Predictors of In-Hospital Mortality Among Hospitalized Nursing Home Residents: An Analysis of the National Hospital Discharge Surveys 2005–2006

Abstract

Objective-To determine the demographic and clinical predictors of in-hospital mortality among hospitalized nursing home (NH) residents. Design-Retrospective Measurements-In-hospital mortality.Methods-A multivariable logistic regression model was developed to determine independent predictors of in-hospital mortality using the 2005 dataset. The model was then applied to the 2006 dataset to determine the generalizability of the predictors.Results-Significant independent predictors of in-hospital mortality in 2005 included ≥85 years (adjusted odds ratio {OR}, 2.53; 95% confidence interval {CI}, 1.21-5.30; P=0.013), acute respiratory failure (adjusted OR, 5.67; 95% CI, 3.51-9.17; P<0.0001), septicemia (adjusted OR, 4.63; 95% CI, 3.08-6.96; P<0.0001) and acute renal failure (adjusted OR, 2.11; 95% CI, 1.30-3.41; P=0.002). These baseline characteristics also predicted in-hospital mortality in 2006: age ≥85 years (adjusted OR, 2.45; 95% CI, 1.31-4.59.30; P=0.005), acute respiratory failure (adjusted OR, 7.11; 95% CI, 4.46-11.33; P<0.0001), septicemia (adjusted OR, 3.91; 95% CI, 2.64-5.80; P<0.0001) and acute renal failure (adjusted OR, 2.75; 95% CI, 1.82-4.15; P<0.0001). Chronic morbidities were not associated with in-hospital mortality.* Correspondence and reprint request: Ali Ahmed, MD, MPH, UAB Center for Aging, 1530 3rd Ave South, CH-19, Ste-219, Birmingham AL 35294-2041, Tel.: 2059349632; Fax: 2059757099; aahmed@uab.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conclusion-In hospitalized NH residents, age ≥85 years and several acute conditions, but not chronic morbidities, predicted in-hospital mortality. Elderly NH residents at risk of developing these acute conditions may benefit from palliative care. NIH Public Access

Predictors of mortality among elderly dependent home care patients

“…Published studies have found that admission to hospital is not always to the benefit of these EDPLH patients because admission could aggravate the pre-existing pathological status of these patients [29-31]. It is thus of paramount importance to identify patients at a high risk of dying during hospitalisation before they are actually admitted.…”

Heart Failure Management in Skilled Nursing Facilities

“…22 In a study of hospitalized SNF residents based on National Hospital Discharge Surveys 2005 and 2006, the prevalence of HF was nearly 30%. 2 Similarly, in a 10% random sampling of 1840 SNFs during 2003 to 2004, 37.4% of the 500 322 SNF residents had HF. 17 Their mean age was 81 years, and twothirds were women; 11% were black, 3% were Hispanic, and 1% were Asian.…”

“…The precise prevalence of HF among SNF residents is unknown, with estimates ranging between 20% and 37.4%. 2,[16][17][18][19] Of the estimated 1 492 200 Americans (nearly 0.5% of the total US population) living as long-term residents in SNFs, 3 1 317 200 (nearly 90%) were ≥65 years of age, representing nearly 5% of the population aged ≥65 years. More than 70% of these were women, and nearly half were ≥85 years old.…”

Heart Failure Among Older Adults in Skilled Nursing Facilities: More of a Dilemma Than Many Now Realize

“…In 2004, the National Nursing Home survey estimated 4.3 % of long-term SNF residents had a primary diagnosis of HF when admitted to their facility [27]. Data derived from the National Hospital Discharge Survey from 2005 to 2006 showed the prevalence of HF among NH patients requiring hospitalization to be near 30 % [28]. The Medicare Payment Advisory Committee (MEDPAC) published a report showing HF prevalence among 1,836,189 SNF stays was 25 % in 2012 [29].…”