Skip to main content
SpringerLink
Log in

Factors related to length of stay in a Geriatric Evaluation and Rehabilitation Unit

  • Original Article
  • Published:
Aging Clinical and Experimental Research Aims and scope Submit manuscript

Abstract

Factors related to length of stay were examined in 295 elderly patients (mean age=79.0±7.3, range 65–94; males=75, females=220), consecutively admitted to a Geriatric Evaluation and Rehabilitation Unit (GERU, P. Richiedei Hospital, Gussago, Brescia, Italy) over a twelve-month period (November 1, 1993–October 31, 1994). Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Basic Activities of Daily Living (BADL), Instrumental Activities of Daily Living (IADL), Tinetti Scale, Prognostic Nutritional Index (PNI), number of diseases and number of administered drugs were evaluated. An Index of Disease Severity (IDS) was utilized to estimate the level of comorbidity severity. Three comorbidity classes were thus defined: I) patients with no disease of relevant severity; II) patients with only one disease of relevant severity accompanied by clinically significant comorbidity; and III) patients with two or more relevant diseases. The variables associated with the length of stay proved to be classes of comorbidity, MMSE, dependence in BADL and IADL, Tinetti scale, and PNI. The association of longer length of stay with greater comorbidity was enhanced by impairment in gait and balance (Tinetti <18) and malnutrition (PNI >45). These data suggest that the length of stay in hospital is related to comorbidity in patients with conditions of physical and biomedical frailty.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Naylor M., Brooten D., Jones R., Lavizzo-Mourey R., Mezey M., Pauly M.: Comprehensive discharge planning for the hospitalized elderly. A randomized clinical trial. Ann. Intern. Med. 120: 999–1006, 1994.

    Article  CAS  PubMed  Google Scholar 

  2. Prospective Payment Assessment Commission: Medicare prospective payment and the American Health care system: Report to Congress. Washington, D.C., Prospective Payment Assessment Commission, 1992.

    Google Scholar 

  3. Manton K.G., Woodbury M.A., Vertrees J.C., Stallard E.: Use of medical services before and after introduction of the prospective payment system. Health Serv. Res. 28: 269–292, 1993.

    CAS  PubMed  Google Scholar 

  4. Pauly M.: Effectiveness research and the impact of financial incentives on outcomes. In: Shortell S.M., Reinhardt U.E. (Eds.), Improving Health Policy and Management: Nine Critical Research Issues for 1990s. Health Administration Press, Ann Arbor, Michigan, 1992, pp. 155–194.

    Google Scholar 

  5. Rockwood K.: Delays in the discharge of elderly patients. J. Clin. Epidemiol. 43: 971–975, 1990.

    Article  CAS  PubMed  Google Scholar 

  6. Maguire P.A., Taylor I.C., Stout R.W.: Elderly patients in acute medical wards: factors predicting length of stay in hospital. Br. Med. J. 292: 1251–1253, 1986.

    Article  CAS  Google Scholar 

  7. Birmingham J.J.: Discharge planning and home care in the United States. J. Cross-Cult. Gerontol. 8: 417–429, 1993.

    Article  CAS  PubMed  Google Scholar 

  8. Folstein M.F., Folstein S.E., Mc Hugh P.R.: “Mini-Mental State”: a practical method for grading the cognitive state of patients for the clinician. J. Psychiatr. Res. 12: 189–198, 1975.

    Article  CAS  PubMed  Google Scholar 

  9. Measso G., Cavarzeran F., Zappalà G.: Il Mini-Mental State Examination: studio normativo di un campione random della popolazione italiana. Dev. Neuropsychol. 9: 77–85, 1993.

    Article  Google Scholar 

  10. Yesavage J.A., Brink T.L., Rose T.L., Lum O., Huang O., Adey V.: Development and validation of a geriatric screening scale: a preliminary report. J. Psychiatr. Res. 17: 37–49, 1983.

    Article  CAS  Google Scholar 

  11. Katz S., Downs T.D., Cash H.R.: Progress in the development of the index of ADL. Gerontologist 1: 20–30, 1970.

    Article  Google Scholar 

  12. Lawton M.P., Brody E.M.: Assessment of older people: self-monitoring and instrumental activities of daily living. Gerontologist 9: 179–186, 1969.

    Article  CAS  PubMed  Google Scholar 

  13. Tinetti M.: Performance-oriented assessment of mobility problems in elderly patients. J. Am. Geriatr. Soc. 34: 119–126, 1986.

    CAS  PubMed  Google Scholar 

  14. Mullen J.L., Buzby G.P., Waldman M.T., Gertner N.H., Hobbs C.L., Rosato E.F.: Prediction of operative morbidity and mortality by preoperative nutritional assessment. Surg. Forum 30: 80–82, 1979.

    CAS  PubMed  Google Scholar 

  15. Bianchetti A., Rozzini R., Inzoli M.R., Trabucchi M.: Recommended dietary allowances in the elderly. N. Engl. J. Med. 314: 1706, 1986.

    Article  Google Scholar 

  16. Magni E., Bianchetti A., Rozzini R., Trabucchi M.: Influence of nutritional intake on 6-year mortality in an Italian elderly population. J. Nutr. Elder. 13: 25–34, 1994.

