Decreasing Hospital Length of Stay: Effects on Daily Functioning in Older Adults

Abstract

OBJECTIVES:To examine the effects of decreasing hospital length of stay (HLOS) on change in functioning from prehospital admission to posthospital discharge in older cohorts. DESIGN: Cohort-sequential design. SETTING: Nationwide, older population-based Longitudinal Aging Study Amsterdam (LASA). PARTICIPANTS: Individuals aged 68 and older with any hospital admission according to national medical registry data: two 10-year age groups (68-77 (younger-old) and 78-87 (older-old)) in two periods (1996-99 (Period 1) and 2006-09 (Period 2)) (N = 1,212). MEASUREMENTS: HLOS was the main independent variable in multinomial logistic models, dichotomized as 1 to 5 days (short) and 6 days or longer (long). Outcomes were change scores in mobility and activities in daily living (ADLs). Respondents who died during the 3-year period were assigned to a third outcome category. RESULTS: Results for both age groups showed more hospital admissions and shorter median HLOS in Period 2 than Period 1 (P < .05). Lower odds of decline in physical functioning were found in respondents with short HLOS than in those with long HLOS (for mobility: odds ratio (OR) = 0.36, 95% confidence interval (CI) = 0.23-0.54 (younger-old) and OR = 0.47, 95% CI = 0.30-0.72 (older-old); for ADLs: OR = 0.30, 95% CI = 0.19-0.48 (younger-old) and OR = 0.30, 95% CI = 0.18-0.53 (older-old)). Adjusting for confounders did not significantly change these estimates. Period did not modify these associations. CONCLUSION: Because the associations of HLOS with change in mobility and ADLs were the same in both periods, hospitalized older adults had neither advantage nor disadvantage from the decrease in HLOS. In addition, in both age groups, a greater percentage experienced the better functional outcomes and lower mortality associated with short admissions, which suggests an advantage of the decrease in HLOS. J Am Geriatr Soc 65:1214-1221, 2017.Key words: hospital length of stay; functional decline; cohort study; older adults; mortality H ospitalization often results in a decline in functioning for older adults due to interactions of aging, disease, and hospital factors.1-3 Hospital length of stay (HLOS) has been shown to predict functional decline for older adults, with longer HLOS associated with a greater likelihood of decline.4-6 HLOS has been decreasing in recent decades. Severely ill individuals are admitted to hospitals for increasingly shorter periods, and individuals with less-severe conditions are receiving increasingly more day care and outpatient treatment. 7,8 A decrease in HLOS may be positive for older adults if the time needed for diagnostic and curative processes is shortened and functional decline during the admission is less severe. Conversely, recovery from functional decline may be adversely affected if the in-hospital recovery period is shorter and posthospital rehabilitation care is not adequately allocated or applied after discharge. The effects of the decrease in HLOS on older adults' daily functioning are unclear. To study the association of the dec...

Health‐care professionals’ experiences of patient participation among older patients in intermediate care—At the intersection between profession, market and bureaucracy

“…[3][4][5][6] This may be a concern in the care of frail older patients with multiple and chronic diseases, a group that is increasing globally. 7 As the length of stay in hospitals in the Western world is significantly reduced, [8][9][10] the establishment of intermediate care (IC) has been one of the initiatives to bridge the treatment gap between hospital and home for older frail patients. The IC services provide rehabilitation for a limited time period, 11,12 often in specialized units in the municipality.…”

Assessment for incipient hospital-acquired deconditioning in acute hospital settings: A systematic literature review

“…D econditioning is "a complex process of physiological change following a period of inactivity, bedrest or sedentary lifestyle" (1, p. 16). Older people are particularly at risk (1)(2)(3)(4)(5), as deconditioning in this age group can quickly progress to irreversible functional deterioration and frailty (3,4,6,7), decreased life expectancy and quality of life.…”

“…Hospital-acquired deconditioning (HAD) can occur within days for adults of any age, during acute hospital admissions involving enforced bed rest, immobilization and/or sedentary behaviours (2)(3)(4)7). There is no standard definition of HAD, and no agreement on common HAD elements, or assessment practices (1)(2)(3)(4)(8)(9)(10). HAD changes can be insidious, and if undetected, can delay safe discharge from hospital and/ or require additional recuperative care (5)(6)(7)9).…”

“…HAD changes can be insidious, and if undetected, can delay safe discharge from hospital and/ or require additional recuperative care (5)(6)(7)9). It is counterintuitive that HAD should occur in healthcare settings, where it could be reasonably expected that health should improve, not decline (2,4,12). However, HAD is a reality in many countries (2,4,12).…”

“…It is counterintuitive that HAD should occur in healthcare settings, where it could be reasonably expected that health should improve, not decline (2,4,12). However, HAD is a reality in many countries (2,4,12). It is coded as M62.81 (generalized muscle weakness) in the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), a system used by healthcare providers to code diagnoses, symptoms and procedures related to hospital care (8).…”