Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-28T06:10:23.576Z Has data issue: false hasContentIssue false
  • English
  • Français

Frailty and adverse outcomes: impact of multiple bed moves for older inpatients

Published online by Cambridge University Press:  03 October 2016

Champa Ranasinghe ,
Aisling Fleury ,
Nancye M. Peel  and
Ruth E. Hubbard
Champa Ranasinghe
Affiliation:
Centre for Research in Geriatric Medicine, School of Medicine, The University of Queensland, Brisbane, Australia Geriatric Medicine, Queensland Health, Brisbane, Queensland, Australia
Aisling Fleury
Affiliation:
Geriatric Medicine, Queensland Health, Brisbane, Queensland, Australia
Nancye M. Peel*
Affiliation:
Centre for Research in Geriatric Medicine, School of Medicine, The University of Queensland, Brisbane, Australia
Ruth E. Hubbard
Affiliation:
Centre for Research in Geriatric Medicine, School of Medicine, The University of Queensland, Brisbane, Australia
*
Correspondence should be addressed to: Dr. Nancye Peel, Centre for Research in Geriatric Medicine, Level 2 Building 33, Princess Alexandra Hospital, Woolloongabba, Queensland 4102, Australia. Phone: +61-7-31767402; Fax: +61-7-31766945. Email: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

A consequence of pressure on hospitals to accommodate care needs of older patients is “boarding” or out-lying from their home ward. This may have greater adverse effects on older inpatients who are frail.

Methods:

A retrospective matched cohort study was conducted in an outer metropolitan general hospital. Randomly selected patients hospitalized between July 2012 and June 2013 under the care of an Older Person Evaluation Review and Assessment (OPERA) team (n = 300) were age and sex matched with patients under the care of general physicians (n = 300). Frequency of boarding and number of bed moves were recorded for all patients. For patients who had three or more moves, adverse outcomes were compared between the two groups.

Results:

A higher proportion of OPERA patients (n = 143; 47.7%) were out-lied from medical wards compared with 94 (31.3%) General Medicine patients (p < 0.001). Three or more bed moves were recorded for 67 (22.3%) OPERA and 24 (8%) General Medicine patients (p < 0.001). Of those with multiple moves, OPERA patients were more likely to have pre-morbid cognitive impairment (p = 0.005), to be moderately to severely frail (p = 0.016) and to suffer acute delirium and falls during admission (p = 0.03), compared with General Medicine patients. OPERA patients were also more at risk of adverse outcomes such as increased dependence, discharge to residential care or death (p = 0.023).

Conclusion:

Compared with age- and sex-matched General Medicine patients, OPERA patients were more likely to undergo multiple bed moves and out-lying, which may have contributed to negative outcomes for these patients.

