LONG-TERM CARE UTILIZATION AND MORTALITY AFTER HOSPITALIZATION IN OLDER PEOPLE WITH HIGH-VOLUME DIAGNOSES: A RETROSPECTIVE LONGITUDINAL COHORT STUDY

Abstract

Background: Hospitalization in older people is associated with disability, mortality and entry to long-term care (LTC, care in care institutions or home care). Aim and research question(s): To describe (predictors of) LTC and mortality in six months post-hospitalization in older patients with stroke, pneumonia, myocardial infarction (MI), hip fracture, chronic obstructive pulmonary disease (COPD) and chronic heart failure. 1) What percentage of patients use LTC or die in the six months post-hospitalization? 2) What percentage of patients discharged to LTC still require LTC at three and six months? 3) Which variables predict LTC and mortality? Methods: Quantitative retrospective longitudinal observational cohort study with data from 3,154 patients >65, hospitalized because of one of six diagnoses. Dependent variables: LTC and mortality. Independent variables: age, gender, ethnicity, urbanization and diagnosis. Percentages of LTC use and mortality were calculated and multinomial logistic regression was performed. Results: Institutionalization at one month was highest in hip fracture (31.1%) and lowest in MI (3.1%). Home care use was highest in COPD (over 12%). Between 16.7% and 26.6% died. At three months >48% discharged to a care institution were institutionalized, at six months >60% were still institutionalized. More than 55% discharged with home care still required this at three months, and 45%-72% at six months. High age and living in strongly urbanized areas predicted LTC and mortality. Pneumonia, stroke and hip fracture predicted institutionalization and COPD both home care and institutionalization. Pneumonia and stroke predicted mortality. Conclusion: LTC utilization and mortality are high after hospitalization in older people and vary between diagnosis groups. LTC is often required for a long duration. Age, urbanization and diagnosis predict LTC and mortality. Recommendations: Health care workers should distinguish patients with poor prognosis from those who benefit from rehabilitation. Home rehabilitation should be further explored to prevent long-term institutionalization.