Skip to main content
PMC home page
Canadian Family Physician logoLink to Canadian Family Physician
. 1996 Mar;42:449-54, 457-61.

Long hospital stays and need for alternate level of care at discharge. Does family make a difference for elderly patients?

J McClaran 1, R T Berglas 1, E D Franco 1
PMCID: PMC2146319  PMID: 8616285

Abstract

OBJECTIVE: To determine whether parental and marital status of elderly patients admitted to acute care affect the likelihood of a need for long hospital stay or alternate level of care (nursing home) at discharge. DESIGN: A 1-year descriptive study was carried out prospectively on elderly hospitalized patients. Marital status and parental status were treated as risk factors for resource use, as were sex, age, admitting service, and diagnosis. SETTING: A 672-bed university hospital. PATIENTS: We studied 495 patients aged 65 years or more sequentially admitted over a 1-year period. Excluded from study were critically ill patients, patients admitted to intensive care, and patients with whom we could not communicate on the day were considered for the study. MAIN OUTCOME MEASURES: Whether acute hospital stay exceed 44 days and need for alternate level of care at discharge. RESULTS: Many (43.4%) of the patients had no spouse and 19.4% had no children; 32.9% stayed 45 days or more and 6.9% required alternate level of care at discharge. Predictive of a long hospital stay were being without children (adjusted RR = 1.85), having a neurologic or psychiatric diagnosis (adjusted RR = 3.39), and having surgery unrelated to reason for admission (adjusted RR = 5.88). Predictive of need for alternate level of care at discharge were increasing age (adjusted RR = 1.08), having no spouse (adjusted RR = 2.59), having no children (adjusted RR = 3.27), and having a neurologic or psychiatric diagnosis (adjusted RR = 7.56).

