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

• Autores: Addie Middleton, Shuang Li--, Yong-Fang Kuo, Kenneth J. Ottenbacher, James S. Goodwin
• Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 66, Nº. 1, 2018, págs. 56-63
• Idioma: inglés
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• Resumen

  • Objectives: Approximately half ofindividuals newly admitted to long-term care (LTC) nursinghomes (NHs) experienced a prior hospitalization followedby discharge to a skilled nursing facility (SNF). The objec-tive was to examine characteristics associated with newinstitutionalizations of older adults on this care trajectory.DESIGN: Retrospective cohort study.SETTING: SNFs and LTC NHs.PATIENTS: Medicare fee-for-service beneficiaries admit-ted to 7,442 SNFs in 2013 (N = 597,986).MEASUREMENTS: We used demographic and clinicalcharacteristics from Medicare data and the Minimum DataSet. We defined “new institutionalization” as LTC NH res-idence for longer than 90 non-SNF days, starting within6 months of hospital discharge.RESULTS: For individuals who survived 6 months afterhospital discharge, the overall rate of new LTC institution-alizations was 10.0% (N = 59,736). Older age, white race,being unmarried, Medicaid eligibility, higher income, morecomorbidities, cognitive impairment, depression, functionallimitations, hallucinations and delusions, aggressive behav-ior, incontinence, and pressure ulcers were associated withhigher adjusted odds of new LTC institutionalization. Inanalyses stratified according to race and ethnicity, higherincome was associated with lower odds of LTC institution-alization for whites (odds ratio (OR) = 0.92, 95% confi-dence interval (CI) = 0.89–0.96) and greater odds forblacks (OR = 1.40, 95% CI = 1.27–1.55) and Hispanics(OR = 1.44, 95% CI = 1.25–1.66). Moderate or severedepression, functional limitations, hallucinations and delu-sions, aggressive behavior, and being unmarried werestronger risk factors for LTC for cognitively intactindividuals than for those with moderate to severe cogni-tive impairment. Being unmarried and having more comor-bidities were stronger predictors in those aged 66 to 70than in those aged 81 to 85 and 91 and older.CONCLUSION: Associations between risk factors andnew LTC institutionalizations varied according to race andethnicity, age, and level of cognitive function. Programsthat target older adults at greater risk may be an effectivestrategy for reducing new institutionalizations and foster-ing aging in place.