Age-specific rates of hospital transfers in long-stay nursing home residents

INTRODUCTION: hospital transfers and admissions are critical events in the care of nursing home residents. We sought to determine hospital transfer rates at different ages. METHODS: a cohort of 1,187 long-stay nursing home residents who had participated in a Centers for Medicare and Medicaid demonstration project. We analysed the number of hospital transfers of the study participants recorded by the Minimum Data Set. Using a modern regression technique, we depicted the annual rate of hospital transfers as a smooth function of age. RESULTS: transfer rates declined with age in a nonlinear fashion. Rates were the highest among residents younger than 60 years of age (1.30-2.15 transfers per year), relatively stable between 60 and 80 (1.17-1.30 transfers per year) and lower in those older than 80 (0.77-1.17 transfers per year). Factors associated with increased risk of transfers included prior diagnoses of hip fracture (annual incidence rate ratio or IRR: 2.057, 95% confidence interval (CI): 1.240, 3.412), dialysis (IRR: 1.717, 95% CI: 1.313, 2.246), urinary tract infection (IRR: 1.755, 95% CI: 1.361, 2.264), pneumonia (IRR: 1.501, 95% CI: 1.072, 2.104), daily pain (IRR: 1.297, 95% CI: 1.055,1.594), anaemia (IRR: 1.229, 95% CI 1.068, 1.414) and chronic obstructive pulmonary disease (IRR: 1.168, 95% CI: 1.010,1.352). Transfer rates were lower in residents who had orders reflecting preferences for comfort care (IRR: 0.79, 95% CI: 0.665, 0.936). DISCUSSION: younger nursing home residents may require specialised interventions to reduce hospital transfers; declining transfer rates with the oldest age groups may reflect preferences for comfort-focused care.