Researchers: Anna Zisberg¹, Efrat Shadmi¹, Hanna Admi², Gary Sinoff¹, Nurit Gur-Yaish¹

Background: Assessment of in-hospital care among older adults is essential for achieving good health outcomes.

Objectives: To examine a model that assesses the effects of organizational infrastructure, quality of care, and treatment procedures among older adults on hospitalization outcomes.

Method: We combined new data with data previously collected via surveys of ~600 older adults hospitalized between 2009-2010. New data included staff characteristics, care procedures, and clinical characteristics of all patients in the departments of survey participants. Organizational characteristics and care procedures were evaluated on the patient level and analyzed together with information about clinical, demographic and outcome measures.

Findings: The sample includes 598 elderly patients, 40% of whom experienced a functional decline. The functional status of all of the patients in the department was associated with the functional decline of survey participants. A relationship was found between nurse skill mix (specifically – the number of nurse aides) and percent of patients with functional decline. Nine patients fell during the hospitalization period, unrelated to them being defined as at risk of falling. A relatively high rate of urinary catheter use was found, without any indication of the reason in the patient’s medical records. Over one-third of the patients were at risk for malnutrition and 50% consumed less than half of their main meals. Moreover, the under-reporting of delirium and its treatment was observed. It was also found that independent individuals moved around and ate less when they received help from the main caregiver.

Conclusions: The study findings depict a complex picture comprised of diverse personal and organizational factors that influence elderly patients’ functioning during and after acute hospitalization.

Recommendations: The findings indicate a need to take practical steps regarding the hospitalization of older adults, including improving general care capabilities and maintaining patients’ functioning during hospitalization. In accordance, healthcare workforce planning must also take these factors into consideration.

Research end date: 11/2017