Unplanned nursing home admission among discharged polymedicated older inpatients: a single-centre, registry-based study in Switzerland

Abstract

ObjectiveTo investigate patient characteristics and the available health and drug data associated with unplanned nursing home admission following an acute hospital admission or readmission.DesignA population-based hospital registry study.SettingA public hospital in southern Switzerland (Valais Hospital).ParticipantsWe explored a population-based longitudinal dataset of 14 705 hospital admissions from 2015 to 2018.Outcome measuresSociodemographic, health and drug data, and their interactions predicting the risk of unplanned nursing home admission.ResultsThe mean prevalence of unplanned nursing home admission after hospital discharge was 6.1% (n=903/N=14 705). Our predictive analysis revealed that the oldest adults (OR=1.07 for each additional year of age; 95% CI 1.05 to 1.08) presenting with impaired functional mobility (OR=3.22; 95% CI 2.67 to 3.87), dependency in the activities of daily living (OR=4.62; 95% CI 3.76 to 5.67), cognitive impairment (OR=3.75; 95% CI 3.06 to 4.59) and traumatic injuries (OR=1.58; 95% CI 1.25 to 2.01) had a higher probability of unplanned nursing home admission. The number of International Classification of Diseases, 10th version diagnoses had no significant impact on nursing home admissions, contrarily to the number of prescribed drugs (OR=1.17; 95% CI 1.15 to 1.19). Antiemetics/antinauseants (OR=2.53; 95% CI 1.21 to 5.30), digestives (OR=1.78; 95% CI 1.09 to 2.90), psycholeptics (OR=1.76; 95% CI 1.60 to 1.93), antiepileptics (OR=1.49; 95% CI 1.25 to 1.79) and anti-Parkinson’s drugs (OR=1.40; 95% CI 1.12 to 1.75) were strongly linked to unplanned nursing home admission.ConclusionsNumerous risk factors for unplanned nursing home admission were identified. To prevent the adverse health outcomes that precipitate acute hospitalisations and unplanned nursing home admissions, ambulatory care providers should consider these risk factors in their care planning for older adults before they reach a state requiring hospitalisation.

Development of a patient-centred medication management model for polymedicated home-dwelling older adults after hospital discharge: results of a mixed methods study

“…Although we found no statistically significant associations between the prescription of analgesics at discharge and hospital readmission,28 discharge-day pain scores have previously been associated with 30-day hospital readmissions 61. Indeed, our logistic regression analysis revealed that older adults with analgesic prescriptions had a higher probability of unplanned nursing home admission (adjusted for age, sex, number of comorbidities and functional status) 29. Four participants and their informal caregivers described inadequate pain management during our qualitative phase, which might be explained by poor discharge planning and older adults’ complaints of not feeling sufficiently listened to or involved in medication-related decisions.…”

“…The mean hospital length of stay was 8.6 days (SD=7.6). The mean number of drugs prescribed at hospital discharge was 9.1 (SD=3.3), with means of 10.9 (SD=3.9) drugs for patients discharged to a nursing home versus 8.9 (SD=3.2) for those discharged home 29…”

“…Detailed quantitative23 28 29 and qualitative43 44 findings have been published in previous papers. Therefore, this section connects and integrates both sets of findings (table 1) and draws conclusions on how the qualitative results help to explain and extend specific quantitative results.…”

“…Furthermore, we included all the hospital stays, from 2015 to 2018, by polymedicated older adults with no missing data who had not died during hospitalisation (n=14 705) to investigate patient characteristics and the available health and drug data associated with their unplanned nursing home admission following an acute hospital admission or readmission 29…”

Safe Medication Management for Polymedicated Home-Dwelling Older Adults after Hospital Discharge: A Qualitative Study of Older Adults, Informal Caregivers and Healthcare Professionals’ Perspectives

“…Without preventative measures, MRPs can lead to physical and cognitive decline, exacerbated chronic medical conditions, rehospitalisations, avoidable health costs [9][10][11], and, sometimes, unplanned institutionalisation [12]. Nurses can play a crucial preventative role in ensuring safe medication management for polymedicated home-dwelling older adults [13,14].…”