A multi-centre European study of factors affecting the discharge destination of older people admitted to hospital: analysis of in-hospital data from the ACMEplus project

Susan Elizabeth Campbell, David Gwyn Seymour, W. R. Primrose, Joanna Evelyn Lynch, E. Dunstan, M. Espallargues, G. Lamura, P. A. Lawson, I. Philp, E. Mestheneos, B. Politynska, I. Raiha, ACMEplus Project Team

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Objectives: to examine the relationship between seven predictor variables (recorded on Day 3 of hospital admission) and discharge destination in non-elective medical patients aged 65+ years.

Design: prospective cohort.

Setting: eight centres in six European countries.

Predictor variables: age, gender, living alone, physical function (three categories based on Barthel Index), cognition (Katzman's orientation-memory-concentration test), main body system affected (based on International Classification of Diseases), number of geriatric giants (GGs) involved in the referral (a GG being a problem with falling, mobility, continence or cognition).

Main outcome measures: discharge destination (by Day 90) in three categories: 'HOMESAME' (return to previous residence), 'INSTIN90' (discharge to alternative residence or still in hospital at 90 days), 'DEADINHO' (death in hospital),

Results: in 1,626 patients, discharge destination was HOMESAME in 84.7%, DEADINHO in 8.9% and INSTIN90 in 6.4%. Mean duration of stay was 17.7 days, median 12. Univariate analyses showed a statistically significant relationship between all seven predictor variables and discharge destination. Physical function was the best single predictor with a sevenfold difference in adverse outcome rates between the best and worst categories. On multiple logistic regression, significant predictor variables were as follows. (i) For DEADINHO: physical function, cognition, gender; (ii) for INSTIN90: physical function, living alone, GGs, age, gender. Multiple linear regression identified physical function, GGs and living alone as predictors of log, length of stay.

Conclusion: case-mix systems to compare risk-adjusted hospital outcome in older medical patients need to incorporate information about physical function, cognition and presenting problems in addition to diagnosis.

Original languageEnglish
Pages (from-to)467-475
Number of pages8
JournalAge and Ageing
Issue number5
Publication statusPublished - 2005


  • activities of daily living
  • aged
  • 80 and over
  • hospitals
  • outcome assessment (health care)
  • risk-adjustment
  • elderly
  • ILL

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