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Factors associated with length of stay in hospital for men and women aged 85 and over: A quantile regression approach

Published:February 22, 2019DOI:https://doi.org/10.1016/j.ejim.2019.02.011

      Highlights

      • Hospital stay in the last year of life differs by gender for adults 85+ years.
      • Women admitted for influenza are associated with shorter length of stay in hospital.
      • Men with poor health behaviours, falls and organ failure have longer length of stay

      Abstract

      Objectives

      Explore characteristics of hospital use for adults aged 85 and over in their last year of life and examine factors associated with cumulative overnight length of stay (LOS).

      Data source/study setting

      NSW 45 and Up Study linked with hospital data.

      Study design

      Longitudinal cohort study.

      Methods

      Quantile regression models were performed for men and women (N = 3145) to examine heterogeneity in predictors of overnight hospital admissions. Coefficients were estimated at the 25th, 50th, 75th and 90th percentiles of the LOS distribution.

      Principal findings

      86% had at least one hospitalisation in their last year of life, with 60% dying in hospital. For men, first admission for organ failure was associated with a 26 day increase at the 90th LOS percentile, and a 0.22 day increase at the 10th percentile compared to men with cancer. Women admitted with influenza had decreased LOS of 20.5 days at the 75th percentile and 6 to 8 fewer days at the lower percentiles compared to those women with cancer.

      Conclusions

      Poor health behaviours were a major driver of highest LOS among older men, pointing to opportunities to achieve health care savings through prevention. For older women, influenza was associated with shorter LOS, which could be an indicator of the high and rapid mortality rates at older ages, and may be easily prevented. Other factors associated with LOS among women, included where they lived before they were admitted, and discharge destination.

      Keywords

      Abbreviations:

      LOS (Length of stay), NSW (New South Wales), BMI (Body mass index), ICD-10 (International Statistical Classification of Diseases and Related Health Problems (10th revision)), COD (Cause of death), OLS (Ordinal least square), IQR (Inter-quartile range)
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