Analysis of care-pathways of older adults hospitalized for influenza-like illness before institutionalization: a...

Influenza infection can represent a key factor for functional decline and loss of independence among older adults. In France, over 600,000 seniors live in social institutions, including nursing homes (NH). Yet, real-world data on the place of influenza hospitalization in care pathway before institutionalization are scarce in France. This study described the care pathway of older adults hospitalized for influenza-like illness (ILI) before NH admission.

A retrospective observational study based on the French National Health System (SNDS) was conducted. All patients aged ≥ 65 years who were admitted to a NH between the start of the 2018-2019 epidemic season and up to eight months after were identified. Those hospitalized for ILI within six months prior to institutionalization were included and followed for six months prior to and up to three months after NH admission. Demographic and clinical characteristics of patients were described. State sequence analysis (SSA) was used to identify clusters of patients based on healthcare events (e.g. hospitalizations, rehabilitation, and deaths) during follow-up.

Among 119,869 NH admissions, 1,239 (1.1%) had prior ILI hospitalization. About 70% of patients had received influenza vaccination. Median age was 88 years; 64.6% were women; over 90% had at least one comorbidity, notably hypertension (75%) and neurodegenerative disorders (31.3%). After ILI-hospitalization, 31.2% of patients were transferred to rehabilitation before NH admission, and 8.4% were admitted directly to NH. SSA identified five patient clusters differing in vaccination rates, comorbidities and healthcare utilization. Cluster 1 and Cluster 2 were generally healthier and admitted to NH immediately after discharge (median 20.5-22.5 days). Cluster 3-5 had more comorbidities and were more frequently transferred to rehabilitation after discharge and before NH admission. The total cost to the French health insurance for these patients exceeded €20 million. Rehabilitation accounted for €9.6 million, ILI hospitalizations €6.0 million, and other hospitalizations (including cardiorespiratory) €4.3 million.

This study explored the place of influenza in the care pathway of French older adults admitted to NH after ILI hospitalization. Findings underscore the important place of rehabilitation care following ILI hospitalization, specifically among adults with multiple comorbidities, highlighting the need for improving vaccination coverage among frail older adults to mitigate post‑ILI care burden.