Factors Influencing Admission or Nonadmission of the Aged to the Hospital

Abstract

A prospective study was carried out to determine which social, functional, or medical factors influenced the decision to admit or not to admit aged people to a general hospital in Israel. The study also focused on characteristics of patients admitted to the geriatric ward of the medical division as distinct from those sent to the internal medicine ward. Two hundred patients over the age of 65 were examined during ten consecutive intake days for the internal medicine ward over a period of five weeks. One hundred and sixty-seven were interviewed in the emergency departments, and the others after transfer from other departments by prearranged consultation. Thirty-five per cent were not admitted, 28 per cent were admitted to internal medicine, and 26 per cent were admitted to the geriatric department. Social factors played little part in the selecting process, the dominant need being acuteness and severity of illness. However, patients in the geriatric ward were found to be functionally much more disabled in regard to mobility, mental state, and incontinence. This was also reflected in a longer average stay of 15 days compared with nine in internal medicine, a higher mortality (19 per cent as against 7 per cent) and a higher degree of disability on discharge from hospital.

A prospective, randomised controlled trial of an aged care nurse intervention within the Emergency Department

“…Only 17 of the 111 others (15%) were referred for geriatric medical review during the hospitalisation (intervention 6, control 11). Seventy-four patients (67%) were referred to a physiotherapist (intervention 36, control 38), 63 (57%) to a social worker (intervention 32, control 31), 52 (47%) to an occupational therapist (intervention 27, control Number referred to nurse for assessment 25), and 20 (18%) were not referred (intervention 9, control 11). Boxes 3, 4 and 5 show the significant predictors for each of the three outcome measures.…”

“…Previous studies consistently report impaired function to be a strong predictor of outcomes, including admission status, 25 LOS 4 and functional decline. 26 In concordance, the Waterlow scale was a significant predictor of all three outcomes in our multivariate analyses.…”

“…Number neurological category (%) 15 (14) 19 (18) Number cardiovascular category (%) 21 (20) 14 (13) Number respiratory category (%) 13 (12) 5 (5) Number musculoskeletal category (%) 29 (27) 27 (25) Number infectious category (%) 14 (13) 21 (20) Number other category (%) 15 (14) 21 (20) group patients had missing data (P = 0.52 for admission; P = 0.52 for LOS; P = 0.27 for functional decline). Those with missing data were less likely to be admitted than those without missing data (63% v 79%; P = 0.03).…”

Disability Impacts Length of Stay in General Internal Medicine Patients

“…Most studies report associations between disability and LOS for selected diagnoses, or in cohorts undergoing rehabilitation rather than general patients in the internal medicine wards. [14][15][16] For example, Bohannon and Cooper demonstrated that LOS and function at discharge were influenced favourably by a higher level of function on admission in selected stroke patients. 14 Also, Greenberg et al observed that geriatric patients, who were more disabled, had longer LOS compared to general medicine patients.…”

“…14 Also, Greenberg et al observed that geriatric patients, who were more disabled, had longer LOS compared to general medicine patients. 15 The purpose of this study was to evaluate the relationships between disability as measured with the Functional Independence Measure (FIM) at discharge and LOS in internal medicine patients. This is essential, as Internal Medicine (IM) patients often form the largest cohort of patients in a tertiary general hospital, including all the public hospitals in our country.…”