Nursing home residents with cognitive impairment more likely to be admitted to hospital

INDIANAPOLIS — Transfers from the nursing home to the emergency department (ED) or the hospital can have negative longer-term impact on the health of older adults. A new study from Regenstrief Institute and Indiana University School of Medicine looked at which residents were most likely to be admitted to the hospital after a trip to the ED with the hope of identifying areas to improve care and reduce unnecessary transfers.

The study team analyzed hundreds of transfers from the nursing facility to the ED and found the factors most associated with discharge back to the facility were:

• Falls, trauma or fracture
• Bleeding (non-gastrointestinal)
• Pain

Residents who had the following characteristics were more likely to be admitted to the hospital following an ED visit:

• Cognitive impairment
• Respiratory difficulties

“Transfers of care can be very difficult on the patient. Our goal in analyzing this data is to identify new opportunities to improve care, whether it’s preventing transfers to the emergency department or finding ways to avoid hospital admissions,” said Kathleen Unroe, M.D., MHA, first author of the paper, Regenstrief research scientist and associate professor of medicine at IU School of Medicine. “This information helps us understand what ailments could potentially be treated in the nursing home, avoiding a potentially risky transfer of care.”

About one quarter of nursing facility residents will experience a transfer to the hospital over the course of a year. There is a significant likelihood of reduced functioning and overall negative impact on their health after discharge from the hospital.

Analyzing the data for hospital admission

The research team looked at 867 long-stay nursing home facility residents enrolled in the OPTIMISTIC project. OPTIMISTIC (Optimizing Patient Transfers, Impacting Medical quality, Improving Symptoms — Transforming Institutional Care) was a demonstration project funded by the Centers for Medicare and Medicaid that successfully reduced potentially avoidable hospitalizations of people in nursing homes.

“Through OPTIMISTIC, we’ve determined that we can reduce avoidable hospitalizations. The next step is to gain a more nuanced understanding of transfers,” said Susan Hickman, PhD, senior author on the paper and director of Indiana University Center for Aging Research at Regenstrief Institute. “This helps us find opportunities for improvement from both the facility perspective and the emergency department perspective.”

Researchers say these results suggest one area for exploration may include targeted resources and protocols focused on treatment for falls or symptom management within nursing homes. Another potential area of improvement is the creation of strategies to ensure that providers in the ED have more information when they are assessing the residents, as well as an understanding of the care capabilities of the nursing home to increase the number of discharges back to the facility and avoid hospitalizations.

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“Long-stay nursing facility resident transfers: Who gets admitted to the hospital?” was published in the Journal of the American Geriatrics Society. This work was supported by the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services [Funding Opportunity 1E1CMS331488].

Authors in addition to Dr. Unroe and Dr. Hickman include Regenstrief and IU School of Medicine faculty Wanzhu Tu, PhD; Jennifer L. Carnahan, M.D., MPH and Greg A. Sachs, M.D. Other authors are Jeffrey M. Caterino, M.D., MPH of Ohio State University School of Medicine; Timothy E. Stump, M.A., of IU School of Medicine; and Joshua Vest, PhD, MPH of Regenstrief and Indiana University Richard M. Fairbanks School of Public Health at IUPUI.

About Regenstrief Institute

Founded in 1969 in Indianapolis, the Regenstrief Institute is a local, national and global leader dedicated to a world where better information empowers people to end disease and realize true health. A key research partner to Indiana University, Regenstrief and its research scientists are responsible for a growing number of major healthcare innovations and studies. Examples range from the development of global health information technology standards that enable the use and interoperability of electronic health records to improving patient-physician communications, to creating models of care that inform practice and improve the lives of patients around the globe.

Sam Regenstrief, a nationally successful entrepreneur from Connersville, Indiana, founded the institute with the goal of making healthcare more efficient and accessible for everyone. His vision continues to guide the institute’s research mission.

About IU School of Medicine

IU School of Medicine is the largest medical school in the U.S. and is annually ranked among the top medical schools in the nation by U.S. News & World Report. The school offers high-quality medical education, access to leading medical research and rich campus life in nine Indiana cities, including rural and urban locations consistently recognized for livability.

Kathleen Tschantz Unroe, M.D., MHA

In addition to being a research scientist at the IU Center for Aging Research at Regenstrief Institute, Kathleen Unroe, M.D., MHA, is an associate professor at IU School of Medicine and a geriatrician practicing in the nursing home setting.

Susan Hickman, Ph.D.

In addition to leading the IU Center for Aging Research at Regenstrief Institute, Susan Hickman, PhD, is a professor at Indiana University School of Nursing, a professor and Cornelius and Yvonne Pettinga Chair of Aging Research at IU School of Medicine, and the co-director of the IUPUI Research in Palliative and End-of-Life Communicating and Training (RESPECT) Signature Center.