Factors Associated with Transfer from an Acute Geriatric Unit to a Post-Acute Care Facility among Community-Dwelling Patients: Results from the DAMAGE Cohort

Figures & data

Figure 1 Study flow chart.

Table 1 Characteristics of the Overall Study Population (n=1928)

	N	Value
CHARACTERISTICS AT HOME
Age, years	1928	86.0 ± 5.3
≥ 85 years		1183 (61.4)
Sex (female)	1928	1243 (64.5)
Living alone	1919	1043 (54.4)
Socially isolated	1910	184 (9.6)
Hospitalized at least once in the previous 6 months	1928	679 (35.2)
Charlson Comorbidity Index	1923	2 (1–3)
Cancer	1914	286 (14.9)
Metastatic cancer	286	37 (12.9)
Heart failure^a	1928
No		1430 (74.2)
Mild		347 (18.0)
Moderate-to-severe		151 (7.8)
GERIATRIC SYNDROMES AT HOME
Cognitive disorder^b	1926	964 (50.1)
History of depression	1914	336 (17.6)
Number of drugs taken at home	1924	7 (5 to 10)
0 to 5		524 (27.2)
6 to 9		863 (44.9)
≥ 10		537 (27.9)
Psychotropic medication	1928	966 (50.1)
Katz ADL score at home		5.0 (4.0–6.0)
0 to 2		235 (12.9)
2.5 to 4.5		484 (26.6)
5 to 6		1099 (60.5)
Walking ability	1916
Cannot walk: confined to bed or a chair		217 (11.3)
Walks with assistance		919 (48.0)
Walks unaided		780 (40.7)
History of falls	1549	796 (51.4)
CHARACTERISTICS AT ADMISSION
Time interval between hospital admission and AGU admission ≥2 days	1877	152 (8.1)
Community-acquired infection	1928	456 (23.7)
Blood hemoglobin level, g/L	1926	11.7 ± 1.9
Serum creatinine level, µmol/mL	1927	88.4 (65.4–114.9)
Estimated glomerular filtration rate, according to the CKD-Epi equation (mL/min/1.73m²)	1928
< 15		31 (1.6)
15 to 29		201 (10.4)
30 to 44		360 (18.7)
45 to 59		426 (22.1)
≥ 60		910 (47.2)
Serum vitamin D level, ng/mL	1815	22.4 ± 13.3
Serum albumin level, g/L	1892	32.1 ± 5.2
Body weight on admission, kg	1843	65.4 (55.4–77.5)
Body mass index, kg.m^−2	1788	25.4 ± 5.6
Obesity^c	1788	336 (18.8)
GERIATRIC SYNDROMES AT ADMISSION
Katz ADL score on admission	1920	4.0 (2.0–5.5)
0 to 2		560 (29.2)
2.5 to 4.5		691 (36.0)
5 to 6		669 (34.8)
Change in the Katz ADL score (home vs admission)	1814	−0.5 (−2.0–0)
−0.5 or less		1050 (57.9)
−1.5 to −1		293 (16.1)
−2.5 to −2		243 (13.4)
−3 or more		228 (12.6)
Malnutrition^d	1928	523 (27.1)
Swallowing disorder	1899	200 (10.5)
Delirium on admission	1928	302 (15.7)
DISCHARGE TO	1928
Home		1317 (68.3)
PAC		611 (31.7)

Notes: Values are presented as the frequency (percentage), mean ± standard deviation, or median [IQR]. ^aNo = no heart failure, mild= New York Heart Association grade 1 or 2, moderate-to-severe = New York Heart Association grade 3 or 4. ^bMemory complaints reported by the family or patient, or known dementia. ^cBody mass index ≥ 30 kg.m^{−2. d}Weight loss >5% in the previous month or >10% in the previous 6 months, or a body mass index <21.

