Aims: To investigate among older patients (≥80 years) admitted to a short-stay acute medical unit (AMU), factors predictive of transfer to inpatient specialty units for ongoing care.
Methods: In a sample of 330 older patients admitted to AMU (mean age 86 ± 4.7 years, 196 (59.4%) female), 125 (37.9%) patients were discharged within 48 to 72hours, and 205 (62.1%) patients were transferred to specialty units. Data was collected on 10 sociodemographic parameters, history of 22 chronic conditions, 10 admission diagnoses, 23 laboratory parameters, and four clinical assessment tools. Univariate analysis of factors was performed using chi-square test and one-way analysis of variance (ANOVA) for categorical and continuous variables, respectively. Significant factors were combined in an adjusted, stepwise multivariate logistic regression analysis.
Results: Independent predictors of transfer, adjusted for age and gender, were admission diagnosis of social issues (OR 6.8, 95%CI 2.3–20.1, p=0.001), sepsis (OR 7.3, 95%CI 1.6–33.1, p=0.01), and pneumonia (OR 1.7, 95%CI 1.0–2.9, p=0.05). Additionally, current smokers (OR 4.0, 95%CI 1.1–14.5, p=0.03) and Clinical Frailty Scale (CFS) >4 (OR 2.4, 95%CI 1.4–4.3, p=0.002) were more likely to be transferred. Other significant predictive factors identified by univariate analysis were diagnosis of delirium, acute kidney injury, high level of services, use of mobility-aid and elevated markers of inflammation.
Conclusions: Among older patients in the short-stay unit, social issues at admission, sepsis, pneumonia, smoking status and at least moderate frailty were predictive of transfer to specialty units for ongoing acute care. Early identification and referral may improve patient flow through AMU.