Factors Influencing Admission or Nonadmission of the Aged to the Hospital

Greenberg, Naomi Schubin; Rosin, Arnold J.

doi:10.1111/j.1532-5415.1982.tb05060.x

Cited by 4 publications

(6 citation statements)

References 11 publications

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“…Only 17 of the 111 others (15%) were referred for geriatric medical review during the hospitalisation (intervention 6, control 11). Seventy-four patients (67%) were referred to a physiotherapist (intervention 36, control 38), 63 (57%) to a social worker (intervention 32, control 31), 52 (47%) to an occupational therapist (intervention 27, control Number referred to nurse for assessment 25), and 20 (18%) were not referred (intervention 9, control 11). Boxes 3, 4 and 5 show the significant predictors for each of the three outcome measures.…”

Section: Resultsmentioning

confidence: 99%

“…Previous studies consistently report impaired function to be a strong predictor of outcomes, including admission status, 25 LOS 4 and functional decline. 26 In concordance, the Waterlow scale was a significant predictor of all three outcomes in our multivariate analyses.…”

Section: Discussionmentioning

confidence: 99%

“…Number neurological category (%) 15 (14) 19 (18) Number cardiovascular category (%) 21 (20) 14 (13) Number respiratory category (%) 13 (12) 5 (5) Number musculoskeletal category (%) 29 (27) 27 (25) Number infectious category (%) 14 (13) 21 (20) Number other category (%) 15 (14) 21 (20) group patients had missing data (P = 0.52 for admission; P = 0.52 for LOS; P = 0.27 for functional decline). Those with missing data were less likely to be admitted than those without missing data (63% v 79%; P = 0.03).…”

Section: Comparison Of Groups At Enrolmentmentioning

confidence: 99%

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A prospective, randomised controlled trial of an aged care nurse intervention within the Emergency Department

Basic

Conforti²

2005

Aust. Health Review

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The aim of this randomised controlled trial involving 224 elderly patients was to determine whether early geriatric assessment (in the form of an aged care nurse intervention based in the emergency department) reduced admission to the hospital, length of inpatient stay (LOS), or functional decline during the hospitalisation. Baseline geriatric assessments were recorded in the medical files of intervention patients (n = 114). The nurse also liaised with the patients' carers and health care providers, organised referrals for out-of-hospital assessment and support services, and assisted in the care of those admitted as inpatients by documenting suggestions for assessment and referral. Assessment data from control patients (n = 110) were withheld, and the nurse had no further involvement in their inpatient or outpatient care. One hundred and seventy-one patients (76%) were admitted to the hospital, for a median LOS of 10 days. The nurse successfully identified those needing admission (odds ratio [OR], 14.0; 95% confidence interval [CI], 2.6-75.1). Thirty-nine of 160 inpatients with available data (24%) had a functional deterioration during the hospitalisation. The intervention had no significant effect on admission to the hospital (OR, 0.7; CI, 0.3-1.7), LOS (hazard ratio, 1.1; CI, 0.7-1.5) or functional decline during the hospitalisation ELDERLY PERSONS VISIT the emergency department (ED) more often than younger persons. 1 They often have serious complaints that limit function and restrict their ability to live independently. For many, hospitalisation results in functional decline despite cure or repair of the condition for which they were admitted. 2,3 Functional status is a strong predictor of LOS, mortality, and nursing home placement. 4,5 Early assessment of elderly patients can identify risk factors that contribute to hospital-acquired dependency. 2,6 The best models of care for older persons visiting emergency departments are not known, and few randomised, controlled trials of interventions in the ED setting have been published. A two-stage intervention, comprising screening and a brief standardised nursing assessment and referral, reduced the rate of functional decline four months after the ED visit. 7 The beneficial outcomes resulted primarily from early provi-

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Comparison Of Groups At Enrolmentmentioning

confidence: 99%

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A prospective, randomised controlled trial of an aged care nurse intervention within the Emergency Department