Abbreviations: ADL, activities of daily living; PAC, post-acute care;

Table 2 Bivariate Analyses of Risk Factors for Transfer to PAC in the Overall Study Population

	Home (n=1317)	PAC (n=611)	OR (95% CI)		P
CHARACTERISTICS AT HOME
Age ≥ 85 years	783 (59.5)	400 (65.5)	1.29 (1.06 to 1.58)		0.012
Sex (female)	819 (62.2)	424 (69.4)	1.38 (1.12 to 1.69)		0.002
Living alone	647 (49.4)	396 (65.0)	1.91 (1.56 to 2.32)		<0.001
Socially isolated	103 (7.9)	81 (13.4)	1.80 (1.33 to 2.46)		<0.001
Hospitalized in the previous 6 months	459 (34.9)	220 (36.0)	1.05 (0.86 to 1.29)		0.62
Charlson Comorbidity Index	2 (1 to 3)	2 (1 to 3)	0.93 (0.88 to 0.98)		0.012
Heart failure^a					0.18
No	977 (74.2)	453 (74.1)	1.00 (ref.)		–
Mild	228 (17.3)	119 (19.5)	1.13 (0.88 to 1.44)		0.35
Moderate-to-severe	113 (8.5)	39 (6.4)	0.75 (0.51 to 1.10)		0.14
Cancer	199 (15.2)	87 (14.3)	0.93 (0.71 to 1.22)		0.58
GERIATRIC SYNDROMES AT HOME
Cognitive disorder^b	633 (48.1)	331 (54.2)		1.27 (1.05 to 1.54)	0.014
History of depression	217 (16.6)	119 (19.6)		1.23 (0.96 to 1.57)	0.11
Number of drugs taken at home					0.091
0 to 5	357 (27.2)	167 (27.4)		1.00 (ref.)	-
6 to 9	572 (43.5)	291 (47.8)		1.09 (0.86 to 1.37)	0.48
≥ 10	386 (29.3)	151 (24.8)		0.84 (0.64 to 1.09)	0.18
Psychotropic medication	650 (49.4)	316 (51.7)		1.10 (0.91 to 1.33)	0.33
Katz ADL score at home					<0.001
0 to 2	186 (15.0)	49 (8.5)		1.00 (ref.)	-
2.5 to 4.5	298 (24.0)	186 (32.3)		2.37 (1.65 to 3.41)	<0.001
5 to 6	758 (61.0)	341 (59.2)		1.71 (1.22 to 2.40)	0.002
Walking ability					<0.001
Cannot walk: confined to bed or a chair	172 (13.1)	45 (7.4)		1.00 (ref.)	-
Walks with assistance	561 (42.8)	358 (59.1)		2.44 (1.71 to 3.48)	<0.001
Walks unaided	577 (44.1)	203 (33.5)		1.35 (0.93 to 1.94)	0.11
History of falls	470 (45.0)	326 (64.7)		2.24 (1.80 to 2.79)	<0.001
CHARACTERISTICS AT ADMISSION
Time interval between hospital admission and AGU admission ≥2 days	96 (7.5)	56 (9.3)	1.26 (0.90 to 1.78)		0.18
Community-acquired infection	334 (25.4)	122 (20.0)	0.73 (0.58 to 0.93)		0.010
Blood hemoglobin level, g/L	11.8 ± 1.9	11.6 ± 1.8	0.96 (0.91 to 1.01)		0.095
Serum creatinine level, µmol/mL^c	88.4(67.6 to 119.8)	84.0(61.9 to 113.2)	0.98 (0.96 to 1.00)		0.050
Estimated glomerular filtration rate, according to the CKD-Epi equation (mL/min/1.73m²)					0.71
< 15	23 (1.7)	8 (1.3)	1.00 (ref.)		-
15 to 29	144 (10.9)	57 (9.3)	1.14 (0.48 to 2.69)		0.77
30 to 44	244 (18.5)	116 (19.0)	1.37 (0.59 to 3.15)		0.46
45 to 59	294 (22.3)	132 (21.6)	1.29 (0.56 to 2.96)		0.55
≥ 60	612 (46.5)	298 (48.8)	1.40 (0.62 to 3.17)		0.42
Serum vitamin D level, ng/mL	22.4 ± 13.3	22.3 ± 13.2	1.00 (0.99 to 1.01)		0.84
Serum albumin level, g/L	32.2 ± 5.3	31.7 ± 5.1	0.98 (0.96 to 1.00)		0.056
Body weight on admission, kg					0.23
31.5 to 55.2	299 (23.9)	159 (26.8)	1.00 (ref.)		-
55.3 to 65.4	307 (24.6)	157 (26.5)	0.96 (0.73 to 1.26)		0.78
65.5 to 77.2	317 (25.4)	144 (24.3)	0.85 (0.65 to 1.13)		0.26
77.3 to 129.0	327 (26.1)	133 (22.4)	0.77 (0.58 to 1.01)		0.059
Obesity^d	248 (20.4)	88 (15.4)	0.71 (0.55 to 0.93)		0.013
GERIATRIC SYNDROMES AT ADMISSION
Katz ADL score on admission					<0.001
0 to 2	338 (25.7)	222 (36.6)		1.00 (ref.)	-
2.5 to 4.5	433 (33.0)	258 (42.5)		0.91 (0.72 to 1.14)	0.40
5 to 6	542 (41.3)	127 (20.9)		0.36 (0.28 to 0.46)	<0.001
Change in the Katz ADL score (home vs admission)					<0.001
−0.5 or more	830 (66.9)	220 (38.4)		1.00 (ref.)	-
−1.5 to −1	192 (15.5)	101 (17.6)		1.99 (1.50 to 2.63)	<0.001
−2.5 to −2	133 (10.7)	110 (19.2)		3.12 (2.33 to 4.18)	<0.001
−3 or less	86 (6.9)	142 (24.8)		6.23 (4.59 to 8.46)	<0.001
Malnutrition^e	326 (24.8)	197 (32.2)		1.45 (1.17 to 1.79)	<0.001
Swallowing disorder	137 (10.6)	63 (10.5)		0.99 (0.72 to 1.36)	0.96
Delirium on admission	172 (13.1)	130 (21.3)		1.80 (1.40 to 2.31)	<0.001

