Department of Health Services Research, School VI - Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraße 114-118, 26129 Oldenburg, Germany.
Department for Health Services Research, Institute of Public Health and Nursing Research, University of Bremen, Grazer Straße 4, 28359 Bremen, Germany.
Int J Environ Res Public Health. 2020 Jun 1;17(11):3915. doi: 10.3390/ijerph17113915.
Nursing home (NH) residents are often transferred to hospital (emergency department (ED) visits or hospital admissions) and this occurs more frequently in males. However, respective reasons are rather unclear. We conducted a multicenter prospective study in 14 northwest German NHs with 802 residents in which NH staff recorded anonymized data between March 2018 and July 2019 for each hospital transfer. Measures were analyzed using descriptive statistics and compared between sexes via univariate logistic regression analyses using mixed models with random effects. Eighty-eight planned transfers (53.5% hospital admissions, 46.5% ED visits) occurred as well as 535 unplanned transfers (63.1% hospital admissions, 36.9% ED visits). The two most common causes for unplanned transfers were deteriorations of health status (35.1%) and falls/accidents/injuries (33.5%). Male transferred residents were younger, more often married; their advance directives were more commonly not considered correctly and the NH staff identified more males nearing the end of life than females (52.9% vs. 38.2%). Only 9.2% of transfers were rated avoidable. For advance directive availability and NH staff's perceptions on transfer conditions, we found marked inter-facility differences. There might be sociocultural factors influencing hospital transfer decisions of male and female nursing home residents and facility characteristics that may affect transfer policy.
养老院（NH）居民经常被转往医院（急诊部（ED）就诊或住院），这种情况在男性中更为常见。然而，各自的原因尚不清楚。我们在德国西北部的 14 家 NH 进行了一项多中心前瞻性研究，其中 802 名居民在 2018 年 3 月至 2019 年 7 月期间由 NH 工作人员为每次医院转院记录匿名数据。使用描述性统计分析措施，并通过混合模型的单变量逻辑回归分析，使用随机效应比较性别之间的差异。计划转院 88 例（53.5%住院，46.5% ED 就诊），非计划转院 535 例（63.1%住院，36.9% ED 就诊）。非计划转院的两个最常见原因是健康状况恶化（35.1%）和跌倒/事故/受伤（33.5%）。男性转院居民更年轻，已婚比例更高；他们的预立医嘱更常被错误考虑，NH 工作人员认为男性比女性更接近生命末期（52.9%比 38.2%）。只有 9.2%的转院被认为是可以避免的。对于预立医嘱的可用性和 NH 工作人员对转院条件的看法，我们发现机构之间存在明显的差异。可能有社会文化因素影响男女养老院居民的医院转院决策和设施特点，可能影响转院政策。
