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Mazzola P, Buttò V, Elli S, et al. Frailty predicts failure to discharge patients home from a subacute-care unit: a 3-year Italian experience. Aging Clin Exp Res. 2021;doi: 10.1007/s40520-021-01908-w.
Mazzola, P., Buttò, V., Elli, S., Galluccio, R., Domenici, G., Stella, V., Haas, J., Peschi, G., Monzio Compagnoni, M., Annoni, G., & Bellelli, G. (2021). Frailty predicts failure to discharge patients home from a subacute-care unit: a 3-year Italian experience. Aging clinical and experimental research, . https://doi.org/10.1007/s40520-021-01908-w
Mazzola, Paolo, et al. "Frailty predicts failure to discharge patients home from a subacute-care unit: a 3-year Italian experience." Aging clinical and experimental research vol. (2021). doi: https://doi.org/10.1007/s40520-021-01908-w
Mazzola P, Buttò V, Elli S, Galluccio R, Domenici G, Stella V, Haas J, Peschi G, Monzio Compagnoni M, Annoni G, Bellelli G. Frailty predicts failure to discharge patients home from a subacute-care unit: a 3-year Italian experience. Aging Clin Exp Res. 2021 Jul 21; doi: 10.1007/s40520-021-01908-w. Epub 2021 Jul 21. PMID: 34291406.
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Aging Clin Exp Res. 2021 Jul 21; doi: 10.1007/s40520-021-01908-w. Epub 2021 Jul 21.

Frailty predicts failure to discharge patients home from a subacute-care unit: a 3-year Italian experience.

Aging clinical and experimental research

Paolo Mazzola, Valeria Buttò, Simona Elli, Riccardo Galluccio, Giulia Domenici, Valentina Stella, Justin Haas, Gianluca Peschi, Matteo Monzio Compagnoni, Giorgio Annoni, Giuseppe Bellelli

Affiliations

  1. School of Medicine and Surgery, University of Milano-Bicocca, U8 Building, Floor 4, Lab 4045 Via Cadore, 48, 20900, Monza, Italy. [email protected].
  2. Acute Geriatrics Unit, San Gerardo Hospital ASST Monza, Monza, Italy. [email protected].
  3. Department of Chronic Care (RICCA), Desio Hospital, Desio, Italy. [email protected].
  4. Clinical Neurosciences Research Area, NeuroMI, Milan Center for Neuroscience, Milano, Italy. [email protected].
  5. Department of Chronic Care (RICCA), Desio Hospital, Desio, Italy.
  6. School of Medicine and Surgery, University of Milano-Bicocca, U8 Building, Floor 4, Lab 4045 Via Cadore, 48, 20900, Monza, Italy.
  7. Faculty of Medicine, University of Toronto, Toronto, Canada.
  8. Direzione Socio-Sanitaria, San Gerardo Hospital ASST Monza, Monza, Italy.
  9. Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milano, Italy.
  10. National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milano, Italy.
  11. Acute Geriatrics Unit, San Gerardo Hospital ASST Monza, Monza, Italy.
  12. Clinical Neurosciences Research Area, NeuroMI, Milan Center for Neuroscience, Milano, Italy.

PMID: 34291406 DOI: 10.1007/s40520-021-01908-w

Abstract

BACKGROUND: The primary purpose of Subacute Care Units (SCU) is to decongest acute hospital wards and facilitate the return of older patients to home.

AIMS: We analyzed the clinical characteristics and outcomes of patients admitted to an Italian SCU, and we explored factors associated with discharge to locations other than home (outcome).

METHODS: This retrospective observational cohort study was conducted at a medium-sized suburban hospital, enrolling all patients consecutively admitted to one SCU from October 2017 to February 2020. We collected demographics, cause of admission, comorbidities, cognition, Barthel Index (BI), nutritional status, Clinical Frailty Scale (CFS), length of stay, and discharge destination. Delirium was screened with the 4AT score. We adopted a multivariable conditional logistic regression model to identify the factors associated with the outcome.

RESULTS: Frail subjects accounted for 58.6% of 406 patients (mean age 78.2 years, SD 11.6), while 61% were classified as functionally dependent. More than half of patients had relevant comorbidity, approximately 80% had a poor nutritional status, and 25% had pre-existing dementia. The overall prevalence of delirium was 14.5%. Most patients came from a hospital setting; recurrent reasons for admission were infections (70.5%) and heart failure (12.7%). Having a urinary bladder catheter at discharge, being overtly frail (CFS > 8), and low BI score were factors independently associated with not being discharged home.

DISCUSSION AND CONCLUSION: The routine assessment of frailty, as expressed by the CFS, may help redirecting the patients eligible for SCU admission.

