Advertisement

The journal of nutrition, health & aging

, Volume 14, Issue 2, pp 141–147 | Cite as

Early markers of prolonged hospital stay in demented inpatients: A multicentre and prospective study

  • P.-O. LangEmail author
  • D. Zekry
  • J.-P. Michel
  • M. Drame
  • J.-L. Novella
  • D. Jolly
  • F. Blanchard
Article

Abstract

Background

Dementia is a serious, chronic, and costly public health problem. Prior studies have described dementia as increasing length of hospital stay, but so far no explanations have been proposed.

Methods

To identify early markers for prolonged hospital stay in demented elderly inpatients, 178 community-dwelling or institutionalized subjects aged 75+, hospitalized through an emergency department in 9 teaching hospitals in France, were analyzed. Prolonged hospital stays were defined according a limit adjusted for Diagnosis Related Group. All patients underwent a comprehensive geriatric assessment at admission. Logistic regression multifactorial mixed model was performed. Center effect was considered as a random effect.

Results

Of the 178 stays, 52 were prolonged. Most concerned community-dwelling patients (86%). Multifactor analysis demonstrated that demographic variables had no influence on the length of stay, while diagnosis of delirium (OR 2.31; 95% CI 1.77–2.91), walking difficulties (OR 1.94; 95% CI 1.62–2.43) and report by the informal caregiver of moderate or severe burden (OR 1.52; 95% CI 1.19–1.86) or low social quality-of-life score (OR 1.25; 95% CI 1.03–1.40), according to the Zarit’s Burden Inventory short scale (12 items) and the Duke’s Health Profile respectively, were identified as early markers for prolonged hospital stays.

Conclusion

At the time of the rising incidence of cognitive disorders, these results suggest that preventive approaches might be possible. In a hospital setting as well as in a community-dwelling population, more specific, specialized and coordinated care, using the expertise of multiple disciplines appears as a probable effective measure to limit prolonged hospital stay. Such approaches require (i) clear patient-oriented goal definition, (ii) understanding and appreciation of roles among various health care and social disciplines and, (iii) cooperation between partners in patient’s management. However, the cost- and health-effectiveness of such approaches should be evaluated.

