高龄老年患者出院时身心状况对家庭照护者生活质量的影响

目的了解高龄老年患者出院时身心状况及其对家庭照护者生活质量自我感知的影响。方法抽取≥70岁老年住院患者及其主要家庭照护者各316例于出院前1 d实施调查,对家庭照护者生活质量的影响因素进行单因素和多元回归分析。结果高龄老年患者出院时生活自理能力不同程度低下者占21.55%,出院后仍需医疗处置的占71.2%、护理服务的占82.2%,有抑郁倾向者占82.9%;高龄老年患者出院时生活自理能力越低、出院后仍需医疗和护理处置,其家庭照护者对生活质量感知明显的评价越低(P0.05);家庭照护者与患者的关系属于非亲属、有其他辅助照护者,其生活质量感知明显较好(P0.05)。结论高龄老年患者出院时身心状况对家庭照护者生活质量感知的影响明显。护士应在进行高龄老年患者出院护理指导的同时,做好其家庭照护者的支援。     

转诊评估和多学科诊疗模式对老年患者临床治疗效果的影响

目的 评估转诊前改良早期预警评分（MEWS）和转诊后老年多学科整合团队（GIT）查房结合的诊疗模式对老年患者转诊后诊疗的效果。方法 对2012年11月至2013年10月在上海市松江区中心医院和上海市第一人民医院（南院）急诊或留观的老年患者采用MEWS进行转诊前评估,转诊至松江区乐都医院老年医学科后分别进行GIT查房（观察组）和传统医疗模式查房（对照组）,比较两组患者的平均住院天数、好转率、死亡率、医疗费用、再住院率和患者家属满意度等指标。结果 共转诊老年患者306例,其中156例（观察组）接受GIT查房诊疗,好转出院150例（96.2%）,死亡1例（0.64%）。其余150例（对照组）接受传统医疗模式查房,好转出院134例（89.1%）,死亡3例（2.0%）。观察组平均住院天数（17.7±13.1）d,好转率96.2%,平均医疗费用（8275.32±4680.33）元,再住院率1.28%,家属满意率95.5%,均优于对照组,差异具有统计学意义（P＜0.05）。结论 老年患者住院需求较高,转诊评估和GIT查房诊疗能为老年共病患者提供有效的医疗管理手段,并提供连续性医疗服务,提高患者及家属的满意度。     

90岁以上老年住院患者的临床特点及预后分析

目的 了解超高龄老年（≥90岁）住院患者的住院现况及其住院死亡的相关危险因素。方法 从医院管理信息系统检索2014年12月1日至2015年11月30日期间从我院普通病区出院的所有年龄≥90岁的病例。采用回顾性分析方法,分别登记患者年龄、性别、就诊病因、住院病区、住院时间、转归等病历资料,从住院病历中和实验室信息系统系统提取入院时的生命体征以及入院时血常规、生化检查结果。结果 过去1年间,我院年龄≥90岁住院患者共231例,住院340例次,患者年龄（92.09±2.08）岁,中位住院时间10（5,16）d。入院诊断前3位疾病分别为肺部感染、冠心病和骨折。231例超高龄老年住院患者中死亡40例（17.32%）。死亡患者的前3位入院诊断分别为肺部感染、脑血管疾病和晚期恶性肿瘤。多因素分析显示,因肺部感染住院、休克指数（SI）≥0.7,中性粒细胞比例≥0.7,血尿素≥12mmol/L和白蛋白＜35g/L是高龄住院患者死亡的危险因素。结论 肺部感染是≥90老年患者最常见的入院原因,应加强超高龄老年住院患者炎症状态、循环状态和营养状态的评估。     

