RETURNING HOME AFTER ACUTE HOSPITALIZATION IN 2 FRENCH TEACHING HOSPITALS - PREDICTIVE VALUE OF PATIENTS AND RELATIVES WISHES

Identifying elderly patients who are unable to return home immediately after acute hospitalization is difficult. For these patients, early p lanning of discharge might reduce the length of hospitalization. We co nducted a cohort study to investigate the roles of patients' character istics and patients' and principal carers' wishes about patients retur ning home in predicting the outcome of hospitalization for 510 patient s aged 75 years or more admitted to acute medical care units via the e mergency departments of two teaching hospitals in Paris (France). Pati ents' characteristics and patients' and principal carers' wishes were investigated within 24-48 hours of admission. The outcome of hospitali zation was defined as discharge to home or residential/nursing home. T he opposition of the principal carer to a patient returning home was t he most powerful predictor of discharge to a residential/nursing home. Advanced age, living alone, disability in Activities of Daily Living, altered mental state and presence of a chronic condition fatal within 4 years were also independently associated with discharge to a reside ntial/nursing home. The patient's wishes were predictive in univariate but not in multivariate analysis. These results suggest that the prin cipal carer's wishes about a patient returning home might be taken int o consideration early in a hospital stay for more effective discharge planning.