Risk factors for nursing home use after hospitalization for medical illness

Background. Hospitalization, a Sentinel event for many older persons, may mark a transition from independent living to either community-based or institutionalized long-term care. We determined the independent risk factors, including loss of function, of nursing home (NH) admission at hospital discharge and NH use at 3 months after hospital discharge among a diverse group of hospitalized older persons. Methods. The subjects in this study were 1,265 noninstitutionalized persons from phase II of Hospital Outcomes Project for the Elderly. Using multiple logistic regression, we modeled NH admission with variables measured at the time of hospital admission as well as with length of stay (LOS) and decline in ADL independence from hospital admission to discharge. In addition, we modeled NH use at 3 months after hospital discharge with variables measured at the time of hospital discharge as well as with post-hospital measures of rehospitalization and decline in ADL independence following hospitalization. Results. The independence risk factors of NH placement at discharge are geographic site, increasing age, living alone, and low baseline ADL independence, LOS, and decline in ADL independence during hospitalization. The independent predictors for NH use at 3-month follow-up are increasing age, living alone, mental status, low discharge ADL independence, LOS, and decline in ADL independence during the 3 months after discharge. Conclusions. Simple but different clinical variables predict NH use at hospital discharge and at 3 months. Furthermore, functional loss during and after hospitalization is an important independent risk factor of nursing home use and is a clinical outcome that may be modified to decrease the likelihood of NH admission.