, University of Manitoba
Charlyn Black
Affiliation:
Centre for Health Services and Policy Research, University of British Columbia
Dan Chateau
Affiliation:
Manitoba Centre for Health Policy, Department of Community Health Services, University of Manitoba
Carmen Steinbach
Affiliation:
Manitoba Centre for Health Policy, Department of Community Health Services, University of Manitoba
*
Requests for offprints should be sent to: / Les demandes de tirés-à-part doivent être addressées à : Anita L. Kozyrskyj, B.Sc.Phm., Ph.D., Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, 727 McDermot Avenue, Suite 408, Winnipeg, MB R3E 3P5. (Anita_Kozyrskyj@cpe.umanitoba.ca)
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Abstract

Hospitalization is a sentinel event that leads to loss of independence for many seniors. This study of long-stay hospitalizations (more than 30 days) in seniors was undertaken to identify risk factors for not going home, to characterize patients with risk factors who did go home and to describe one year outcomes following home discharge. Using Manitoba's health care databases, the likelihood of death in hospital, discharge to a nursing home, and transfer to another hospital was determined for a set of risk factors in seniors with long-stay hospitalizations in Winnipeg's acute hospitals. Of the 17,984 long-stay hospitalizations during 1993–2000, 45 per cent were discharged home, 20 per cent died, and 30 per cent were discharged to a nursing home or another hospital. Seniors who received home care prior to hospitalization were more likely to be discharged to a nursing home or die in hospital than to go home. Stroke and cognitive impairment increased the likelihood of discharge to a nursing home. Seniors with neoplasms, multiple co-morbidities, and length-of-stay more than 120 days were more likely to die in hospital. Long-stay patients with risk factors who did go home had few co-morbidities. Within one year of home discharge, 20 per cent of seniors died, 5–15 per cent were admitted to a nursing home or long-term care institution, and 26–35 per cent of persons were re-hospitalized from home. A full 37 per cent experienced none of these outcomes. Our findings point to opportunities to improve discharge outcomes and plan support services for seniors.

Résumé

L'hospitalisation constitue un précurseur de la perte d'autonomie pour de nombreux aînés. Cette étude sur les hospitalisations de longue durée (plus de 30 jours) visait à déterminer les facteurs de risque qui incitent les personnes âgées à ne pas retourner à la maison, de déterminer les caractéristiques des patients ayant des facteurs de risque et qui ont choisi de retourner à la maison ainsi que de décrire les conséquences pouvant survenir dans l'année qui suit la sortie de l'hôpital. À l'aide des bases de données sur les soins de santé du Manitoba, les probabilités d'un déce`s à l'hôpital, d'un congé vers une maison de soins infirmiers et d'un transfert vers un autre hôpital ont été déterminées pour un ensemble de facteurs de risques chez les aînés ayant subi des hospitalisations de longue durée dans les hôpitaux de courte durée de Winnipeg. Des 17 984 personnes hospitalisées pour une longue période entre1993 et 2000, 45 p. 100 ont pu retourner chez elles, 20 p. 100 sont décédées et 30 p. 100 ont été transférées dans une maison de soins infirmiers ou un autre hôpital. Les aînés qui avaient reçu des soins à domicile avant leur hospitalisation avaient plus de chances d'obtenir un congé dans une maison de soins infirmiers ou de mourir à l'hôpital que de retourner chez elles. La probabilité d'être envoyé dans une maison de soins infirmiers augmentait dans le cas d'accidents cérébraux vasculaires et de troubles cognitifs. Les aînés atteints de tumeurs, de multiples comorbidités et qui sont restés plus de 120 jours étaient plus susceptibles de mourir à l'hôpital. Les patients de longue durée qui avaient des facteurs de risque et qui sont retournés chez eux avaient peu de comorbidités. Dans l'année qui a suivi la sortie de l'hôpital, 20 p. 100 des aînés sont décédés, 5 à 15 p. 100 d'entre eux ont été admis dans une maison de soins infirmiers ou un établissement de soins de longue durée et 26 à 35 p. 100 des personnes ont été de nouveau hospitalisées à partir de leur domicile. Enfin, 37 p. 100 des personnes n'ont subi aucune de ces conséquences. Nos conclusions mettent l'accent sur des moyens possibles de réduire les conséquences notées apre`s un séjour à l'hôpital et d'améliorer les services de soutien pour les aînés.

Keywords

agedhospitalizationnursing homesmortalityhome care servicesco-morbiditypersonnes âgéeshospitalisationmaisons de soins infirmiersmortalitéservices de soins à domicilecomorbidite
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 24 , Issue S1: Health and Health Care Use Among Older Adults: Using Population-Based Information Systems to Inform Policy in Manitoba , Spring/Printemps 2005 , pp. 107 - 119
Copyright
Copyright © Canadian Association on Gerontology 2005

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