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New Institutionalization in Long-Term Care After Hospital Discharge to Skilled Nursing Facility.

New Institutionalization in Long-Term Care After Hospital Discharge to Skilled Nursing Facility.
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Middleton A, Li S, Kuo YF, Ottenbacher KJ, Goodwin JS,


Middleton A, Li S, Kuo YF, Ottenbacher KJ, Goodwin JS, (click to view)

Middleton A, Li S, Kuo YF, Ottenbacher KJ, Goodwin JS,

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Journal of the American Geriatrics Society 2017 11 07() doi 10.1111/jgs.15131
Abstract
BACKGROUND/OBJECTIVES
Approximately half of individuals newly admitted to long-term care (LTC) nursing homes (NHs) experienced a prior hospitalization followed by discharge to a skilled nursing facility (SNF). The objective was to examine characteristics associated with new institutionalizations of older adults on this care trajectory.

DESIGN
Retrospective cohort study.

SETTING
SNFs and LTC NHs.

PATIENTS
Medicare fee-for-service beneficiaries admitted to 7,442 SNFs in 2013 (N = 597,986).

MEASUREMENTS
We used demographic and clinical characteristics from Medicare data and the Minimum Data Set. We defined "new institutionalization" as LTC NH residence for longer than 90 non-SNF days, starting within 6 months of hospital discharge.

RESULTS
For individuals who survived 6 months after hospital discharge, the overall rate of new LTC institutionalizations was 10.0% (N = 59,736). Older age, white race, being unmarried, Medicaid eligibility, higher income, more comorbidities, cognitive impairment, depression, functional limitations, hallucinations and delusions, aggressive behavior, incontinence, and pressure ulcers were associated with higher adjusted odds of new LTC institutionalization. In analyses stratified according to race and ethnicity, higher income was associated with lower odds of LTC institutionalization for whites (odds ratio (OR) = 0.92, 95% confidence interval (CI) = 0.89-0.96) and greater odds for blacks (OR = 1.40, 95% CI = 1.27-1.55) and Hispanics (OR = 1.44, 95% CI = 1.25-1.66). Moderate or severe depression, functional limitations, hallucinations and delusions, aggressive behavior, and being unmarried were stronger risk factors for LTC for cognitively intact individuals than for those with moderate to severe cognitive impairment. Being unmarried and having more comorbidities were stronger predictors in those aged 66 to 70 than in those aged 81 to 85 and 91 and older.

CONCLUSION
Associations between risk factors and new LTC institutionalizations varied according to race and ethnicity, age, and level of cognitive function. Programs that target older adults at greater risk may be an effective strategy for reducing new institutionalizations and fostering aging in place.

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