Análisis del índice de consecución de residencia pública asistida tras ingreso hospitalario en ancianos frágiles / Analysis of placement in public nursing homes after hospital admission in the fragile elderly

Introducción Analizar el índice de consecución de plaza en residencia pública asistida (RPA) en ancianos hospitalizados y orientados a este recurso por la Unidad de Trabajo Social.Material y métodos Estudio de cohortes realizado en una unidad de agudos de Geriatría de un hospital terciario. Se estudian los datos demográficos, clínicos, funcionales y socioeconómicos registrados en el ingreso hospitalario (período de inclusión de 4 años). Seguimiento al alta durante 6 meses, determinando porcentaje de consecución de RPA, tiempo de espera (tasa de incidencia mensual) y causas de no consecución. Las variables que se asocian a la consecución de RPA se introducen en un modelo de regresión logística multivariado.Resultados Cuatrocientos quince ancianos orientados a RPA, edad de 85,1 años (DE=6,7), 61,9% de mujeres. En el período de seguimiento obtuvieron plaza 72 ancianos (17,3%; tasa de incidencia mensual: 3,14%). En el análisis multivariado vivir solo (odds ratio [OR]: 2,788; p=0,005), recibir menos ingresos (OR: 0,807; p=0,018), tener informe de derivación social desde el hospital (OR: 2,132; p=0,037), haber solicitado RPA previamente (OR: 3,298; p=0,002) y ubicación al alta hospitalaria diferente al domicilio (OR: 5,792; p<0,001) se asociaron de modo independiente a consecución de RPA. Fallecer en espera (41,4%) y no finalizar trámites (32,9%) fueron las causas fundamentales de no consecución de plaza.Conclusiones La hospitalización de pacientes ancianos frágiles conduce frecuentemente a la solicitud de RPA, aunque su consecución a corto plazo desde la unidad de agudos es escasa. Determinados factores socioeconómicos y la intervención social facilitan el acceso, aunque la espera condiciona una importante proporción de fallecimientos e interrupción de trámites debido, en gran medida, a la complejidad del proceso (AU)

Introduction To analyze placement in public nursing homes in elderly inpatients referred by the social work unit. Material and methods We performed a cohort study in an acute geriatric unit of a tertiary hospital. The sociodemographic, clinical, functional and socioeconomic data registered on admission (inclusion period: 4 years) were analyzed. The patients were followed-up for 6 months after discharge. The percentage gaining places in public nursing homes, the waiting time (monthly incidence rate) and the reasons for not gaining a place were evaluated. The variables associated with gaining a place were introduced into a multivariate logistic regression model. Results A total of 415 elders were referred to public nursing homes. The mean age was 85.1 years (SD=6.7), and 61.9% were women. During the follow-up period, 72 elders were granted a place (17.3%; monthly incidence rate 3.14%). In the multivariate analysis, the factors independently associated with gaining a place at a public nursing home were living alone (OR 2.788; p=0.005), having a lower income (OR 0.807; p=0.018), having a social work report from the hospital (OR 2.132; p=0.037), having previously requested a place at a public nursing home (OR 3.298; p=0.002) and discharge destination other than the home (OR 5.792; p<0.001). The main causes associated with not gaining a place were death while on the waiting list (41.4%) and not completing the paperwork (32.9%). ConclusionsHospitalization in the frail elderly frequently leads to requests for public nursing home admission, although few places are granted in the short term to patients in the acute unit. Certain socioeconomic factors and referral by social workers were positively associated with gaining a place. However, the waiting time leads to a substantial proportion of deaths and incomplete paperwork, largely due to the complexity of the process (AU)

[Analysis of placement in public nursing homes after hospital admission in the fragile elderly]. / Análisis del índice de consecución de residencia pública asistida tras ingreso hospitalario en ancianos frágiles.

INTRODUCTION: To analyze placement in public nursing homes in elderly inpatients referred by the social work unit. MATERIAL AND METHODS: We performed a cohort study in an acute geriatric unit of a tertiary hospital. The sociodemographic, clinical, functional and socioeconomic data registered on admission (inclusion period: 4 years) were analyzed. The patients were followed-up for 6 months after discharge. The percentage gaining places in public nursing homes, the waiting time (monthly incidence rate) and the reasons for not gaining a place were evaluated. The variables associated with gaining a place were introduced into a multivariate logistic regression model. RESULTS: A total of 415 elders were referred to public nursing homes. The mean age was 85.1 years (SD=6.7), and 61.9% were women. During the follow-up period, 72 elders were granted a place (17.3%; monthly incidence rate 3.14%). In the multivariate analysis, the factors independently associated with gaining a place at a public nursing home were living alone (OR 2.788; p=0.005), having a lower income (OR 0.807; p=0.018), having a social work report from the hospital (OR 2.132; p=0.037), having previously requested a place at a public nursing home (OR 3.298; p=0.002) and discharge destination other than the home (OR 5.792; p<0.001). The main causes associated with not gaining a place were death while on the waiting list (41.4%) and not completing the paperwork (32.9%). CONCLUSIONS: Hospitalization in the frail elderly frequently leads to requests for public nursing home admission, although few places are granted in the short term to patients in the acute unit. Certain socioeconomic factors and referral by social workers were positively associated with gaining a place. However, the waiting time leads to a substantial proportion of deaths and incomplete paperwork, largely due to the complexity of the process.

