Rehabilitation and nursing home admission after hospitalization in acute geriatric patients.

Objectives: This study explored the effect of multimorbidity, cognitive and physical impairment, and sociodemographic factors on the choice of allocation of geriatric patients at hospital discharge. Design: Cross-sectional study Setting and Participants: Eight hundred thirty patients 65 years or older admitted into an acute geriatric ward in Italy were evaluated (1998–2000). Measurements: Social characteristics before hospitalization, multimorbidity, physical functioning, and cognitive status were related to allocation of living place after hospitalization (home, rehabilitation unit, or nursing home). Results: Most patients were discharged to their homes (85%); 7% of the younger patients (65–74 years) and 11% of the very old (75 years) were referred to a rehabilitation unit, while only among the very old 4% were discharged to a nursing home. Worse functional status, longer hospitalization, and being affected by dementia and cerebrovascular diseases (CVD) were associated with the admission to both rehabilitation and nursing home. Cognitive impairment and multimorbidity played a role in discharge destination, but only in functionally impaired patients. Living alone before hospitalization was correlated only with being discharged to a rehabilitation unit. Conclusion: In geriatric patients, both medical and sociodemographic characteristics are key factors for referral to rehabilitation or nursing home at discharge. (J Am Med Dir Assoc 2008; 9: 265–270

Self-rated socio-economic status, social, physical and leisure activities and risk for malnutrition in late life: a cross-sectional population-based study

Abstract: Objectives: Our goal was to evaluate the proportion of community-dwelling elderly people at risk for malnutrition and the effect of different socioeconomic status (SES) indicators as well as social, physical and leisure activities in late life on the risk for malnutrition. Design: A cross-sectional population-based study. Setting: A sub-urban area in Northern Italy. Participants: 698 community-dwelling older persons. Measurements: The nutritional status of participants was assessed through the Mini Nutritional Assessment- Short Form (MNA-SF). SES was defined by means of early-life education, longest occupation, and late-life financial conditions. The following indicators were also evaluated: social contacts, and performing mental, physical and leisure activities during late-life. Chronic diseases, functional, cognitive and affective status were considered as potential confounders when examining the risk for malnutrition by logistic regression models. Results: 8% of the participants (average age 75.6 years, 408 women) were at risk for malnutrition (MNA-SF ≤ 11). Low education, poor financial condition, and lack of physical and leisure activities showed a crude association with risk for malnutrition. Multi-adjusted logistic regression models showed that only low education (OR=2.9; 95% CI=1.2-6.8) and lack of physical activity (OR=4.4;95%CI=2.0-9.7) were independently associated with the risk for malnutrition. Conclusions: Low education and lack of physical activity in late-life may affect the risk for malnutrition in the elderly. Further studies are needed to clarify the cause-effect relationship between lack of physical activity and malnutrition