© 2021. The Author(s).

Keywords: Discharge home; Elderly; Frailty; Subacute care

References

  1. Royal College of Physicians (2012) Hospitals on the edge? The time for action. London: RCP.   Available at: https://www.rcplondon.ac.uk/sites/default/files/documents/hospitals-on-the-edge-report.pdf - PubMed
  2. Melis RJF, Olde Rikkert MGM, Parker SG et al (2004) What is intermediate care? BMJ 329:360 - PubMed
  3. Regional Decree by Lombardy Region n. IX/1479 dated 30/03/2011 “Determinazioni in ordine alla gestione del servizio socio sanitario regionale per l'esercizio 2011—II° provvedimento di aggiornamento in ambito sanitario”, available at: http://www.buongiornocreg.it/assets/DGR_RL_1479_30_03_2011.pdf - PubMed
  4. Mazzola P, Rimoldi SML, Rossi P et al (2016) Aging in Italy: the need for new welfare strategies in an old country. Gerontologist 56:383–390 - PubMed
  5. Charlson ME, Pompei P, Ales KL et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383 - PubMed
  6. Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198 - PubMed
  7. Bellelli G, Morandi A, Davis DHJ et al (2014) Validation of the 4AT, a new instrument for rapid delirium screening: a study in 234 hospitalised older people. Age Ageing 43:496–502 - PubMed
  8. Mahoney FI, Barthel DW (1965) Functional evaluation: the Barthel Index. Md State Med J 14:61–65 - PubMed
  9. Guigoz Y, Vellas B (1999) The Mini Nutritional Assessment (MNA) for grading the nutritional state of elderly patients: presentation of the MNA, history and validation. Nestle Nutr Workshop Ser Clin Perform Programme 1:3–11; discussion 11–2. https://doi.org/10.1159/000062967 - PubMed
  10. Rockwood K, Song X, MacKnight C et al (2005) A global clinical measure of fitness and frailty in elderly people. CMAJ 173:489–495 - PubMed
  11. Bellelli G, Magnifico F, Trabucchi M (2008) Outcomes at 12 months in a population of elderly patients discharged from a rehabilitation unit. J Am Med Dir Assoc 9:55–64 - PubMed
  12. Chong MS, Empensando EF, Ding YY, Tan TL (2012) A subacute model of geriatric care for frail older persons: the Tan Tock Seng Hospital experience. Ann Acad Med Singap 41:354–361 - PubMed
  13. Gual N, Font AY, Montes BE et al (2017) Profile and evolution of chronic complex patients in a subacute unit. Aten Primaria 49:510–517 - PubMed
  14. Noaman S, Al-Mukhtar O, Abramovic S et al (2019) Changes in statin prescription patterns in patients admitted to an Australian geriatric subacute unit. Heart Lung Circ 28:423–429 - PubMed
  15. Sánchez-Rodríguez D, Marco E, Miralles R et al (2014) Sarcopenia, physical rehabilitation and functional outcomes of patients in a subacute geriatric care unit. Arch Gerontol Geriatr 59:39–43 - PubMed
  16. Thomas DR, Zdrowski CD, Wilson M et al (2002) Malnutrition in subacute care. Am J Clin Nutr 75:308–313 - PubMed
  17. National Audit of Intermediate Care, summary report—England. 2017. Assessing progress in services aimed at maximising independence and reducing use of hospitals. https://s3.eu-west-2.amazonaws.com/nhsbn-static/NAIC+(Providers)/2017/NAIC+England+Summary+Report+-+upload+2.pdf - PubMed
  18. Haley MN, Wells YD, Holland AE (2014) Relationship between frailty and discharge outcomes in subacute care. Aust Health Rev 38:25–29 - PubMed
  19. Mulley GP (2001) Alternatives to hospital care for older people. Age Ageing 30(Suppl 3):1 - PubMed
  20. Cesari M, Marzetti E, Thirm U et al (2016) The geriatric management of frailty as paradigm of “The end of the disease era. Eur J Intern Med 31:11–14 - PubMed
  21. Bo M, Porrino P, Di Santo SG et al (2019) The association of indwelling urinary catheter with delirium in hospitalized patients and nursing home residents: an explorative analysis from the “Delirium Day 2015.” Aging Clin Exp Res 31:411–420 - PubMed
  22. Saint S (2000) Clinical and economic consequences of nosocomial catheter-related bacteriuria. Am J Infect Control 28:68–75 - PubMed
  23. Mody L, Krein SL, Saint SK et al (2015) A targeted infection prevention intervention in nursing home residents with indwelling devices: a randomized clinical trial. JAMA Intern Med 175:714–723 - PubMed

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