Unplanned nursing home admission among discharged polymedicated older inpatients: a single-centre, registry-based study in Switzerland

Filipa Pereira; Henk Verloo; Armin von Gunten; María Del Río Carral; Carla Meyer-Massetti; Maria Manuela Martins; Boris Wernli

doi:10.1136/bmjopen-2021-057444

Unplanned nursing home admission among discharged polymedicated older inpatients: a single-centre, registry-based study in Switzerland

BMJ Open. 2022 Mar 4;12(3):e057444. doi: 10.1136/bmjopen-2021-057444.

Authors

Filipa Pereira^{1

2}, Henk Verloo^{2

3}, Armin von Gunten³, María Del Río Carral⁴, Carla Meyer-Massetti^{5

6}, Maria Manuela Martins⁷, Boris Wernli⁸

Affiliations

¹ Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal filipa.pereira@hevs.ch.
² School of Health Sciences, HES-SO Valais Wallis, Sion, Switzerland.
³ Département de Psychiatrie, Centre Hospitalier Universitaire Vaudois, Prilly, Switzerland.
⁴ Institute of Psychology, Research Center for the Psychology of Health, Aging and Sports Examination, University of Lausanne, Lausanne, Switzerland.
⁵ Institute for Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
⁶ Clinical Pharmacology and Toxicology, Clinical of General Internal Medicine, Inselspital - University Hospital of Bern, Bern, Switzerland.
⁷ Escola Superior de Enfermagem do Porto, Porto, Portugal.
⁸ FORS, Swiss Centre of Expertise in the Social Sciences, University of Lausanne, Lausanne, Switzerland.

Abstract

Objective: To investigate patient characteristics and the available health and drug data associated with unplanned nursing home admission following an acute hospital admission or readmission.

Design: A population-based hospital registry study.

Setting: A public hospital in southern Switzerland (Valais Hospital).

Participants: We explored a population-based longitudinal dataset of 14 705 hospital admissions from 2015 to 2018.

Outcome measures: Sociodemographic, health and drug data, and their interactions predicting the risk of unplanned nursing home admission.

Results: The mean prevalence of unplanned nursing home admission after hospital discharge was 6.1% (n=903/N=14 705). Our predictive analysis revealed that the oldest adults (OR=1.07 for each additional year of age; 95% CI 1.05 to 1.08) presenting with impaired functional mobility (OR=3.22; 95% CI 2.67 to 3.87), dependency in the activities of daily living (OR=4.62; 95% CI 3.76 to 5.67), cognitive impairment (OR=3.75; 95% CI 3.06 to 4.59) and traumatic injuries (OR=1.58; 95% CI 1.25 to 2.01) had a higher probability of unplanned nursing home admission. The number of International Classification of Diseases, 10th version diagnoses had no significant impact on nursing home admissions, contrarily to the number of prescribed drugs (OR=1.17; 95% CI 1.15 to 1.19). Antiemetics/antinauseants (OR=2.53; 95% CI 1.21 to 5.30), digestives (OR=1.78; 95% CI 1.09 to 2.90), psycholeptics (OR=1.76; 95% CI 1.60 to 1.93), antiepileptics (OR=1.49; 95% CI 1.25 to 1.79) and anti-Parkinson's drugs (OR=1.40; 95% CI 1.12 to 1.75) were strongly linked to unplanned nursing home admission.

Conclusions: Numerous risk factors for unplanned nursing home admission were identified. To prevent the adverse health outcomes that precipitate acute hospitalisations and unplanned nursing home admissions, ambulatory care providers should consider these risk factors in their care planning for older adults before they reach a state requiring hospitalisation.

Keywords: clinical pharmacology; epidemiology; geriatric medicine; health informatics.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Activities of Daily Living*
Aged
Hospitalization
Humans
Inpatients
Nursing Homes
Patient Discharge*
Patient Readmission
Registries
Risk Factors
Switzerland / epidemiology