住院老年共病患者5 505例疾病分布特点分析

目的：了解老年共病患者的患病数量、患病种类及不同年龄组老年共病患者所患疾病的分布特点,为加强老年共病管理及防治提供参考数据。方法对2008年至2013年住院的5505例老年共病患者进行数据收集,记录所患疾病及一般特征。按年龄分为3组,低龄组65～74岁,中龄组75～84岁,高龄组≥85岁。结果5505例老年共病患者,年龄65～104（80.70±6.41）岁,其中男性3772例,女性1733例。所患共病数量2～23种,其中患病数量在5～9种之间的患者人数为3125例,占56.76%。老年共病患者患病种类统计分析显示脑血管病占首位（58.31%）,此后依次是高血压（52.97%）、感染性疾病（51.57%）、冠心病（41.11%）、糖尿病（30.55%）、心功能不全（28.45%）、肾脏病（23.67%）、骨关节病（21.91%）、肿瘤（17.31%）、胃肠道疾病（16.17%）。按各年龄组进行分析,不同年龄组患病种类有所不同,感染性疾病在≥85岁的老年共病患者中所占比例较＜85岁的显著性增高（78.89%vs 27.15%,P＜0.05）。结论老年共病患者患病数量多集中在5～9种,以脑血管病、高血压、感染性疾病、冠心病、糖尿病为高发疾病,不同年龄老年共病患者所患疾病有所不同,感染性疾病在高龄老年患者中增多。     

社区老年人日常生活能力及影响因素

目的了解社区居住老年人日常生活能力(ADL)情况,分析影响老年人ADL的因素。方法采用2013年"上海市老年长期照护需求调查"中上海市江宁街道的调查数据,以巴特尔日常生活能力指数评估研究对象的ADL情况,分析调查对象ADL分布情况及其相关因素。结果研究对象共8 389人,年龄为(72.13±9.17)岁。其中,15.6%存在ADL损害,失能者(ADL中度及以上依赖)为3.9%;3.9%需要照护者未得到充足的照护。年龄、居住模式、慢性病患病、健康状况和得到照护情况与失能相关。结论社区居住老年人中存在一定比例的失能老人,部分老人未得到充足照护,尤其在ADL依赖等级高的老年人中。随着年龄增加,失能的风险增加。预防慢性疾病发生,尤其是预防多种慢性疾病并存,改善全身健康状况将有助于预防老年失能的发生。     

基于社区单向转诊老年急性心肌梗死患者的临床特点

目的分析社区单向转诊老年急性心肌梗死(AMI)患者的临床特征。方法回顾调查单向转诊老年AMI患者117例,根据年龄分为老年组(≥60岁)和非老年组(<60岁),比较两组患者临床特征。结果社区单向转诊老年AMI患者的临床特征为:男女性别比例不明显、有较多冠心病和脑血管意外病史、发病时心功能较差、接受择期经皮冠状动脉成形术(PCI)手术较多(P<0.05)。结论社区单向转诊老年AMI患者行择期PCI更合理,建议制定社区与三级医院老年AMI双向转诊和分级救治指南。     

居家高龄老人生活自理能力及相关因素

目的了解上海市闸北区共和新社区居家高龄老人的日常生活自理能力及其相关因素。方法通过问卷调查了366名高龄老人的基本情况、健康状况、生活自理能力状况等方面内容。结果 77.6%调查对象生活自理能力为正常,单因素分析表明年龄、脑血管疾病患病情况、负面情绪、健康状况自评及生活满意度与生活自理能力受损有关,多因素回归分析表明年龄、文化程度、健康状况自评、生活满意度四项因素和生活自理能力相关。结论社区卫生人员应加强高龄老人慢性病管理,积极进行健康教育,并关注高龄老人心理健康。     

