Utilization of emergency room and hospitalization by Chinese nursing home residents: a cross-sectional study

J Am Med Dir Assoc. 2010 Jun;11(5):325-32. doi: 10.1016/j.jamda.2009.10.003. Epub 2010 Mar 24.

Abstract

Objectives: This study determined factors associated with increased use of emergency room (ER) and hospitalization of Chinese nursing home residents.

Design: A cross-sectional study.

Setting: The setting was 14 nursing homes in Hong Kong.

Participants: Participants were 1820 Chinese nursing home residents.

Measurements: Data on facility factors and resident factors were collected. Resident factors were mainly collected by the Minimum Data Set-Resident Assessment Instrument 2.0 (MDS-RAI 2.0).

Results: Residing in a for-profit home (OR=6.51), having less than one third of time spent in activities (OR=1.84), having had recent fall (OR=3.81), having renal failure (OR=3.17), having had recent initiation of new medications (OR=1.42), and having had recent physician visit (OR=1.67) were factors associated with increased use of ER. Male gender (OR=1.49), having a body mass index (BMI) less than 18.5 kg/m(2) (OR=1.51), being more functionally dependent (OR=1.18 per 1-point increment in the ADL Hierarchy Scale), having higher burden of illness (OR=1.29 per 1-point increment in the CHESS score), having a feeding tube (OR=3.07), having an indwelling urinary catheter (OR=2.75), having had recent fall (OR=1.94), having respiratory tract infection (OR=2.05), having Parkinson's disease (OR=1.55), having anemia (OR=1.70), having had recent initiation of new medications (OR=2.08), and having had recent physician visit (OR=1.83) were factors associated with increased risk of hospitalization.

Conclusions: Although some of the associated factors reflect frailty characteristics of residents, differences in association between for-profit and not-for-profit institutions provide evidence of overreliance on the ER, perhaps as a result of inadequate primary care support.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Asian People*
  • Cross-Sectional Studies
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Hong Kong
  • Hospitalization / trends*
  • Humans
  • Male
  • Nursing Homes / statistics & numerical data*
  • Odds Ratio