Análisis de mortalidad tras el ingreso en una unidad de agudos de geriatría: influencia de la dependencia funcional / Analysis of mortality after admission to an acute geriatric unit: influence of functional dependency

Objetivo: analizar la influencia de diversos factores clínicos y funcionales en la tasa de mortalidad anual tras ingreso en unidad de agudos de geriatría (UGA). Material y métodos: pacientes ingresados durante 6 meses en la UGA. Se excluyeron los ingresos inadecuados o trasladados a otro servicio en el primer día. Para la valoración clínica, funcional y psíquica basal se utilizaron los índices de Katz y de Barthel, la escala de la Cruz Roja física y la presencia de demencia. Los datos al ingreso: mortalidad, complicaciones, impacto funcional del ingreso. En el seguimiento al año se analizaron los datos de mortalidad cruda y comorbilidad (índice de Charlson [ICh]). Se analizó la influencia de los datos basales y del ingreso en la supervivencia. El análisis estadístico se realizó mediante la comparación de medias y proporciones mediante las pruebas de la χ2, de la t de Student y ANOVA de un factor. El estudio de supervivencia se realizó mediante curvas de Kaplan-Meier y regresión de Cox, con un intervalo de confianza del 95%. Se utilizó el programa SPSS 11.0 para el procesamiento estadístico de los datos. Resultados: se analizó a 336 pacientes, con una edad media ± desviación estándar de 85,6 ± 6,9 años; el 59,2% eran mujeres. El grupo relacionado de diagnóstico principal fue de 541. Datos basales: demencia moderada o grave, 39,3%; dependencia en más de 3 actividades básicas, 45,4%; movilidad restringida, 48,2%, e incontinencia funcional, 29,9%. Datos del ingreso: impacto funcional, 19,5%, e infección nosocomial, 47,6%. La mortalidad intrahospitalaria fue del 22,9%. Durante el seguimiento hubo un 5,1% de pérdidas. Al año fallecieron 107 pacientes más (total 184; 54,8%). La mitad de los fallecimientos se produjo en los primeros 59 días contados desde el día del ingreso. Mediana de supervivencia, 275 días. Comorbilidad ICh > 2 (47,6%). Las causas de defunción fueron: en el 37,5% de los casos, respiratoria, y en el 31,0% de los pacientes, circulatoria. Los factores relacionados con la mortalidad fueron: sexo varón (p = 0,029), demencia (p = 0,002), pérdida funcional (p < 0,001), infección respiratoria nosocomial (p = 0,026), cuadro confusional (p < 0,001) y comorbilidad (p = 0,015); no se encontró asociación con la edad u otros factores clínicos. En el modelo de regresión de Cox, únicamente ser varón (p = 0,021) y la pérdida funcional asociada al ingreso (p < 0,001) se asociaron a mortalidad en el seguimiento. Conclusiones: se observó una elevada mortalidad durante los primeros dos meses desde el ingreso hospitalario, sobre todo por afección respiratoria y circulatoria. Aunque el sexo se asocia con la mortalidad en el seguimiento, ésta depende en mayor medida de la situación funcional. Se hace necesario establecer estrategias preventivas o de intervención en determinados grupos de ancianos de riesgo en los que es previsible una elevada mortalidad

Objective: to analyze the influence of several clinical and functional factors on the annual mortality rate following admission to an acute geriatric unit (AGU). Material and methods: patients admitted to the AGU over a 6-month period were included. Inappropriate admissions and those transferred to another service within 24 hours were excluded. Clinical, functional and psychic evaluations (Katz index, Barthel index, Physical Red Cross scale, presence of dementia) were performed. Admission data: mortality, complications, functional impact of admission. Follow-up at 1 year: data on crude mortality and comorbidity (Charlson index). The influence of baseline data and of admission on survival was analyzed. The statistical analysis consisted of comparison of means and proportions through the chi-squared test, Student's t-test and one-way ANOVA. Survival was studied through Kaplan-Meier curves and Cox regression. A 95% confidence interval was used. Data were analyzed with the SPSS 11.0 statistical package. Results: there were 336 patients (mean age 85.6 years; SD 6.9); 59.2% were women. Main diagnosis-related group: 541. Baseline data: moderate or severe dementia was found in 39.3%, dependency for more than three basic activities of daily living in 45.4%, restricted mobility in 48.2%, and functional incontinence in 29.9%. Admission data: functional impact was found in 19.5% and nosocomial infection in 47.6%. In-hospital mortality: 22.9%. Follow-up: 5.1% were lost to follow-up. At 1 year a further 107 patients had died (total 184; 54.8%). Half of the deaths occurred in the first 59 days after admission. The median survival was 275 days. The Charlson comorbidity index score was >2: 47.6%. Causes of death were respiratory in 37.5% and circulatory in 31.0%. The factors related to mortality were male sex (P=.029), dementia (P =.002), functional loss (P<.001), nosocomial respiratory infection (P =.026), confusional syndrome (P<.001), and comorbidity (P =.015). No association was found with age or other clinical factors. In the Cox regression model, only male sex (P=.021) and functional loss associated with admission (P<.001) were related to mortality during follow-up. Conclusions: mortality was high during the first 2 months after hospital admission, especially that due to respiratory and circulatory disease. Although sex was associated with mortality during follow-up, mortality was to a greater extent due to functional status. Preventive strategies and/or interventions are required in specific groups of elderly patients with an elevated risk of mortality