Duration and Determinants of First Unplanned Hospitalization among Nursing Home Residents

Abstract

Background: Unplanned hospitalization is an important indicator of changes in nursing home care quality. Institutional residents have higher healthcare usage and hospitalization rates than do the elderly in the general population, leading to negative health effects and increased costs. This study aimed to examine the duration, causes, and determinants of first unplanned hospitalizations among nursing home residents.Methods: A retrospective cohort study was conducted of new residents admitted to nursing homes between 2006 and 2011, residents were observed until 2012 when the causes and duration of unplanned first hospitalizations were investigated. Data, including demographics, admission evaluation findings, care records, and emergency transfer records, were reviewed from resident care records. Results: There was a total of 622 subjects, with unplanned hospitalizations occurring in 54.7% (340) of subjects; the average duration to the first unplanned hospitalization was 13.9 months. From 2006 to 2011, incidents occurred on average at 15.2, 13.6, 10.7, 13.4, 7.8, and 3.2 months. The average duration between occurrences decreased over time. The primary diagnosis for first unplanned hospitalizations were fever, pneumonia, and urinary tract infection. A Cox proportional hazards model analysis showed that older age and the presence of a nasogastric tube, Foley catheter, pulmonary disease, cancer, and gastrointestinal diseases increased the odds of unplanned hospitalization among nursing home residents.Conclusion: Highly dependent nursing home residents requiring intensive care belong to a population at high risk of hospitalization. Future institutional care professionals should identify risk factors in order to provide more appropriate care strategies.