Patterns and predictors of readmission in a national cohort of elderly nursing home entrants

摘要

Longitudinal patterns of exit and reentry to and from nursing homes were examined in a nationally representative cohort of 3,362 people admitted to a nursing home for the first time in 1984-5. Five years of longitudinal data from the 1985 National Nursing Home Survey (NNHS) and follow-up was used. Three types of movement in and out of nursing homes were identified: an interruption (two nursing home stays separated by an acute hospital stay or by a period of less than 30 days); a transfer (two nursing home stays without any intervening interval of time); and a readmission (two nursing home stays separated by at least 30 days spent in the community). These events were not mutually exclusive and many individuals experienced multiple events over time.;Residents 65 years and older at the time of first admission made up 88% of the first admission cohort (n = 2,968). Almost half (49%) of these elderly in the first admission cohort experienced at least one type of multiple admission. Thirty-six percent experienced at least one interruption, 14% experienced at least one transfer, and 12% experienced at least one readmission.;Among the elderly, 60% left the first nursing home stay alive, 13% died in the first nursing home, and 19% remained there throughout the study period. Among the elderly who left the first nursing home stay alive, 65% experienced at least one type of multiple admission. Forty-three percent experienced at least one interruption, 22% experienced at least one transfer, and 20% experienced at least one readmission. Multivariate proportional hazards models were estimated to determine risk factors for readmission in the entire elderly admission cohort and in just the subgroup of elderly who left the first nursing home admission alive. In the entire elderly admission cohort predictors of a decreased risk of readmission (in order of magnitude) were: Medicaid as an initial payor, having a cognitive diagnosis, having lived alone before entering the nursing home, and being female. In the subgroup who left the first nursing home alive, predictors of decreased risk of readmission (in order of magnitude) were Medicaid, having lived alone, being female, and length of the first nursing home stay. Continence impairment predicted a higher risk of readmission in the subgroup who left the first nursing home alive.