Days at Home After Serious Health Events Among Community-Living Older Persons

Days spent at home have been identified as a clinically meaningful patient-centered outcome, especially in older persons. Serious health events in this population have pronounced deleterious effects on functional well-being. Our objective was to determine whether and how days spent at home differ in the 6 months after specific types of serious health events.

From a prospective longitudinal study of 754 community-living persons, aged 70 years or older, we calculated the number of days at home as 180 minus the number of overnight days in a health care facility and days not alive. The occurrence of serious health events, including critical illness, major surgery (non-elective and elective), and other hospitalizations, were ascertained primarily through linkages with Medicare data.

Days at home were diminished in the 180 days after each type of serious health event. Relative to a reference group, the adjusted rate ratios (95% CI), representing the mean number of days at home as a proportion, were 0.70 (0.64-0.77) for critical illness, 0.70 (0.64-0.76) for non-elective major surgery, 0.87 (0.84-0.91) for elective major surgery, and 0.86 (0.83-0.89) for other hospitalization. The corresponding absolute reductions (95% CI) in mean days at home were 48.6 (37.9-59.3), 50.1 (39.7-60.5), 20.7 (14.3-27.0), and 22.9 (17.9-28.0), respectively. Of the time not spent at home, days in a nursing facility were most common except for critical illness, which had the highest mortality; days in a hospice facility were least common; and days in a hospital differed relatively little across the groups.

Days spent at home are considerably diminished after serious health events. These findings may help guide older persons, their families, and physicians about what to expect after hospital discharge for different types of serious health events, and they suggest potential strategies that may optimize time spent at home.