综合医院老年住院患者联络会诊精神医学服务模式探讨

目的：通过对某三级甲等医院老年病房的住院患者进行老年综合评估CGA,并在此基础上提供联络会诊精神医学服务（CLPS）,对如何提高综合医院老年住院患者精神医学服务的可及性进行探索。方法回顾性地分析2009年9月至2012年8月期间入住该医院老年示范病房的患者（年龄≥65岁）,入院时接受CGA（Zung自评抑郁量表和Zung自评焦虑量表）,必要时进行老年多学科团队查房和精神医学会诊。由精神科医师根据国际疾病分类标准-10（ICD-10）做出精神科诊断。经过上述CLPS的老年患者与同期其他病房接受应邀精神科会诊的老年患者（年龄≥65岁）进行比较。结果老年病房共146例患者接受CLPS,其他病房共520例患者接受应邀会诊精神医学服务。老年病房的会诊率为28.2%,显著高于其他病房1.5%的会诊率（P＝0.000）。接受精神医学服务的前3位原因在老年病房分别为情绪问题（44.5%）、随诊问题（16.4%）和内科疾病无法解释的症状（10.3%）;在其他病房分别为情绪问题（37.9%）、精神问题（20.4%）和内科疾病无法解释的症状（10.1%）,两者比较差异有统计学意义（P＝0.000）。老年病房前3位精神科诊断为神经症及应激相关障碍（29.7%）、情感障碍（26.9%）和器质性精神障碍（21.4%）;其他病房为神经症及应激相关障碍（35.0%）、器质性精神障碍（28.8%）和情感障碍（16.5%）,两者比较差异有统计学意义（P＝0.001）。结论以CGA、精神科访谈和多学科治疗团队联合查房模式进行的CLPS可提高综合医院老年住院患者的精神科会诊率,上述医学服务模式值得在综合医院推广。     

温州城乡585例空巢老人健康状况的调查分析

目的 了解城乡空巢老人的健康状况和社区护理需求,为空巢老人的健康老龄化提供依据.方法 采用问卷调查表,随机抽取温州市所属区县和乡镇的常住人口中的≥60岁空巢老人.通过入户问卷进行调查,问卷包括人口学统计资料、健康状况、护理需求、日常生活能力等8项内容组成.结果 空巢老人患病率高,患1种以上疾病者占81.70%,患4种以上疾病者占20.85%,文盲组与大专组患病有显著差异性（＜0.01）;干部与农民组有极显著差异性（＜0.001）,干部在老年人群中患病比例最高.结论 高血压是最常见的慢性病;文化程度对空巢老人患病影响非常明显,脑力劳动者患病率较高.改善社会支持系统,建立社区老年人健康档案,合理的社区护理,对空巢老人健康老龄化很有必要.     

北京社区老年人群促红细胞生成素水平及贫血相关因素研究

目的 调查北京部分社区60岁以上老人促红细胞生成素（EPO）水平,并分析老年贫血的相关因素。方法 2011年2月至2011年9月,通过随机抽样方法对从北京市朝阳区411名社区老人进行问卷调查、实验室检查,包括人口学资料,血红蛋白（Hb）、铁蛋白（FER）、叶酸（FOL）、维生素B12（VB12）、肌酐（Cr）和白细胞（WBC）等内容;采用酶联免疫吸附实验定量（ELISA）测定血清EPO水平及采用Logistic回归分析老年贫血的相关因素。结果北京社区60岁以上老年人群EPO95%医学参考值范围,男性：2.37～29.83mIU/ml,女性：2.40～26.96mIU/mL。贫血患病率为8.52%,男性、女性患病率分别为：7.99%、8.97%,无统计学差异（P〉0.05）。贫血组与非贫血组人群EPO、WBC水平的差异有统计学意义（P〈0.05）。Logistic回归分析显示,老年贫血发生的相关因素有EPO、年龄、VB12（P〈0.05）。结论北京社区老年贫血患者EPO水平显著高于非贫血人群,老年贫血与年龄、血EPO及VB12水平相关。     

