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Factors associated with increased hospitalisation risk among nursing home residents in Sweden: a prospective study with a three-year follow-up
Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.ORCID iD: 0000-0003-4149-9787
Department of Clinical Sciences, Lund University, Sweden.
Department of Medical and Health Sciences, Linköping University, Sweden.
Show others and affiliations
2016 (English)In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 11, no 2, 130-139 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Hospitalisation of nursing home residents might lead to deteriorating health.

AIM: To evaluate physical and psychological factors associated with hospitalisation risk among nursing home residents.

DESIGN: Prospective study with three years of follow-up.

METHODS: Four hundred and twenty-nine Swedish nursing home residents, ages 65-101 years, from 11 nursing homes in three municipalities were followed during three years. The participants' physical and psychological status was assessed at baseline. A Cox proportional hazards model was used to evaluate factors associated with hospitalisation risk using STATA.

RESULTS: Of the 429 participants, 196 (45.7%) were hospitalised at least once during the three-year follow-up period, and 109 (25.4%) during the first six months of the study. The most common causes of hospitalisation were cardiovascular diseases or complications due to falls. A Cox regression model showed that residents who have had previous falls (P < 0.001), are malnourished (P < 0.001), use a greater number of drugs (P < 0.001) and have more diseases (P < 0.001), are at an increased risk of hospitalisation.

CONCLUSION: Nursing home residents are frequently hospitalised, often due to falls or cardiovascular diseases. Study results underscore the relationships between malnutrition, previous falls, greater numbers of drugs and diseases and higher risk of hospitalisation.

IMPLICATIONS FOR PRACTICE: Preventive interventions aimed at malnutrition and falls at the nursing home could potentially reduce the number of hospitalisations. With improved education and support to nurses concerning risk assessment at the nursing homes, it may be possible to reduce the numbers of avoidable hospitalisation among nursing home residents and in the long run improve quality of life and reduce suffering.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2016. Vol. 11, no 2, 130-139 p.
Keyword [en]
hospitalization; nursing home residents; preventive care; prospective design
National Category
Gerontology, specializing in Medical and Health Sciences
Identifiers
URN: urn:nbn:se:hj:diva-29964DOI: 10.1111/opn.12107ISI: 000382486700006PubMedID: 26663380Scopus ID: 2-s2.0-84949845065OAI: oai:DiVA.org:hj-29964DiVA: diva2:929749
Available from: 2016-05-19 Created: 2016-05-19 Last updated: 2017-01-26Bibliographically approved
In thesis
1. Should I stay or should I go – Factors associated with hospitalization risk among older persons in Sweden
Open this publication in new window or tab >>Should I stay or should I go – Factors associated with hospitalization risk among older persons in Sweden
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

An increasingly older population will most likely lead to greater demands on the health care system, as older age is associated with an increased risk of having acute and chronic conditions. The number of diseases or disabilities is not the only marker of the amount of health care utilized, as persons may seek hospitalization without a disease and/or illness that requires hospital healthcare. Hospitalization may pose a severe risk to older persons, as exposure to the hospital environment may lead to increased risks of iatrogenic disorders, confusion, falls and nosocomial infections, i.e., disorders that may involve unnecessary suffering and lead to serious consequences.

Aims: The overall aim of this thesis was to describe and explore individual trajectories of cognitive development in relation to hospitalization and risk factors for hospitalization among older persons living in different accommodations in Sweden and to explore older persons' reasons for being transferred to a hospital.

Methods: The study designs were longitudinal, prospective and descriptive, and both quantitative and qualitative methods were used. Specifically, latent growth curve modelling was used to assess the association of cognitive development with hospitalization. The Cox proportional hazards regression model was used to analyse factors associated with hospitalization risk overtime. In addition, an explorative descriptive design was used to explore how home health care patients experienced and perceived their decision to seek hospital care.

Results: The most common reasons for hospitalization were cardiovascular diseases, which caused more than one-quarter of first hospitalizations among the persons living in ordinary housing and nursing home residents (NHRs). The persons who had been hospitalized had a lower mean level of cognitive performance in general cognition, verbal, spatial/fluid, memory and processing speed abilities compared to those who had not been hospitalized. Significantly steeper declines in general cognition, spatial/fluid and processing speed abilities were observed among the persons who had been hospitalized. Cox proportional hazards regression analysis showed that the number of diseases, number of drugs used, having experienced a fall and being assessed as malnourished according to the Mini Nutritional Assessment scale were related to an increased hospitalization risk among the NHRs. Among the older persons living in ordinary housing, the risk factors for hospitalization were related to marital status, i.e., unmarried persons and widows/widowers had a decreased hospitalization risk. In addition, among social factors, receipt of support from relatives was related to an increased hospitalization risk, while receipt of support from friends was related to a decreased risk. The number of illnesses was not associated with the hospitalization risk for older persons in any age group or for those of either sex, when controlling for other variables. The older persons who received home health care described different reasons for their decisions to seek hospital care. The underlying theme of the home health care patients’ perceptions of their transfer to a hospital involved trust in hospitals. This trust was shared by the home health care patients, their relatives and the home health care staff, according to the patients.

Conclusions: This thesis revealed that middle-aged and older persons who had been hospitalized exhibited a steeper decline in cognition. Specifically, spatial/fluid, processing speed, and general cognitive abilities were affected. The steeper decline in cognition among those who had been hospitalized remained even after controlling for comorbidities. The most common causes of hospitalization among the older persons living in ordinary housing and in nursing homes were cardiovascular diseases, tumours and falls. Not only health-related factors, such as the number of diseases, number of drugs used, and being assessed as malnourished, but also social factors and marital status were related to the hospitalization risk among the older persons living in ordinary housing and in nursing homes. Some risk factors associated with hospitalization differed not only between the men and women but also among the different age groups. The information provided in this thesis could be applied in care settings by professionals who interact with older persons before they decide to seek hospital care. To meet the needs of an older population, health care systems need to offer the proper health care at the most appropriate level, and they need to increase integration and coordination among health care delivered by different care services.

Place, publisher, year, edition, pages
Jönköping: Jönköping University, School of Health and Welfare, 2016. 117 p.
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 70
Keyword
Older persons, hospitalization, risk factors, cognitive decline, qualitative content analyses, longitudinal, Cox regression, latent growth curve modelling
National Category
Gerontology, specializing in Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-29966 (URN)978-91-85835-69-0 (ISBN)
Public defence
2016-06-17, Forum Humanum, School of Health and Welfare, Jönköping, 13:00
Opponent
Supervisors
Available from: 2016-05-19 Created: 2016-05-19 Last updated: 2016-05-23Bibliographically approved

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