Age and sex differences in hospitalisation of nursing home residents: a systematic review

Abstract

ObjectivesNursing home residents (NHRs) are frequently suffering from multimorbidity, functional and cognitive impairment, often leading to hospital admissions. Studies have found that male NHRs are more often hospitalised. The influence of age is inconclusive. We aimed to investigate the epidemiology of hospitalisations in NHRs, particularly focusing on age-specific and sex-specific differences.DesignA systematic review was performed in PubMed, CINAHL and Scopus. Quality of studies was assessed.SettingStudies conducted in nursing homes were included.ParticipantsNursing home residents.Primary and secondary outcomesOutcome measures were the prevalence, incidence or duration of all-cause hospitalisation by age or sex.ResultsWe identified 21 studies, 13 were conducted in the USA. The proportion of residents being hospitalised ranged across studies from 6.8% to 45.7% for various time periods of follow-up. A total of 20 studies assessed the influence of sex and found that hospitalisations are more often in male NHRs. A total of 16 studies conducted multivariate analyses and the OR of hospitalisation for males was between 1.22 and 1.67. Overall, 18 studies assessed the influence of age. Some studies showed an increasing proportion of admissions with increasing age, but several studies also found decreasing hospitalisations above the age of about 80–85 years. 8 of 13 studies conducting multivariate analyses included age as a continuous variable. Only 1 study reported stratified analyses by age and sex. 2 studies investigating primary causes of hospitalisation stratified by sex found some differences in main diagnoses.DiscussionMale NHRs are more often hospitalised than females, but reasons for that are not well investigated. The influence of age is less clear, but there seems to be no clear linear relationship between age and the proportion being hospitalised. Further studies should investigate age and sex differences in frequencies and reasons for hospitalisation in NHRs.

Influence of age and sex on hospitalization of nursing home residents: A cross-sectional study from Germany

“…Although not statistically significant in our study, the finding that male nursing home residents are more often hospitalized than females is consistent with the existing literature [3, 10–14, 18]. However, in our systematic review [18] we only found one study that reported further analyses stratified by sex and age [10] and no study systematically assessed reasons for these differences or compared predictors of hospitalizations in multivariate analyses between sexes.…”

“…This was also observed in our study, where persons institutionalized within the last 6 months were more often hospitalized during the preceding 12 months than residents with a longer length of stay. When compared to studies also including prevalent nursing home residents [3, 14, 18, 31, 32], the proportion with one or more hospitalizations is much higher in our study than those reported from other western countries. These comparably high hospitalization rates in Germany have already been pointed out by Ramroth et al [11] in an earlier study using data that are now 15 years old.…”

“…The literature indicates that hospitalizations of nursing home residents are relatively common but estimates vary widely across studies [3, 18]. Besides different geographic areas and types of nursing homes or hospitalizations, the published studies use a wide range of measures, time periods and populations, making comparisons difficult.…”

“…However, in our systematic review [18] we only found one study that reported further analyses stratified by sex and age [10] and no study systematically assessed reasons for these differences or compared predictors of hospitalizations in multivariate analyses between sexes. However, understanding such sex-dependent patterns is a prerequisite to assess whether oversupply or undersupply might exist and to optimise care, but data on care needs, chronic medical conditions and service utilization in nursing home residents are often presented in aggregate for both sexes [16].…”

“…In a recently published systematic review, we found that 20 studies assessed the influence of sex and all found that hospitalizations are more often in male residents [18]. However, just 4 of these studies discussed these findings at all [10, 11, 19, 20], only one presented analyses according to age groups between males and females [10] and none of the existing studies have conducted multivariate analyses stratified by sex [18]. Therefore, it is also not clear whether differences are present in male and female residents with comparable health status or if predictors of hospitalization differ between sexes.…”