Geriatric syndromes as predictors of adverse outcomes of hospitalization

Aims: The aim of this study was to determine the association between the common geriatric syndromes and predefined adverse outcomes of hospitalization and to identify the most important independent predictors of adverse outcomes using information gained within 24 h of admission in older general medical patients. Methods: A prospective longitudinal cohort study of patients aged ≥75 years admitted to the rapid assessment medical unit in a teaching hospital was carried out. The role of geriatric syndromes in predicting outcomes was examined in univariate and multivariate models. The outcome measures were (i) length of hospital stay (LOS) of 28 days or more, (ii) institutionalization or change in residential care status to a more dependent category at discharge or during 3 months post‐discharge, (iii) unplanned readmissions during 3 months and (iv) mortality in hospital or 3 months post‐discharge. Results: The presence of geriatric syndromes was significantly associated with increased LOS and institutionalization or change in residential care status to a more dependent category. The factors most predictive of these outcomes were impaired pre‐admission functional status in activities of daily living, recurrent falls, urinary incontinence and supported living arrangements. The geriatric syndromes appeared less important in predicting unplanned readmission and death. Conclusion: The presence of geriatric syndromes in older general medical patients is an important determinant of adverse outcomes of hospitalization, particularly of LOS and admission to residential care. The predictors most useful for screening patients for these outcomes, within 24 h of admission, appear to be the presence of certain pre‐existing geriatric syndromes before admission.     

Effects of functional status changes before and during hospitalization on nursing home admission of older adults

BACKGROUND: Functional status changes before and during hospitalization may have important effects on outcomes in older adults, but these effects are not well understood. We determined the influence of functional status changes on the risk of nursing home (NH) admission after hospitalization. METHODS: Subjects were 551 general medical patients > or = 70 years old (66% female; mean age = 80 years) admitted from home to a large Midwestern teaching hospital. Functional status change measures were based on patients' need for assistance in five personal activities of daily living (ADL) 2 weeks prior to hospital admission, the day of admission, and the day of discharge. Sociodemographic and clinical characteristics were included in multivariate models predicting NH admission. RESULTS: Functional status change categories were: stable in function before and during hospitalization (45% of study patients); decline in function before and improvement during hospitalization (26%); stable before and decline during hospitalization (15%); decline before and no improvement during hospitalization (13%). In multivariate analyses, patients in the decline-no improvement group (odds ratio [OR] = 3.19; 95% confidence interval [CI] = 1.46-6.96) and patients in the stable-decline group (OR = 2.77; 95% CI = 1.29-5.96) were at greater risk for NH admission than patients in the stable-stable group. In a multivariate model that controlled for ADL function at hospital discharge, functional status change was no longer statistically significantly associated with NH admission. CONCLUSIONS: Discharge function is a key risk factor for NH admission among hospitalized older adults. Because functional status changes before and during hospitalization are key determinants of discharge function, they provide important clues about the potential to modify that risk. Functional recovery during a hospital stay after prior functional decline, and prevention of in-hospital functional decline after prior functional stability, are important targets for clinical intervention to minimize the risk of NH admission.     

卡托普利早期和长期治疗对老年急性心肌梗死患者生存率的影响

目的　比较早期和长期卡托普利治疗对≥65岁和＜65岁急性心肌梗死(心梗)患者生存率的影响。　方法　根据是否早期及长期卡托普利治疗,将822例首次心梗72h内入院患者分为＜65岁卡托普利组209例、≥65岁卡托普利组269例,＜65岁对照组131例、≥65岁对照组213例。　　结果　住院期(1～42d)＜65岁卡托普利组死亡8例(3.83%),＜65岁对照组死亡10例(7.63%),差异无显著性(P＞0.05);≥65岁卡托普利组死亡25例（9.29%）,≥65岁对照组死亡52例（24.41%）,差异有显著性(P＜0.0001)。卡托普利治疗患者住院期心原性死亡与年龄相关(P=0.0002),随访1.3～54.0个月表明,心原性死亡与年龄关系不密切;＜65岁卡托普利组158例中猝死3例(1.9%),＜65岁对照组97例猝死11例(11.4%,P＜0.01);≥65岁卡托普利终访192例中猝死7例(3.6%),≥65岁对照组终访128例中猝死25例(19.5%,P＜0.01)。≥65岁和＜65岁卡托普利组心源性事件发生也低于相应对照组(P＜0.01)。　结论　卡托普利治疗急性心梗作用住院期有年龄差异,而长期应用改善预后作用无年龄差异。     

