Predictors of institution admission in the year following acute hospitalisation of elderly people

Objectives

The aim of the study was to identify factors related to institutionalisation within one-year follow up of subjects aged 75 or over, hospitalised via the emergency department (ED).

Design

Prospective multicentre cohort.

Setting

Nine French university teaching hospitals.

Participants

One thousand and forty seven (1 047) non institutionalised subjects aged 75 or over, hospitalised via ED. A sub group analysis was performed on the 894 subjects with a caregiver.

Measurements

Patients were assessed using Comprehensive Geriatric Assessment (CGA) tools. Cox survival analysis was performed to identify predictors of institutionalisation at one year.

Results

Within one year after hospital admission, 210 (20.1%) subjects were institutionalised For the overall study population, age >85 years (HR 1.6; 95% CI 1.1–2.1; p=0.005), inability to use the toilet (HR 1.6; 95%CI 1.1–2.4; p=0.007), balance disorders (HR 1.6; 95%CI 1.1–2.1; p=0.005) and presence of dementia syndrome (HR 1.9; 95%CI 1.4–2.6; p<0.001) proved to be independent predictors of institutionalisation; while a greater number of children was inversely linked to institutionalisation (HR 0.8; 95%CI 0.7–0.9; p<:0.001). Bathing was of borderline significance (p=.09). For subjects with a caregiver, initial caregiver burden was significantly linked to institutionalisation within one year, in addition to the predictors observed in the overall study population.

Conclusions

CGA performed at the beginning of hospitalisation in acute medical wards is useful to predict institutionalisation. Most of the predictors identified can lead to targeted therapeutic options with a view to preventing or delaying institution admission.