Key words

Prolonged hospital stay dementia elderly SAFEs cohort 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Fillenbaum G, Heyman A, Peterson BL, Pieper CF, Weiman AL. Use and cost of hospitalization of patients with AD by stage and living arrangement. Neurology 2001;56:201–6.PubMedGoogle Scholar
  2. 2.
    Üstüm TB, Rehm J, Chatterji S, Saxena S, Trotter R, Room R, Bickenbach J et al. Multiple-informant ranking of the disabling effects of different health conditions in 14 countries. Lancet 1999;354:111–5.CrossRefGoogle Scholar
  3. 3.
    Waldemar G, Dubois B, Emre M, Georges J, McKeith IG, Rossor M, Scheltens P, Tariska P, Winblad B. Recommendations for the diagnosis and management of Alzheimer’s disease and other disorders associated with dementia: EFNS guideline. Eur J Epidemiol 2006;14:e1–e26.Google Scholar
  4. 4.
    Weiner M, Powe N, Weller WE, Shaffer TJ, Anderson GF. Alzheimer’s disease under managed care: implications from Medicare utilization and expenditure patterns. J Am Geriatr Soc 1998;46:762–70.PubMedGoogle Scholar
  5. 5.
    Lang PO, Heitz Damien, Hedelin G et al. Early markers of prolonged hospital stays in older people: a prospective, multicenter study of 908 inpatients in French acute hospitals. J Am Geriatr Soc 2006;54:1031–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Lyketsos CG, Sheppard JM, Rabins PV. Dementia in elderly persons in general hospital. Am J Psychiatry 2000;157:704–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Satish S, Winograd CH, Cavez C, Bloch D Geriatric targeting criteria as predictor of survival and health care utilization. J Am Geriatr Soc 1996;44:914–21.PubMedGoogle Scholar
  8. 8.
    Eaker ED, Mickel SF, Chyou PH, Mueller-Rizner NJ, Slusser JP. Alzheimer’s disease or other dementia and medical care utilization. Ann Epidemiol 2002;12:39–45.PubMedCrossRefGoogle Scholar
  9. 9.
    Lang PO, Ebel M, Hasenfratz A, Autelitano-Boohs AM, Bandelier S, Boudebouda Y et al. Disabled elderly people waiting for institutionalization from a hospital ward: prospective study in the administrative district of Strasbourg (France). Rev Epidemiol Sante Publique 2008;56:87–95.PubMedCrossRefGoogle Scholar
  10. 10.
    Margiotta A, Bianchetti A, Ranieri P, Trabucchi M. Clinical characteristics and risk factors of delirium in demented and not demented elderly medical inpatients. J Nutr Health Aging 2006;10:535–9.PubMedGoogle Scholar
  11. 11.
    van Zyl T, Seitz DP. Delirium concisely: condition is associated with increased morbidity, mortality, and length of hospitalization. Geriatrics 2006;61:18–21.PubMedGoogle Scholar
  12. 12.
    Zarit SH, Reever KE, Bach-Peterson J. Relatives of impaired elderly: Correlates of feelings of burden. Gerontologist 1980;20:649–55.PubMedGoogle Scholar
  13. 13.
    Pakerson GR, Broahead WE, Tse CKJ. The Duke Health Profile. A 17-item measure of health and dysfunction. Med Care 1990;28:1056–72.CrossRefGoogle Scholar
  14. 14.
    Bedard M, Molloy DW, Squire L, Dubois S, Lever JA, O’Donnell M. The Zarit Burden Interview: a new short version and screening version. Gerontologist 2001;41:652–7.PubMedGoogle Scholar
  15. 15.
    Weinberg DB, Lusenhop RW, Gittell JH, Kautz CM Coordination between formal providers and informal caregivers. Health Care Manage Rev 2007;32:140–9.PubMedGoogle Scholar
  16. 16.
    Katz S. Assessing self-maintenance. Activities of daily-living, mobility and instrumental activities of daily-living. J Am Geriatr Soc 1983;31:721–7.PubMedGoogle Scholar
  17. 17.
    Fillenbaum GC. Functional ability. In: Ebrahim S, Kalache A, eds Epidemiology in Old Age. London: BMJ Publishing Group; 1996:228–35.Google Scholar
  18. 18.
    Vellas B, Wayne SJ, Baumgartner RN et al. One-leg-balance is an important predictor of injurious falls in older persons. J Am Geriatr Soc 1997;45:735–8.PubMedGoogle Scholar
  19. 19.
    Podsialdo D, Richardson S. The timed “Get up & Go”: A test for basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991;39:142–8.Google Scholar
  20. 20.
    Schwab JJ, Holzer CE, Warheit GJ. Depressive symptomatology and age. Psychosomatics 1973;14:135–41.PubMedGoogle Scholar
  21. 21.
    Gilleard CJ, Willmott M, Viddadi KS. Self-report measures of mood and morale in elderly depressive. Br J Psychiat 1981;138:230–5.CrossRefGoogle Scholar
  22. 22.
    American Psychiatric Association. Diagnosis and Statistical Manual of mental Disorders, 4th Ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar
  23. 23.
    Rubenstein LZ, Harker JO, Salva et al. Screening for undernutrition in geriatric practice: Developing the short form mini-nutritional assessment (MNA-sf). J Gerontol A Biol Sci Med 2001;56:M366–M72.Google Scholar
  24. 24.
