Predictors of In-Hospital Mortality Among Hospitalized Nursing Home Residents: An Analysis of the National Hospital Discharge Surveys 2005–2006

Objective

To determine the demographic and clinical predictors of in-hospital mortality among hospitalized nursing home (NH) residents.

Design

Retrospective analysis of the public-use copies of the 2005–2006 National Hospital Discharge Survey (NHDS) datasets.

Setting

Non-federal acute-care, short-stay hospitals in all 50 states and the District of Columbia.

Participants

Participants were 1904 and 1752 NH residents, 45 years or older, hospitalized in 2005 and 2006, respectively.

Measurements

In-hospital mortality.

Methods

A multivariable logistic regression model was developed to determine independent predictors of in-hospital mortality using the 2005 dataset. The model was then applied to the 2006 dataset to determine the generalizability of the predictors.

Results

Significant independent predictors of in-hospital mortality in 2005 included age 85 years or older (adjusted odds ratio [OR], 2.53; 95% confidence interval [CI], 1.21–5.30; P=.013), acute respiratory failure (adjusted OR, 5.67; 95% CI, 3.51–9.17; P < .0001), septicemia (adjusted OR, 4.63; 95% CI, 3.08–6.96; P < .0001), and acute renal failure (adjusted OR, 2.11; 95% CI, 1.30–3.41; P=.002). The following baseline characteristics also predicted in-hospital mortality in 2006: age 85 years or older (adjusted OR, 2.45; 95% CI, 1.31–4.59; P=.005), acute respiratory failure (adjusted OR, 7.11; 95% CI, 4.46–11.33; P < .0001), septicemia (adjusted OR, 3.91; 95% CI, 2.64–5.80; P < .0001), and acute renal failure (adjusted OR, 2.75; 95% CI, 1.82–4.15; P < .0001). Chronic morbidities were not associated with in-hospital mortality.

Conclusion

Among hospitalized NH residents, age 85 years or older and several acute conditions, but not chronic morbidities, predicted in-hospital mortality. Elderly NH residents at risk of developing these acute conditions may benefit from palliative care.

Keywords: Nursing home, hospitalization, in-hospital mortality