Risk of Continued Institutionalization After Hospitalization in Older Adults
Open accessAbstract
BACKGROUND: Little is known about the role of hospitalization as a risk factor for placement into long-term care. We therefore sought to estimate the percentage of long-term care nursing home stays precipitated by a hospitalization and factors associated with risk of nursing home placement after hospitalization. METHODS: We studied a retrospective cohort of a 5% sample of Medicare enrollees aged ≥ 66 years. The study included 762,243 patients admitted 1,149,568 times in January-April of 1996-2008, with 3,880,292 nonhospitalized controls. We measured residence in a nursing home 6 months after hospitalization. RESULTS: From 1996 through 2008, 5.55% of hospitalized patients resided in a nursing home 6 months later compared with 0.54% of nonhospitalized control patients. Three quarters of new nursing home placements were precipitated by a hospitalization. Independent risk factors for long-term care placement after hospitalization included advanced age (odds ratio [OR] = 3.56 for age 85-94 vs. 66-74 years), female gender (OR = 1.41), dementia (OR = 6.15), and discharge from the hospital to a skilled nursing facility (SNF; OR = 10.83). Having a primary care physician was associated with reduced odds (OR = 0.75). In the adjusted analyses, risk of institutionalization after hospitalization decreased 4% per year from 1996 to 2008. There were very large geographic variations in rates of long-term care after hospitalization, from < 2% in some hospital referral regions to > 13% in others for patients > 75 years in 2007-2008. CONCLUSIONS: Most placements in nursing homes are preceded by a hospitalization followed by discharge to a SNF. Discharge to a SNF is associated with a high risk of subsequent long-term care.
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People with dementia have disproportionately high use of acute and post-acute care, including hospitalizations, emergency department visits, 30-day re-hospitalizations, repeat emergency department visits, and post-acute care entry.
“Specifically, people with dementia experience disproportionately higher rates of acute and post-acute care utilization, including hospitalizations, emergency department visits, 30-day re-hospitalization events, repeat emergency department visits, and entry into post-acute care settings.3, 15–20”
From Discharge Communication of Dementia-Related Neuropsychiatric Symptoms and Care Management Strategies during Hospital to Skilled Nursing Facility Transitions (2021) · cites this paper as [16]
The Results (p. 1321) report that, among hospitalized older adults, those with dementia had more than sixfold higher odds of nursing-home residence six months later. That supports a higher risk of subsequent institutionalization, but the paper does not establish higher hospitalization or emergency-department use, 30-day rehospitalization, repeat emergency visits, or entry into short-term post-acute care for people with dementia. Its outcome was long-term nursing-home residence, not short-term skilled-nursing-facility placement. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIndividuals with dementia are generally over-represented among those using long-term care, and consequently the findings may reflect a dementia population with more advanced disease.
“However, it is likely that individuals with dementia are generally over-represented among those using long-term care, and consequentially findings may reflect a dementia population with more advanced disease.16”
From Discharge Communication of Dementia-Related Neuropsychiatric Symptoms and Care Management Strategies during Hospital to Skilled Nursing Facility Transitions (2021) · cites this paper as [16]
The Results report that a dementia diagnosis was associated with more than sixfold higher odds of nursing-home residence six months after hospitalization, supporting an association between dementia and long-term care use in the studied older adults. The paper does not establish that people with dementia are generally over-represented across long-term care settings, and it does not assess whether residents with dementia have more advanced disease. (LLM, conf=0.86)
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References 35 · Cited by 116
Research works printed but not linked: 2
- [4]4. Schoenberg NE, Coward RT. Attitudes about entering a nursing home. J Aging Stud. 1997;11:27-47.
- [32]32. Sharma G, Fletcher KE, Zhang D, Zhang D, Kuo YF, Freeman JL, Goodwin JS. Continuity of outpatient and inpatient care for hospital- ized older adults. JAMA. 2009;301:1671-1680.
- Authors
- Goodwin, J. S., Howrey, B., Zhang, D. D., & Kuo, Y.-F.
- Affiliations
- The University of Texas Medical Branch at Galveston (US)
- Venue
- The Journals of Gerontology Series A: Biological Sciences and Medical Sciences
- Publisher
- Oxford University Press (OUP)
- Published
- 2011-10-03
- Volume
- 66A
- Issue
- 12
- Pages
- 1321-1327
- ISSN
- 1079-5006 (ISSN-L)
- 1758-535X
- PMC
- PMC3210963
- OpenAlex
- W2155966976
- Cited by
- 116
- References
- 35
- Citations by year
- 2026: 9 · 2025: 7 · 2024: 12 · 2023: 5 · 2022: 5 · 2021: 9 · 2020: 8 · 2019: 9 · 2018: 10 · 2017: 11 · 2016: 5 · 2015: 8 · 2014: 7 · 2013: 7 · 2012: 3
- FWCI
- 10.61
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journals of Gerontology Series A (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (AG024832)
- National Institute on Aging (R01AG033134, P30AG024832)
- National Cancer Institute (K05CA134923)
- Topics
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Keywords
- nursing home admission, long-term care, hospitalization, older adults, skilled nursing facilities, institutionalization, dementia, primary care physicians, Medicare enrollees, regional variation, risk factors
- MeSH terms
- Aged, Aged, 80 and over, Female, Medicare, Homes for the Aged, Hospitalization, Humans, Institutionalization, Long-Term Care, Male, Nursing Homes, Retrospective Studies, Risk Factors, United States, Cohort Studies
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