A study of hepatitis C prevalence in healthcare workers in the West of Scotland

BACKGROUND AND AIMS: Whether healthcare workers have an increased prevalence of hepatitis C virus infection as a result of exposure to patient's blood and body fluids is controversial. This study assesses the prevalence of hepatitis C virus infection in healthcare workers, and its relation to the performance of exposure prone procedures and duration of occupational exposure, allowing an estimate to be made of the incidence of occupationally acquired hepatitis C infection among medical staff. METHODS: In this anonymous retrospective cohort study, we estimated the prevalence of hepatitis C infection in 10 654 healthcare workers. ELISA-3 testing was performed on pools of five sera collected during immunisation against hepatitis B. Healthcare workers were arranged into five occupational groups, according to the degree of patient exposure, and three age bands (<30 years, 30-39 years, >40 years). RESULTS: Prevalence of antibodies to hepatitis C was 0.28% (30/10 654), comparable in all occupational groups (p=0.34) and unrelated to duration of potential exposure. Assuming that all detected infections had been occupationally acquired, the maximum estimated risk of hepatitis C infection in exposure prone medical staff was low: 1.4% for surgeons and 1.0% for physicians over a 35 year professional career. CONCLUSIONS: Hepatitis C infection is infrequent in healthcare workers in Glasgow. Those conducting exposure prone procedures do not seem to be at higher risk than other healthcare staff.     

Disparities between black and white patients in functional improvement after hospitalization for an acute illness

The aim of this study was to determine whether older black and white patients experience different rates of improvement in functioning after being acutely hospitalized. Of the 2,364 community-living patients in this prospective cohort study, 25% self-reported their race/ethnicity to be black. The outcomes were improvement in basic activities of daily living (ADLs) and instrumental activities of daily living (IADLs) from admission to discharge and 90 days postdischarge. Multivariable models that included statistical adjustment for age, illness severity, in-hospital social service referral, dementia, admission level of functioning, and change in functioning from 2 weeks before admission were computed to determine whether black and white patients experienced significantly different rates of recovery at discharge and 90 days after discharge in ADL and IADL functioning. Black patients were as likely as white patients to improve in ADL functioning by discharge (odds ratio (OR)=0.97, 95% confidence interval (CI)=0.76-1.24) or by 90 days after discharge (OR=0.95, 95% CI=0.73-1.24) but significantly less likely to improve IADL functioning by discharge (OR=0.72, 95% CI=0.56-0.93) or by 90 days after discharge (OR=0.68, 95% CI=0.51-0.90). The findings suggest that differential rates of recovery in functioning after an acute hospitalization may contribute to racial/ethnic disparities in IADL functioning, which has implications for the setting of future interventions oriented toward reducing these disparities.     

Investigation of colonization with methicillin-resistant and methicillin-susceptible Staphylococcus aureus in an outpatient population in Turkey

Methicillin-resistant Staphylococcus aureus (MRSA), known as a nosocomial pathogen, has been isolated from community-acquired infections since the 1980s. It has been reported that there are carriers of MRSA in the community although the rate of carriers is low and the most important risk factor of community-acquired carriage is hospitalization or referral to healthcare facilities. We attempted to investigate methicillin-resistant and methicillin-susceptible S. aureus colonization, respectively, in nasal and axillary swabs obtained from 500 patients without a history of hospitalization who were admitted to outpatient clinics and from 102 healthcare workers chosen as a control group. Of the patients, 9.4% had nasal S. aureus colonization without methicillin-resistant strains. Of the health care workers, 8.8% had S. aureus colonization without methicillin-resistant strains and only one worker had MRSA. The nasal carriage ratio of S. aureus in children was found to be 19.1% (22 of 115), and that in adults was 6.5% (25 of 385). The difference between the two age groups was determined as statistically significant (P = 0.006).     

Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age

OBJECTIVES: To describe the changes in activities of daily living (ADL) function occurring before and after hospital admission in older people hospitalized with medical illness and to assess the effect of age on loss of ADL function. DESIGN: Prospective observational study. SETTING: The general medical service of two hospitals. PARTICIPANTS: Two thousand two hundred ninety-three patients aged 70 and older (mean age 80, 64% women, 24% nonwhite). MEASUREMENTS: At the time of hospital admission, patients or their surrogates were interviewed about their independence in five ADLs (bathing, dressing, eating, transferring, and toileting) 2 weeks before admission (baseline) and at admission. Subjects were interviewed about ADL function at discharge. Outcome measures included functional decline between baseline and discharge and functional changes between baseline and admission and between admission and discharge. RESULTS: Thirty-five percent of patients declined in ADL function between baseline and discharge. This included the 23% of patients who declined between baseline and admission and failed to recover to baseline function between admission and discharge and the 12% of patients who did not decline between baseline and admission but declined between hospital admission and discharge. Twenty percent of patients declined between baseline and admission but recovered to baseline function between admission and discharge. The frequency of ADL decline between baseline and discharge varied markedly with age (23%, 28%, 38%, 50%, and 63% in patients aged 70-74, 75-79, 80-84, 85-89, and > or =90, respectively, P <.001). After adjustment for potential confounders, age was not associated with ADL decline before hospitalization (odds ratio (OR) for patients aged > or =90 compared with patients aged 70-74 = 1.26, 95% confidence interval (CI) = 0.88-1.82). In contrast, age was associated with the failure to recover ADL function during hospitalization in patients who declined before admission (OR for patients aged > or =90 compared with patients aged 70-74 = 2.09, 95% CI = 1.20-3.65) and with new losses of ADL function during hospitalization in patients who did not decline before admission (OR for patients aged > or =90 compared with patients aged 70-74 = 3.43, 95% CI = 1.92-6.12). CONCLUSION: Many hospitalized older people are discharged with ADL function that is worse than their baseline function. The oldest patients are at particularly high risk of poor functional outcomes because they are less likely to recover ADL function lost before admission and more likely to develop new functional deficits during hospitalization     

Bacterial infection in cirrhotic patient

BACKGROUND: Bacterial infections at admission or during hospitalization are frequent complication of cirrhosis that occurs in about 30% of the cases. Furthermore they are responsible for 25% of deaths in this population. AIM: Evaluate the prevalence of bacterial infections in cirrhotic patients at a general hospital and determine its correlation with alcoholic etiology of liver disease; degree of hepatic dysfunction and upper gastrointestinal bleeding. PATIENTS/METHODS: Five hundred and forty one admissions were retrospectively evaluated in 426 cirrhotic patients at years 1992 to 2000. The mean age was 50.5 years (15-95), being 71.2% male. The alcoholic etiology of cirrhosis was 35.4%. The main outcome considered was discharge or death during admission. RESULTS: One hundred and thirty five episodes of bacterial infections (25%) were diagnosed. The most frequent are urinary tract infection (31.1%), spontaneous bacterial peritonitis (25.9%) and pneumonia (25.2%). The association between urinary tract infection and pneumonia occurred in 3.7% and erysipelas or cellulites in 11.1%. Bacteremia occurred in 2.9%. There was a correlation between bacterial infection and alcoholic etiology of liver disease, hepatic dysfunction and upper gastrointestinal bleeding. The mortality was higher in the infected patients (8.9%) and in those with a poor hepatic function. CONCLUSIONS: Bacterial infections are common complications in cirrhotic patients and are correlated with alcoholic etiology, Child Pugh classification and upper gastrointestinal bleeding. Furthermore, bacterial infections are correlated with poor prognosis.     