    Norton D, Mclaren R, Exton-Smith AN. An investigation of nursing problems in hospitals. New York: Churchill Livingstone; 1975.Google Scholar
  25. 25.
    Sundararajan V, Henderson T, Perry C, et al.. New ICD-10 version of the Charlson Comorbidity Index predicted in-hospital mortality. J Clin Epidemiol 2004;57:1288–94.PubMedCrossRefGoogle Scholar
  26. 26.
    Brown H, Prescott R. Applied mixed model in medicine. New-York: John Willey & Sons; 2000.Google Scholar
  27. 27.
    Inouye SK. Delirium in older persons. N Engl J Med 2006;354:1157–65.PubMedCrossRefGoogle Scholar
  28. 28.
    Flacker JM, Lipsitz LA. Neural mechanisms of delirium: current hypotheses and evolving concepts J Gerontol A Biol Sci Med Sci 1999;54A:B239–46.CrossRefGoogle Scholar
  29. 29.
    Cole MG. Delirium in elderly patients. Am J Geriatr Psychiatry 2004;12:7–21.PubMedGoogle Scholar
  30. 30.
    Casarett DJ, Inouye SK Diagnosis and management of delirium near the end of life. Ann Intern Med 2001;135:32–40.PubMedGoogle Scholar
  31. 31.
    Breitbart W, Rosenfeld B, Roth A, et al.. The memorial delirium assessment scale. J Pain Symptom Manage 1997;13:128–37.PubMedCrossRefGoogle Scholar
  32. 32.
    Heyn PC, Johnson KE, Kramer AF. Endurance and strength training outcomes on cognitively impaired and cognitively intact older adults: a meta-analysis. J Nutr Health Aging 2008;12:401–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Belmin J. La malnutrition protéino-énergétique du senior: une situation fréquente après une hospitalisation. Rev de Gériatrie 2006;31:415–9.Google Scholar
  34. 34.
    Milne AC, Avenell A, Potter J. Meta-analysis: protein and energy supplementation in older people. Ann Intern Med 2006;144:37–48.PubMedGoogle Scholar
  35. 35.
    Wolff JL, Kasper JD. Informal caregiver characteristics and subsequent hospitalization outcomes among recipients of care. Aging Clin Exp Res 2004;16:307–13.PubMedGoogle Scholar
  36. 36.
    Balardy L, Voisin T, Cantet C, Vellas B; REAL.FR Group Predictive factors of emergency hospitalisation in Alzheimer’s patients: results of one-year follow-up in the REAL.FR Cohort J Nutr Health Aging 2005;9:112–6.Google Scholar
  37. 37.
    Matsumoto N, Ikeda M, Fukuhara R, Shinagawa S, Ishikawa T, Mori T, Toyota Y, Matsumoto T, Adachi H, Hirono N, Tanabe H Caregiver burden associated with behavioural and psychological symptoms of dementia in elderly people in the local community. Dement Geriatr Cogn Disord 2007;23 219–24.PubMedCrossRefGoogle Scholar
  38. 38.
    Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J The Neuropsychiatric Inventory: Comprehensive assessment of psychopathology in dementia. Neurology 1994;44:2308–18.PubMedGoogle Scholar
  39. 39.
    Imbert F, Lang PO, Meyer N et al. Description des conditions de vie de la population âgée de 75 ans ou plus vivant à domicile en Alsace. Rev Epidemiol Sante Publique 2005;53:153–65.PubMedCrossRefGoogle Scholar
  40. 40.
    Coudin G. Family caregiver’s reluctance toward community services: a social psychology perspective. Psychol Neuropsychiatr Vieil 2004;2:285–96.PubMedGoogle Scholar
  41. 41.
    Keough ME, Field TS, Gurwitz JH. A model of community-based interdisciplinary team training in the care of the frail elderly. Acad Med 2002;77:936.PubMedCrossRefGoogle Scholar
  42. 42.
    Benedict L, Robinson K, Holder C. Clinical nurse specialist practice within the Acute care for Elders interdisciplinary team model. Clin Nurse Spec 2006;20:248–51.PubMedCrossRefGoogle Scholar
  43. 43.
    Hilleret H, Falconnet C, Le Saint L, Perrenoud JJ, Michel JP, Vogt-Ferrier N. Prescribing psychotropic drugs to patients aged 80 and over. Rev Med Suisse 2008;4:2405–8, 10-1.PubMedGoogle Scholar
  44. 44.
    Thompson P, Lang L, Annells M. A systematic review of the effectiveness of inhome community nurse led interventions for the mental health of older persons. J Clin Nurs 2008;17:1419–27.PubMedCrossRefGoogle Scholar
  45. 45.
    Robinson A, Street A. Improving networks between acute care nurses and an aged care assessment team. J Clin Nurs 2004;13:486–96.PubMedCrossRefGoogle Scholar

Copyright information

© Serdi and Springer Verlag France 2010

Authors and Affiliations

  • P.-O. Lang
    • 1
    • 2
    Email author
  • D. Zekry
    • 1
  • J.-P. Michel
    • 1
  • M. Drame
    • 2
    • 3
  • J.-L. Novella
    • 2
    • 3
  • D. Jolly
    • 2
    • 4
  • F. Blanchard
    • 2
    • 3
  1. 1.Department of rehabilitation and geriatricsMedical school and University Hospitals of GenevaGenevaSwitzerland
  2. 2.School of MedicineUniversity of Reims Champagne-ArdenneReimsFrance
  3. 3.Department of GerontologyUniversity Hospitals of ReimsReimsFrance
  4. 4.Clinical Research UnitUniversity Hospitals of ReimsReimsFrance

Personalised recommendations