    Article  CAS  PubMed  Google Scholar 

  17. Bianchetti A., Rozzini R., Carabellese C., Zanetti O., Trabucchi M.: Nutritional, socio-economic and health status in a large elderly population. J. Am. Geriatr. Soc. 38: 521–526, 1990.

    CAS  PubMed  Google Scholar 

  18. Bianchetti A., Zanetti O., Rozzini R., Trabucchi M.: Risk factors for the development of pressure sores in hospitalized elderly patients: results of a prospective study. Arch. Geron-tol. Geriatr. 16: 225–232, 1993.

    Article  CAS  Google Scholar 

  19. Greenfield S., Blanco D.M., Elashoff R.M.: Development and testing of a new index of comorbidity. Clin. Res. A35: 346, 1987.

    Google Scholar 

  20. Statistical Package for the Social Science. Rel. 5.0. Chicago, Illinois, 1992.

  21. Rubenstein L.: The clinical effectiveness of multidimensional geriatric assessment. J. Am. Geriatr. Soc. 31: 758–762, 1983.

    CAS  PubMed  Google Scholar 

  22. Rubenstein L.Z., Stuck A.E., Siu A.L., Wieland D.: Impacts of geriatric evaluation and management programs on defined outcomes: overview of the evidence. J. Am. Geriatr. Soc. 39: S8–S16, 1991.

    Google Scholar 

  23. Applegate W., Deyo R., Kramer A., Meehan S.: Geriatric evaluation and management: current status and future research directions. J. Am. Geriatr. Soc. 39: S2–S7, 1991.

    Google Scholar 

  24. Wilder C.S.: Limitation of activity and mobility due to chronic conditions: United States, July 1965–June 1966. Vital and Health Statistics, Series 10, No. 45, 1968.

    Google Scholar 

  25. Charlson M.E., Pompei P., Ales K.L., Mackenzie C.R.: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J. Chron. Dis. 40: 373–383, 1987.

    Article  CAS  PubMed  Google Scholar 

  26. Fetter R.B., Youngsoo S., Freeman J.L.: Case mix definition by diagnosis-related groups. Med. Care 18 (Suppl.): 1–39, 1980.

    Google Scholar 

  27. Applegate W.B., Miller S.T., Graney M.J., Elam J.T., Burns R., Akins D.E.: A randomized clinical trial of a geriatric assessment unit in a communitary rehabilitation hospital. N. Engl. J. Med. 322: 1572–1578, 1990.

    Article  CAS  PubMed  Google Scholar 

  28. Watchel T.J., Fulton J.P., Goldfab Y.: Early prediction of discharge disposition after hospitalization. Gerontologist 27: 98–103, 1987.

    Article  Google Scholar 

  29. Ferrucci L., Frisoni G.B.: Pathway from disease to disability: from the WHO conceptual framework toward the identification of an operative definition. In: Osterweil D., Reuben D.B., Rozzini R., Rubenstein L.Z., Trabucchi M. (Eds.), New Frontiers in Geriatric Medicine. Kendall Press, Italy, 1993, pp. 35–42.

  30. Ferrucci L., Guralnik J.M., Baroni A., Tesi G., Antonini E., Marchionni N.: Value of combined assessment of physical health and functional status in community-dwelling aged: a prospective study in Florence, Italy. J. Gerontol. 46: M52–M56, 1991.

    Article  CAS  PubMed  Google Scholar 

  31. Ford A.B., Folmar S.J., Salmon R.B., Medalie J.H., Roy A.W., Galazka S.S.: Health and function in the old and very old. J. Am. Geriatr. Soc. 36: 187–197, 1988.

    CAS  PubMed  Google Scholar 

  32. Rozzini R., Bianchetti A., Trabucchi M.: Disease-Disability-Mortality. J. Am. Geriatr. Soc. 36: 1164, 1988.

    CAS  PubMed  Google Scholar 

  33. Rozzini R., Frisoni G.B., Bianchetti A., Zanetti O., Trabucchi M.: Physical Performance Test and Activities of Daily Living Scales in the assessment of health in elderly people. J. Am. Geriatr. Soc. 41: 1109–1113, 1993.

    CAS  PubMed  Google Scholar 

  34. Zanetti O., Bianchetti A., Frisoni G.B., Rozzini R., Trabucchi M.: Determinants of disability in Alzheimer’s disease. Int. J. Geriatr. Psychiatry 8: 581–586, 1993.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Geriatric Evaluation and Rehabilitation Unit, P. Richiedei Hospital, Gussago, Brescia, Italy

    B. Bertozzi M.D., P. Barbisoni, S. Franzoni & R. Rozzini

  2. Alzheimer’s Disease Unit, S.Cuore Hospital - Fatebenefratelli, Brescia, Italy

    G. B. Frisoni

  3. Geriatric Research Group, Via Romanino 1, 25122, Brescia, Italy

    G. B. Frisoni & M. Trabucchi

Authors
  1. B. Bertozzi M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Barbisoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Franzoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. Rozzini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. B. Frisoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Trabucchi
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bertozzi, B., Barbisoni, P., Franzoni, S. et al. Factors related to length of stay in a Geriatric Evaluation and Rehabilitation Unit. Aging Clin Exp Res 8, 170–175 (1996). https://doi.org/10.1007/BF03339673

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03339673

Keywords

Search

Navigation