Notes: Values are presented as the frequency (percentage), mean ± standard deviation, or median [IQR]. ^aNo = no heart failure, Mild= New York Heart Association grade 1 or 2, Moderate-to-severe = New York Heart Association grade 3 or 4. ^bMemory complaints reported by the family or patient, or known dementia. ^cOR for a 10 µmol/mL increment. ^dBody mass index ≥ 30 kg.m^{−2. e}Weight loss >5% in the previous month or >10% in the previous 6 months, or a body mass index <21.

Abbreviations: OR, odds ratio; CI, confidence interval; ADL, activities of daily living; PAC, post-acute care.

Table 3 Multivariable Analysis of Risk Factors for Transfer to PAC in the Overall Population

	OR (95% CI)	P
CHARACTERISTICS AT HOME
Living alone	1.74 (1.37 to 2.19)	<0.001
Socially isolated	1.48 (1.03 to 2.10)	0.031
GERIATRIC SYNDROMES AT HOME
Walking ability		0.006
Cannot walk: confined to bed or a chair	1.00 (ref.)	–
Walks with assistance	1.52 (0.91 to 2.53)	0.11
Walks unaided	1.05 (0.61 to 1.81)	0.86
History of fall	1.58 (1.22 to 2.04)	<0.001
CHARACTERISTICS AT ADMISSION
Community-acquired infection	0.70 (0.53 to 0.91)	0.008
Serum albumin level, g/L	0.98 (0.95 to 0.99)	0.044
Obesity^a	0.68 (0.51 to 0.91)	0.009
GERIATRIC SYNDROMES AT ADMISSION
Katz ADL score on admission		0.041
0 to 2	1.00 (ref.)	-
2.5 to 4.5	0.93 (0.68 to 1.27)	0.66
5 to 6	0.63 (0.42 to 0.95)	0.027
Change in the Katz ADL score (home vs admission)		<0.001
−0.5 or more	1.00 (ref.)	-
−1.5 to −1	1.52 (1.09 to 2.11)	0.012
−2.5 to −2	1.98 (1.38 to 2.83)	<0.001
−3 or less	3.69 (2.44 to 5.59)	<0.001
Delirium on admission	1.40 (1.04 to 1.87)	0.024

Notes: Odds ratios and p-values were calculated after handling missing values by multiple imputation (m=25). ^aBody mass index ≥ 30 kg.m⁻².

Abbreviations: OR, odds ratio; CI, confidence interval; ADL, activities of daily living; PAC, post-acute care.