[Causes for in-hospital treatment of nursing home residents]

The high rates of hospitalization in nursing home residents are as well known as the hazards of in-hospital treatment especially in this group of frail older people. Moreover, hospital admissions cause considerable costs. The objective of the study was to analyze why nursing home residents are admitted for in-hospital geriatric care, and to form hypotheses of how to prevent these admissions without loss of quality of care. Reason of admission, comorbidity, competence and length of in-hospital stay were assessed in all nursing home residents referred to the Geriatric Centre at the University Hospital of Heidelberg over 12 months. There were 245 admissions of 231 nursing home residents (83.1% female; age 84.2 +/- 7.10 years). Comorbidity was substantial (77% urinary incontinence, 69% dementia, 40% stool incontinence, 22% pressure ulcers), and 56% of residents needed assistance in using the toilet before admission. Mean length of in-hospital stay was 32.6 days (median 29 days). Out of a total amount of 7983 days of in-hospital care, 3627 (45%) were caused by falls and fractures, 2039 (26%) by cardiovascular events (mainly ischemic stroke), 835 (11%) by infections and 495 (6%) by problems concerning nutrition. Most of the leading causes of admission of nursing home residents to in-hospital geriatric care might be affected by improvements in nursing home care. Thus, data suggest that hospitalization rates might be substantially reduced by targeted prevention and therapy as well as by structural measures to improve case management in the nursing homes. Such interventions should be developed and proved in controlled studies.