Background: Nursing home short stays (NHSS) in the canton of Vaud
have been introduced for respite care purpose. However, a growing
number of older patients are urgently admitted from home (within 24h)
or directly after hospital discharge (58% of all admissions in 2010).
NHSS appears therefore as an increasingly important component of the
health care system, but the characteristics of admitted patients have
not been previously described. A better knowledge would contribute
to identify specific care needs and enhance their care.
Objectives: 1) To describe the characteristics of patients admitted
in unplanned NHSS ( after hospital stay or urgently from home);
2) To determine living disposition 3-month after NHSS discharge.
Method: Over a 18-month period, elderly patients with unplanned
NHSS admission to 2 facilities in Lausanne were identified.
Demographic, social, health, and functional data, as well as main
reason for admission were collected. Death and place of living at
3-months were collected using the administrative database.
Results: Overall, 114 patients (mean age 83.1 ± 6.2 years, 77%
women, 84% living alone) were assessed, 80% being admitted from
hospital. Mean score in Lawton's instrumental ADL before NHSS
admission was 4.6 ± 2.5 and 69% of the patients were home care
recipients (median number of weekly visits: 5 ± 3). Patients reported
going out 4.2 ± 1.3 times/week and 56% reported at least one fall over
the past year. Among the 91 patients coming from the hospital, main
reason for admission was injury/limb immobilization (58%), recuperation
(13%) and functional impairment in basic ADL (10%). Mean score at
Katz's Basic ADL at admission was 3.7 ± 1.9. Overall, 90% of patients
were identified with gait and balance impairment, 78% with cognitive
impairment and 70% with polypharmacy (>6 different drugs). At
3-month after NHSS discharge (N = 92), 72% patients were living at
home, 16% had been admitted to long term care, and 6% died. Among
patients living at home at follow-up, 11% had been readmitted to
hospital during the follow-up period.
Conclusion: Older patients with unplanned NHSS admission show
a high prevalence of functional, mobility, and cognitive impairments,
as well as other geriatric syndromes. Specific measures should be
considered during these stays to prevent further functional decline and,
possibly, hospital readmission. Patients admitted with basic ADLs
impairment might be candidate for higher levels of care (rehabilitation).