Predictors of institution Admission in the YeAr following Acute hosPitAlisAtion of elderlY PeoPle

the aim of the study was to identify factors related to institutionalisation within one-year follow up of subjects aged 75 or over, hospitalised via the emergency department (éD). Design: Prospective multicentre cohort. Setting: nine French university teaching hospitals. Participants: one thousand and forty seven (1 047) non institutionalised subjects aged 75 or over, hospitalised via éD. a sub-group analysis was performed on the 894 subjects with a caregiver. Measurements: Patients were assessed using comprehensive geriatric assessment (cga) tools. cox survival analysis was performed to identify predictors of institutionalisation at one year. Results: Within one year after hospital admission, 210 (20.1%) subjects were institutionalised. For the overall study population, age >85 years (hr 1.6; 95%ci 1.1-2.1; p=0.005), inability to use the toilet (hr 1.6; 95%ci 1.1-2.4; p=0.007), balance disorders (hr 1.6; 95%ci 1.1-2.1; p=0.005) and presence of dementia syndrome (hr 1.9; 95%ci 1.4-2.6; p<0.001) proved to be independent predictors of institutionalisation; while a greater number of children was inversely linked to institutionalisation (hr 0.8; 95%ci 0.7-0.9; p<0.001). bathing was of borderline significance (p=.09). For subjects with a caregiver, initial caregiver burden was significantly linked to institutionalisation within one year, in addition to the predictors observed in the overall study population. Conclusions: cga performed at the beginning of hospitalisation in acute medical wards is useful to predict institutionalisation. Most of the predictors identified can lead to targeted therapeutic options with a view to preventing or delaying institution admission