Older patients’ depressive symptoms 6 months after prolonged hospitalization: Course and interrelationships with major associated factors

The aim of this study was to examine the course of depressive symptoms in older patients 6 months following a prolonged, acute hospitalization, especially the interrelationships among depressive symptoms and its major associated factors. For this study, we conducted a secondary analysis of data from a prospective cohort study of 351 patients aged 65 years and older. Participants were recruited from five surgical and medical wards at a tertiary medical center in northern Taiwan and assessed at three time points: within 48 h of admission, before discharge, and 6 months post-discharge. The course of depressive symptoms was dynamic with symptoms increased spontaneously and substantially during hospitalization and subsided at 6 months after discharge, but still remained higher than at admission. Overall, 26.7% of older patients at hospital discharge met established criteria for minor depression (15-item Geriatric Depressive Scale (GDS-15) scores 5–9) and 21.2% for major depression (GDS-15 scores >10). As the strongest associated factors, functional dependence and nutritional status influenced depressive symptoms following hospitalization. Depressive symptoms at discharge showed significant cross-lagged effects on functional dependence and nutritional status at 6 months after discharge, suggesting a reciprocal, triadic relationship. Thus, treating one condition might improve the other. Targeting the triad of depressive symptoms, functional dependence, and nutritional status, therefore, is essential for treating depressive symptoms and improving the overall health of older adults hospitalized for acute illness.     

Characteristics associated with inappropriate hospital use in elderly patients admitted to a general internal medicine service

Our objective was to identify patient characteristics associated with inappropriate hospital days in a cohort of elderly medical inpatients. This prospective cohort study included a total of 196 patients aged 75 years and older, who were consecutively admitted over eight months to the internal medicine service of a regional, non-academic public hospital located in a rural area of Western Switzerland. Patients with severe cognitive impairment, terminal disease, or previously living in a nursing home were excluded. Data on demographics, medical, physical, social and mental status were collected at admission. A blinded hospitalization review was performed concurrently using a modified version of the Appropriateness Evaluation Protocol (AEP). Subjects' mean age was 82.4 years; 63.3% were women. Median length of stay was 8 days. Overall, 68 patients (34.7%) had at least one inappropriate day during their stay, including 18 patients (9.2%) whose hospital admission and entire stay were considered inappropriate. Most inappropriate days were due to discharge delays (87.10%), primarily to nursing homes (59.30%). Univariate analysis showed that subjects with inappropriate days were more likely to be living alone (69.1 vs 48.4%, p=0.006), and receiving formal in-home help (48.5 vs 32.8%, p=0.031). In addition, they were more impaired in basic and instrumental activities of daily living (BADLs, and IADLs, p<0.001 and p=0.015, respectively), and more frequently had a depressed mood [29.4 vs 10.9%, p=0.001 with a score > 6 at the Geriatric Depression Scale (GDS), short form]. Using multivariate analysis, independent associations remained for patients living alone (OR 2.6, 95%CI 1.2-5.8, p=0.016), those with a depressed mood (OR 2.8, 95%CI 1.1-7.3, p=0.032), with BADL dependencies (OR 1.5, 95%CI 1.2-1.8, p=0.001), and IADL dependencies (OR 1.3, 95%CI 1.0-1.6, p=0.032). Cardiovascular (OR 0.2, 95%CI 0.1-0.7, p=0.008) and pulmonary admission diagnoses (OR 0.1, 95%CI 0.0-0.7, p=0.022) were inversely associated with inappropriate hospital days. In conclusion, patients living alone, functionally impaired and showing depressive symptoms were at increased risk for inappropriate hospital days. These characteristics might permit better targeting for early discharge planning in these at-risk subjects, and contribute to avoiding premature discharge of other vulnerable elderly patients. Whether these interventions for at-risk patients will also result in prevention of hospitalization hazards, such as deconditioning and related functional decline, will require further study.