Basic

Conforti²

2005

Aust. Health Review

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“…Most studies report associations between disability and LOS for selected diagnoses, or in cohorts undergoing rehabilitation rather than general patients in the internal medicine wards. [14][15][16] For example, Bohannon and Cooper demonstrated that LOS and function at discharge were influenced favourably by a higher level of function on admission in selected stroke patients. 14 Also, Greenberg et al observed that geriatric patients, who were more disabled, had longer LOS compared to general medicine patients.…”

Section: Introductionmentioning

confidence: 99%

“…14 Also, Greenberg et al observed that geriatric patients, who were more disabled, had longer LOS compared to general medicine patients. 15 The purpose of this study was to evaluate the relationships between disability as measured with the Functional Independence Measure (FIM) at discharge and LOS in internal medicine patients. This is essential, as Internal Medicine (IM) patients often form the largest cohort of patients in a tertiary general hospital, including all the public hospitals in our country.…”

Section: Introductionmentioning

confidence: 99%

Disability Impacts Length of Stay in General Internal Medicine Patients

Tan

Koh³

et al. 2014

J GEN INTERN MED

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BACKGROUND: Disability is prevalent among patients treated in Internal Medicine (IM), but its impact on length of inpatient stay (LOS) is unknown. Current systems of patient management and resource allocation are disease-focused with scant attention paid to functional impairment. Earlier studies in selected cohorts suggest that disability prolongs LOS. OBJECTIVE: To investigate the relationship of disability with LOS in IM, controlling for comorbidity. DESIGN: Prospective cohort study. PATIENTS: We charted 448 patients from an IM team admitted between 2008 and 2012 for sociodemographic, disease, biochemical and functional characteristics. Each IM team is on duty for one month annually, and patients were hence recruited for one month each year. MAIN MEASURES: Disability was measured using the Functional Independence Measure (FIM) recorded at discharge. Comorbidity was measured using the Charlson Comorbidity Index (CCI). KEY RESULTS: Of the 448 patients, 57.4 % were male with mean age 68.6 years. The mean LOS was 9.58 days. The mean motor and cognitive FIM scores were 57.1 and 25.7, respectively. The mean CCI score was 2.69. Thirty-four percent had major social issues impacting discharge plans. The five most common diagnoses for admission were pneumonia (8.9 %), urinary tract infection (7.8 %), cellulitis (7.6 %), heart failure (7.1 %) and falls (6.0 %). Both cognitive and motor FIM scores were negatively correlated with longer LOS (P<0.001). On multivariate analysis, variables independently associated with longer LOS included the motor FIM score (P<0.001), presence of social issues such as caregiver unavailability (P<0.001), non-realistic patient expectations (P=0.001) and administrative issues impeding discharge (P=0.016). CONCLUSION: Disability predicts LOS in IM patients, and thus their comprehensive care should involve functional assessment. As social and administrative factors were also independently associated with LOS, there is a need to involve social workers and administrators in a multidisciplinary approach towards optimizing LOS.KEY WORDS: internal medicine; hospital medicine; disability; length of stay (LOS). J Gen Intern Med 29(6):885-90

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Benefits of Access to On‐site Acute and Critical Care for the Residential Section of a Multi‐level Geriatric Center

Gordon

Vadas

1984

J American Geriatrics Society

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Of 220 residents living in the residential unit of a multi-level geriatric center, 95 required a total of 131 transfers to other facilities over a one-year period. Fifty-three of these patients were transferred to the associated chronic-care hospital for short-term acute medical investigation or treatment. The average length of stay of 17 days was similar to that of patients of comparable age with comparable medical conditions admitted to an affiliated acute general hospital from the community. In addition to continuity of medical care and the social and psychologic advantages of remaining within the geriatric center, this transfer potential resulted in substantial financial savings. The cost of hospitalization in the general hospital would have been more than twice that of the geriatric unit.

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Factors Influencing Admission or Nonadmission of the Aged to the Hospital

Cited by 4 publications

References 11 publications

A prospective, randomised controlled trial of an aged care nurse intervention within the Emergency Department

A prospective, randomised controlled trial of an aged care nurse intervention within the Emergency Department

Disability Impacts Length of Stay in General Internal Medicine Patients

Benefits of Access to On‐site Acute and Critical Care for the Residential Section of a Multi‐level Geriatric Center

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