Returning home after acute hospitalization in two French teaching hospitals: predictive value of patients' and relatives' wishes.

Identifying elderly patients who are unable to return home immediately after acute hospitalization is difficult. For these patients, early planning of discharge might reduce the length of hospitalization. We conducted a cohort study to investigate the roles of patients' characteristics and patients' and principal carers' wishes about patients returning home in predicting the outcome of hospitalization for 510 patients aged 75 years or more admitted to acute medical care units via the emergency departments of two teaching hospitals in Paris (France). Patients' characteristics and patients' and principal carers' wishes were investigated within 24-48 hours of admission. The outcome of hospitalization was defined as discharge to home or residential/nursing home. The opposition of the principal carer to a patient returning home was the most powerful predictor of discharge to a residential/nursing home. Advanced age, living alone, disability in Activities of Daily Living, altered mental state and presence of a chronic condition fatal within 4 years were also independently associated with discharge to a residential/nursing home. The patient's wishes were predictive in univariate but not in multivariate analysis. These results suggest that the principal carer's wishes about a patient returning home might be taken into consideration early in a hospital stay for more effective discharge planning.