https://orcid.org/0000-0002-5061-2991
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Abstract
Background
Acute geriatric units (AGUs) require efficient discharge planning tools. Risk factors for discharge from an AGU to post-acute care (PAC) have not previously been investigated in detail.
Methods
The objective is to identify risk factors for PAC transfer. The DAMAGE (prospective multicenter cohort) consecutively included more than 3500 subjects aged 75 or older and admitted to an AGU. The patients underwent a comprehensive geriatric assessment (CGA) during their stay in the AGU. Only community-dwelling patients admitted to the AGU from the emergency department were included in the analysis. We recorded the characteristics of the care pathway and identified risk factors for discharge to home or to a PAC facility.
Results
1928 patients were included. Loss of functional independence (a decrease in the Katz activities of daily living (ADL) score between 1 month prior to admission and AGU admission), living alone, social isolation, a high Katz ADL score at home, a low Katz ADL on admission, and delirium on admission were risk factors for transfer to PAC. Obesity, an elevated serum albumin level, and community-acquired infection were associated with discharge to home. Neither sex nor age was a risk factor for home discharge or transfer to PAC.
Conclusion
The present results might help clinicians and discharge planning teams to identify patients at risk of transfer to PAC more reliably and promptly in AGUs.
Acknowledgments
We thank all the physicians who helped to recruit patients in the centres, and notably Julien Moyet, Véronique Gallopin, Sanaa Hannat, Saliha Sid Idris, Claire Delmas, Mélissa Pierre, Wilhelm Pommier, Rozenn Hequette, Eric Boulanger, Aurélie Moraud, Elisabeth Brocquet, Pierre Robinet, Francois Maladry, Fouad El Dirani, Christine Yves, Jean Mari Nkunzimana, Yassine Benhammacht, Celine Boufflet, Karim Boulanouar. We also thank the members of the clinical research support team at Lille University Hospital for their help and logistical support throughout the study, and notably Sara Frade, Martin Wojcik, Aurélie Gozdziaszek and Samir Boukla. We thank David Fraser PhD (Biotech Communication SARL, Ploudalmézeau, France) for copy-editing assistance.
Author Contributions
All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Disclosure
Professor Jean-Baptiste Beuscart reports grants from French government’s interregional hospital-based clinical research program, during the conduct of the study. No authors have any conflicts of interest to declare.