JAMDA
Volume 3, Issue 3 , Pages 130-135, May 2002

Hospitalization Risk Following Admission to an Academic Nursing Home

  • Kenneth Boockvar, MD, MS

      Affiliations

    • Department of Geriatrics, Mount Sinai School of Medicine, and The Jewish Home and Hospital, New York, New York
    • Corresponding Author InformationAddress correspondence and requests for reprints to Kenneth S. Boockvar, MD, MS, Mount Sinai School of Medicine, Department of Geriatrics, Box 1070, One Gustave L. Levy Place, New York, NY 10029-6574.
    • ,
  • Mark Lachs, MD, MPH

      Affiliations

    • Division of Geriatrics, Weill Medical College of Cornell University, New York, New York

Objectives

Nursing home residents are at risk for experiencing acute illness and hospitalization early in nursing home stay. The objectives of this study were (1) to measure the probability of hospitalization over time from nursing home admission, and (2) to determine resident risk factors for early hospitalization.

Design

Prospective observational study.

Setting

409-bed urban, not-for-profit academic nursing home.

Participants

204 consecutive newly admitted residents who did not previously reside in the nursing home.

Measurements

Demographic profile, chronic comorbidity, physical function, recent medical events, admission condition and anticipated length of stay were ascertained on admission to the nursing home. Hospitalization and acute illness were recorded each week after nursing home admission. Data were collected primarily by chart review except for acute illness, which was identified by nurse report and chart review according to previously established criteria.

Results

Subjects were 69% female and 62% white. The mean age was 83. The percentage of residents experiencing their first hospitalization peaked 2 and 7 weeks after nursing home admission and after 14 weeks plateaued at a low rate. The percentage with acute illness (commonly gastroenteritis, urinary tract infection, and pneumonia) paralleled that of hospitalization. In multivariate proportional hazards analysis, resident factors independently associated with early first hospitalization were atrial fibrillation (21% of subjects, 2.6 risk ratio), history of stroke (26%, 2.5), history of depression (25%, 1.9), absence of dementia (62%, 2.3), and receiving antibiotics on admission (23%, 3.3). Residents with 0, 1, 2, and ≥ 3 of these characteristics had 9%, 19%, 34% and 62% probability, respectively, of being hospitalized in the first 8 weeks of nursing home stay.

Conclusions

In a large, urban, academic nursing home, residents’ risk of hospitalization varied over time from admission and among different subgroups of residents. These results can be used to develop interventions to prevent acute illness and hospitalization early in nursing home stay and to enhance the communication of prognostic risk to nursing home residents, their caregivers and medical providers.

Keywords: nursing homes, hospitalization, risk factors, acute disease

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 This work was performed in part while Dr. Boockvar was supported by Agency for Health Care Policy and Research (now Agency for Health Research and Quality) Health Services Research training Grant OKT2HS00066B. Dr. Boockvar is now a Hartford Foundation Center of Excellence Scholar at Mount Sinai and recipient of the Hoar Fellowship from the New York Academy of Medicine. Dr. Lachs is a Paul Beeson Physician Faculty Scholar (American Federation for Aging Research) and recipient of National Institute on Aging academic leadership award KO7AG00853–03.

PII: S1525-8610(04)70454-5

doi:10.1016/S1525-8610(04)70454-5

JAMDA
Volume 3, Issue 3 , Pages 130-135, May 2002

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