Abstract
ObjectiveThe importance of cognitive and physical functioning for nursing home admission among medically hospitalized older patients is rarely studied in a one-year follow-up perspective. This study aims to explore the association between patient characteristics and nursing home admission within one year after hospitalization in persons 65 years or more.DesignA one-year longitudinal study.MethodsWe included 463 (234 women) persons aged 65 years or more from internal medical wards in a rural area of Norway. Cognitive function was assessed using the Mini Mental State Examination; physical and instrumental functional status was assessed using the physical self-maintenance scale and instrumental activities of daily living scale of Lawton and Brody. Comorbidity was measured with the Charlson index. Admission to nursing home within one year (yes versus no) was analyzed using logistic regression analysis and Cox proportional hazard regression analysis.ResultsThe mean age of the sample was 80.5 (SD 7.4) years, mean Mini Mental State Examination score was 24.1 (SD 3.8) (maximum score is 30). In adjusted analysis participants with cognitive impairment (a Mini Mental State Examination score <25) or impaired physical functioning at baseline had higher risk of admission to nursing home within one year (OR 3.0, 95%CI 1.5–6.2 and OR 3.5, 95%CI 1.8–9.6, respectively). The time before admission was also associated with cognitive impairment and impaired physical functioning in the adjusted analysis (HR 2.6 95%CI 1.4–4.8 and HR 3.7, 95%CI 1.5–8.9, respectively).ConclusionImpaired cognitive and physical functioning increased the risk for nursing home admission within one year after hospitalization. However, putative regressors, such as education and social network were not included in the analysis.
Highlights
The risk of admission to nursing home after discharge from hospital within a period of one year is increased compared to older persons with no hospitalization [1,2]
Impaired cognitive and physical functioning increased the risk for nursing home admission within one year after hospitalization
The independent importance of cognitive function at baseline for later nursing home admission among medically hospitalized older persons is rarely studied in the perspective of one year or longer, but communitybased studies have shown that more severe cognitive impairment independently increases the risk of nursing home admission [1,6,7]
Summary
The risk of admission to nursing home after discharge from hospital within a period of one year is increased compared to older persons with no hospitalization [1,2]. In a recently published study, using a validated screening tool it was reported that the risk of nursing home admission within one year was very high among older community dwelling persons with pronounced cognitive impairment [8]. One of them followed acutely hospitalized Dutch older patients and found failure to regain functional status within three months after hospitalization to be important for nursing home admission [2].The second study including patients discharged from internal medicine wards in France, found that a higher frailty index score increased the risk of institutionalization within one year [16]. The importance of each health indicator for nursing home admission was, difficult to assess in this study because the authors used a single index measure instead of multiple measures
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