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

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).