Full text

PDF
460

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Artinian N. T., Duggan C. H. Patterns of concerns and demands experienced by spouses following coronary artery bypass surgery. Clin Nurs Res. 1993 Aug;2(3):278–295. doi: 10.1177/105477389300200305. [DOI] [PubMed] [Google Scholar]
  2. Bennett B. R., Jacobs L. M., Schwartz R. J. Incidence, costs, and DRG-based reimbursement for traumatic brain injured patients: a 3-year experience. J Trauma. 1989 May;29(5):556–565. doi: 10.1097/00005373-198905000-00003. [DOI] [PubMed] [Google Scholar]
  3. Berkman B., Walker S., Bonander E., Holmes W. Early unplanned readmissions to social work of elderly patients: factors predicting who needs follow-up services. Soc Work Health Care. 1992;17(4):103–119. doi: 10.1300/J010v17n04_06. [DOI] [PubMed] [Google Scholar]
  4. Beveridge P. Staging acute medical care for the elderly: an analysis of patient admissions. N Z Med J. 1986 Jun 25;99(804):461–464. [PubMed] [Google Scholar]
  5. Brotman S. L., Yaffe M. J. Are physicians meeting the needs of family caregivers of the frail elderly? Can Fam Physician. 1994 Apr;40:679–685. [PMC free article] [PubMed] [Google Scholar]
  6. Coburn A. F., Fortinsky R. H., McGuire C. A. The impact of Medicaid reimbursement policy on subacute care in hospitals. Med Care. 1989 Jan;27(1):25–33. doi: 10.1097/00005650-198901000-00003. [DOI] [PubMed] [Google Scholar]
  7. Dean C., Phillips J., Gadd E. M., Joseph M., England S. Comparison of community based service with hospital based service for people with acute, severe psychiatric illness. BMJ. 1993 Aug 21;307(6902):473–476. doi: 10.1136/bmj.307.6902.473. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Freedman V. A. Kin and nursing home lengths of stay: a backward recurrence time approach. J Health Soc Behav. 1993 Jun;34(2):138–152. [PubMed] [Google Scholar]
  9. Hertzman C., Pulcins I. R., Barer M. L., Evans R. G., Anderson G. M., Lomas J. Flat on your back or back to your flat? Sources of increased hospital services utilization among the elderly in British Columbia. Soc Sci Med. 1990;30(7):819–828. doi: 10.1016/0277-9536(90)90206-8. [DOI] [PubMed] [Google Scholar]
  10. Hinrichsen G. A., Hernandez N. A. Factors associated with recovery from and relapse into major depressive disorder in the elderly. Am J Psychiatry. 1993 Dec;150(12):1820–1825. doi: 10.1176/ajp.150.12.1820. [DOI] [PubMed] [Google Scholar]
  11. Kane R. L., Matthias R., Sampson S. The risk of placement in a nursing home after acute hospitalization. Med Care. 1983 Nov;21(11):1055–1061. doi: 10.1097/00005650-198311000-00002. [DOI] [PubMed] [Google Scholar]
  12. Kominski G. F., Schoenman J. A. Improving payments for Medicare patients with unrelated surgical procedures. Med Care. 1990 Aug;28(8):657–671. doi: 10.1097/00005650-199008000-00001. [DOI] [PubMed] [Google Scholar]
  13. Lewis H., Purdie G. The blocked bed: a prospective study. N Z Med J. 1988 Sep 14;101(853):575–577. [PubMed] [Google Scholar]
  14. MacLeod F., Mate A. Life enrichment for long-stay patients in acute care: an interdisciplinary program. Perspectives. 1991 Summer;15(2):2–6. [PubMed] [Google Scholar]
  15. McWhinney I. R. Continuity of care in family practice. Part 2: implications of continuity. J Fam Pract. 1975 Oct;2(5):373–374. [PubMed] [Google Scholar]
  16. Morris P. L., Robinson R. G., Raphael B., Bishop D. The relationship between the perception of social support and post-stroke depression in hospitalized patients. Psychiatry. 1991 Aug;54(3):306–316. doi: 10.1080/00332747.1991.11024559. [DOI] [PubMed] [Google Scholar]
  17. Muñoz E., Josephson J., Tenenbaum N., Goldstein J., Shears A. M., Wise L. Diagnosis-related groups, costs, and outcome for patients in the intensive care unit. Heart Lung. 1989 Nov;18(6):627–633. [PubMed] [Google Scholar]
  18. Narain P., Rubenstein L. Z., Wieland G. D., Rosbrook B., Strome L. S., Pietruszka F., Morley J. E. Predictors of immediate and 6-month outcomes in hospitalized elderly patients. The importance of functional status. J Am Geriatr Soc. 1988 Sep;36(9):775–783. doi: 10.1111/j.1532-5415.1988.tb04259.x. [DOI] [PubMed] [Google Scholar]
  19. Oktay J. S., Volland P. J. Post-hospital support program for the frail elderly and their caregivers: a quasi-experimental evaluation. Am J Public Health. 1990 Jan;80(1):39–46. doi: 10.2105/ajph.80.1.39. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Patrick C., Padgett D. K., Schlesinger H. J., Cohen J., Burns B. J. Serious physical illness as a stressor: effects on family use of medical services. Gen Hosp Psychiatry. 1992 Jul;14(4):219–227. doi: 10.1016/0163-8343(92)90091-n. [DOI] [PubMed] [Google Scholar]
  21. Prohaska T. R., Ehrenpreis T. The prospective payment system: DRGs and the frail elderly--issues, problems, and recommendations. J Geriatr Psychiatry. 1989;22(2):219–229. [PubMed] [Google Scholar]
  22. Retsinas J., Garrity P. Going home: analysis of nursing home discharges. Gerontologist. 1986 Aug;26(4):431–436. doi: 10.1093/geront/26.4.431. [DOI] [PubMed] [Google Scholar]
  23. Roos N. P. Predicting hospital utilization by the elderly. The importance of patient, physician, and hospital characteristics. Med Care. 1989 Oct;27(10):905–919. doi: 10.1097/00005650-198910000-00001. [DOI] [PubMed] [Google Scholar]
  24. Rowland K., Maitra A. K., Richardson D. A., Hudson K., Woodhouse K. W. The discharge of elderly patients from an accident and emergency department: functional changes and risk of readmission. Age Ageing. 1990 Nov;19(6):415–418. doi: 10.1093/ageing/19.6.415. [DOI] [PubMed] [Google Scholar]
  25. Rubenstein L. Z., Josephson K. R., Wieland G. D., Kane R. L. Differential prognosis and utilization patterns among clinical subgroups of hospitalized geriatric patients. Health Serv Res. 1986 Feb;20(6 Pt 2):881–895. [PMC free article] [PubMed] [Google Scholar]
  26. Scheeres D. E., Scholten D. J. DRGs and outliers in surgical critical care. Am Surg. 1989 Aug;55(8):511–515. [PubMed] [Google Scholar]
  27. Sloane P. D., Redding R., Wittlin L. Longest-term placement problems in an acute care hospital. J Chronic Dis. 1981;34(6):285–290. doi: 10.1016/0021-9681(81)90033-3. [DOI] [PubMed] [Google Scholar]
  28. Williams R., Boyce W. T., Wright A. L. The relationship of family structure and perceived family support to length of hospital stay. Fam Pract Res J. 1993 Jun;13(2):185–193. [PubMed] [Google Scholar]
  29. Wimo A., Gustafsson L., Mattson B. Predictive validity of factors influencing the institutionalization of elderly people with psycho-geriatric disorders. Scand J Prim Health Care. 1992 Sep;10(3):185–191. doi: 10.3109/02813439209014059. [DOI] [PubMed] [Google Scholar]
  30. Wolfson C., Handfield-Jones R., Glass K. C., McClaran J., Keyserlingk E. Adult children's perceptions of their responsibility to provide care for dependent elderly parents. Gerontologist. 1993 Jun;33(3):315–323. doi: 10.1093/geront/33.3.315. [DOI] [PubMed] [Google Scholar]
  31. Yang C. T., Kirschling J. M. Exploration of factors related to direct care and outcomes of caregiving. Caregivers of terminally ill older persons. Cancer Nurs. 1992 Jun;15(3):173–181. [PubMed] [Google Scholar]

Articles from Canadian Family Physician are provided here courtesy of College of Family Physicians of Canada

RESOURCES