Abstract
OBJECTIVES: To examine the effects of decreasing hospital length of stay (HLOS) on change in functioning from prehospital admission to posthospital discharge in older cohorts.
DESIGN: Cohort-sequential design.
SETTING: Nationwide, older population-based Longitudinal Aging Study Amsterdam (LASA).
PARTICIPANTS: Individuals aged 68 and older with any hospital admission according to national medical registry data: two 10-year age groups (68-77 (younger-old) and 78-87 (older-old)) in two periods (1996-99 (Period 1) and 2006-09 (Period 2)) (N = 1,212).
MEASUREMENTS: HLOS was the main independent variable in multinomial logistic models, dichotomized as 1 to 5 days (short) and 6 days or longer (long). Outcomes were change scores in mobility and activities in daily living (ADLs). Respondents who died during the 3-year period were assigned to a third outcome category.
RESULTS: Results for both age groups showed more hospital admissions and shorter median HLOS in Period 2 than Period 1 (P < .05). Lower odds of decline in physical functioning were found in respondents with short HLOS than in those with long HLOS (for mobility: odds ratio (OR) = 0.36, 95% confidence interval (CI) = 0.23-0.54 (younger-old) and OR = 0.47, 95% CI = 0.30-0.72 (older-old); for ADLs: OR = 0.30, 95% CI = 0.19-0.48 (younger-old) and OR = 0.30, 95% CI = 0.18-0.53 (older-old)). Adjusting for confounders did not significantly change these estimates. Period did not modify these associations.
CONCLUSION: Because the associations of HLOS with change in mobility and ADLs were the same in both periods, hospitalized older adults had neither advantage nor disadvantage from the decrease in HLOS. In addition, in both age groups, a greater percentage experienced the better functional outcomes and lower mortality associated with short admissions, which suggests an advantage of the decrease in HLOS.
Original language | English |
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Pages (from-to) | 1214-1221 |
Number of pages | 8 |
Journal | Journal of the American Geriatrics Society |
Volume | 65 |
Issue number | 6 |
DOIs | |
Publication status | Published - Jun 2017 |
Funding
We thank M.H.L. van der Horst for organization of the LASA data collection, J.L. Poppelaars for managing the LASA data, and T.N. van den Kommer for developing “persistent cognitive decline,” which was used as a covariate. An oral presentation of the first draft was made at the annual scientific meeting of the Gerontological Society of America, Boston, Massachusetts, November 19, 2011. A poster of the second draft was presented at the International Association of Gerontology and Geriatrics European Region Congress, Dublin, Ireland, April 23, 2015. Financial Disclosure: LASA has received funding from the Dutch Ministry of Health, Welfare and Sports. Martijn Huisman has received a VIDI Fellowship from the Netherlands Organisation for Scientific Research (Grant 452–11–017). Conflict of Interest: Dutch Ministry of Health, Welfare and Sports: The former, D. Deeg, and the current, M. Huisman, Scientific Director from LASA received funding for collecting the data, M. van Vliet supports in organizing the data collection. Netherlands Organisation for Scientific Research: Martijn Huisman received a VIDI Fellowship; Grant no 452–11–017. Author Contributions: Van Vliet: data acquisition, analysis, and interpretation; drafting of manuscript. Huisman, Deeg: concept, design, data interpretation; critical revision of manuscript. Sponsor's Role: The sponsors had no role in the design, methods, subject recruitment, data collections, analysis, and preparation of the manuscript.
Funders | Funder number |
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Gerontological Society of America | |
Ministerie van Volksgezondheid, Welzijn en Sport | |
Nederlandse Organisatie voor Wetenschappelijk Onderzoek | 452–11–017 |
Keywords
- Activities of Daily Living
- Aged
- Aging
- Geriatric Assessment
- Hospitalization
- Humans
- Journal Article
- Length of Stay
- Longitudinal Studies
- Mortality
- Netherlands
- Risk Factors