Keywords

geriatric medicineinpatientadverse eventsfrail older adultsbed moves
Type
Research Article
Information
International Psychogeriatrics , Volume 29 , Issue 2 , February 2017 , pp. 345 - 349
Copyright
Copyright © International Psychogeriatric Association 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Australian Institute of Health and Welfare (2014). Australia's Health 2014. Canberra: AIHW.Google Scholar
Australian Institute of Health and Welfare, Karmel, R., Lloyd, J. and Hales, C. (2007). Older Australians in Hospital. Canberra: AIHW, 2007 Bulletin no. 53. Cat. no. AUS 92.Google Scholar
Charlson, M., Szatrowski, T. P., Peterson, J. and Gold, J. (1994). Validation of a combined comorbidity index. Journal of Clinical Epidemiology, 47, 1245–1251.Google Scholar
Ellis, G., Whitehead, M. A., Robinson, D., O'Neill, D. and Langhorne, P. (2011). Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials. British Medical Journal, 343, d6553. doi: 10.1136/bmj.d6553.CrossRefGoogle ScholarPubMed
Goldberg, A., Straus, S. E., Hamid, J. S. and Wong, C. L. (2015). Room transfers and the risk of delirium incidence amongst hospitalized elderly medical patients: a case-control study. BMC Geriatrics, 15, 69. doi: 10.1186/s12877-015-0070-8.CrossRefGoogle ScholarPubMed
Kafetz, K. (2010). How effective are acute geriatric wards at admitting geriatric patients? Clinical Medicine, 10, 420–421.CrossRefGoogle ScholarPubMed
Katz, S. (1983). Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living. Journal of the American Geriatrics Society, 31, 721–727.Google Scholar
Knickman, J. R. and Snell, E. K. (2002). The 2030 problem: caring for aging baby boomers. Health Services Research, 37, 849–884.Google Scholar
Lafont, C., Gerard, S., Voisin, T., Pahor, M. and Vellas, B. (2011). Reducing “iatrogenic disability” in the hospitalized frail elderly. Journal of Nutrition, Health and Aging, 15, 645–660.CrossRefGoogle ScholarPubMed
McCusker, J., Cole, M., Abrahamowicz, M., Han, L., Podoba, J. E. and Ramman-Haddad, L. (2001). Environmental risk factors for delirium in hospitalized older people. Journal of the American Geriatrics Society, 49, 1327–1334.Google Scholar
McKnight, J. A. and Espie, C. (2012). Managing acute medical admissions: the plight of the medical boarder. Scottish Medical Journal, 57, 45–47. doi: 10.1258/smj.2011.011187.CrossRefGoogle ScholarPubMed
McMurdo, M. E. and Witham, M. D. (2013). Unnecessary ward moves. Age and Ageing, 42, 555–556. doi: 10.1093/ageing/aft079.Google Scholar
National Institute for Health and Care Excellence. (2010). Delirium: diagnosis, prevention and management 2010. Cited 6 July 2015. Available from: http://www.nice.org.uk/guidance/CG103.Google Scholar
Nobili, A., Garattini, S. and Mannucci, P. M. (2011). Multiple diseases and polypharmacy in the elderly: challenges for the internist of the third millennium. Journal of Comorbidity, 1, 28–44.Google Scholar
Perimal-Lewis, L., Li, J. Y., Hakendorf, P. H., Ben-Tovim, D. I., Qin, S. and Thompson, C. H. (2013). Relationship between in-hospital location and outcomes of care in patients of a large general medical service. Internal Medicine Journal, 43, 712–716. doi: 10.1111/imj.12066.CrossRefGoogle ScholarPubMed
Rockwood, K. (2005). Frailty and its definition: a worthy challenge. Journal of the American Geriatrics Society, 53, 1069–1070. doi: 10.1111/j.1532-5415.2005.53312.x.CrossRefGoogle ScholarPubMed
Rockwood, K. and Hubbard, R. (2004). Frailty and the geriatrician. Age and Ageing, 33, 429–430. doi: 10.1093/ageing/afh153.CrossRefGoogle ScholarPubMed
Rose, M., Pan, H., Levinson, M. R. and Staples, M. (2014). Can frailty predict complicated care needs and length of stay? Internal Medicine Journal, 44, 800–805. doi: 10.1111/imj.12502.CrossRefGoogle ScholarPubMed
Singh, I., Gallacher, J., Davis, K., Johansen, A., Eeles, E. and Hubbard, R. E. (2012). Predictors of adverse outcomes on an acute geriatric rehabilitation ward. Age and Ageing, 41, 242–246. doi: 10.1093/ageing/afr179.CrossRefGoogle Scholar
Stowell, A. et al. (2013). Hospital out-lying through lack of beds and its impact on care and patient outcome. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 21, 17. doi: 10.1186/1757-7241-21-17.Google Scholar
Travers, C. M. et al. (2008). The acute-aged care interface: exploring the dynamics of ‘bed blocking’. Australasian Journal on Ageing, 27, 116–120. doi: 10.1111/j.1741-6612.2008.00310.x.Google Scholar
Tropea, J., Slee, J. A., Brand, C. A., Gray, L. and Snell, T. (2008). Clinical practice guidelines for the management of delirium in older people in Australia. Australasian Journal on Ageing, 27, 150–156. doi: 10.1111/j.1741-6612.2008.00301.x.Google Scholar
Trueland, J. (2013). A moving experience. Nursing Standard, 27, 20–21.Google Scholar
Xu, G., Whitaker, E. and Hubbard, I. (2011). Inpatient elderly care: reducing re-admission rates. British Journal of Healthcare Management, 17, 599–602.Google Scholar