Purpose: This study was designed to investigate the characteristics and length of hospitalization of patients who have been transferred from long-term care hospitals to general hospital intensive care units, and to analyze the factors influencing them to contribute to the management of patients in nursing hospitals and to provide basic data.
Methods: In this study, the analysis encompassed patients aged 65 or older who were admitted to intensive care units after they had been to emergency departments in long-term care hospitals. The study period was two years (January 1, 2017, to December 31, 2018).
The data were performed technical statistical analysis, chi square and t-test, logistic regression analysis using SPSS 25.0 Window program.
Results: The results of this study are summarized as follows.
1) Among the 243 patients who were admitted to intensive care units from long-term care hospitals, 37% (n=90) were elderly male and 63% (n=153) were elderly females. Subjects' ages ranged as follows: 25.5%, aged 75-79 years; 23.5% aged 80-84 years; 19.8%, 85-89 years; 18.1%, aged 70-74 years; 7.8% over 90 years; and 5.3%, aged 65-69 years. The lowest percentage was for the group aged 65 years. Subjects' average age was 80.32(± 6.99) years.
The most common hospitalization period was fall with 28% (n=68). The most common type of departure in the intensive care unit was 51%(n=124) in the general ward, 24.7% (n=60) in the long-term care hospitals and 24.3%(n=59) in death cases.
The highest rate was 28.4% in three cases of comorbidity, and 12.8% in five drugs. The duration of the ICU stay was less than 15 days in 80.2% of the cases, and the average ICU stay was 13.37(±24.74)days.
2) For those hospitalized, the average systolic blood pressure was 121.24(±25.91)mmHg, and the average diastolic blood pressure was 70.37(±19.70)mmHg. For 52.3% of the hospitalized patients, the pulse rate was in the normal range, with the average rate at 97.10(±21.93) times/minute; for 48.6% of the patients, the respiratory rate was in the normal range, with the average at 19.84 (±5.48)times/minute. For 93% of patients, body temperature was within the normal range; the average temperature was 36.43(±0.52)℃.
The medical department were 41.2% in infectious medicine, 24.7% in respiratory medicine, and 10.3% in renal medicine. At the time of admission, 32.5% of the patients were diagnosed with pneumonia; 16%, with urinary tract infection; 6.2%, with sepsis; and 6.2%, with renal failure.
Reasons for hospitalization were dyspnea(28.4%); fever, 28.0%; mental change, 6.6%; and hematochezia&melena, 6.6%. The state accounted for 42.8% which was the alert mentality.
Regarding nursing care, group 5 had the most severe cases(53.9%); 37.4% of patients had pressure sores, and 81.9% had bed ridden. Further, 29.2% were diagnosed with Multi-drug resistant organism; for 58.4%, the white blood cell count exceeded 10,000(x10^3/uL).
Oxygen therapy was prescribed for 69.5% of the patients with respiratory problems.
Moreover, 30.9% required use of a ventilator. A tracheotomy tube was placed in 17.3% of the patients. The oxygen saturation level was 95% or more, with an average of 98.36(±2.66)%.
For patients with circulatory problems, a central line was needed in 61.3% of the cases; 31.3% of the cases involved blood transfusions. In cases involving the urinary tract, the highest incidence was 95.5% for insertion of a foley catheter; in 70% of the cases, the blood urea nitrogen level exceeded 17mg/dL in 44.4% of the cases, creatinine secretions were 0.6-1.2mg/dL. Body mass index was 44.0% for normal body weight(18.5-22.9kg/m²), 28.8% for the underweight condition, 15.6% for obesity(≥25kg/m²), and 11.5% for the overweight(23-24.9kg/m²) condition. The average body mass index was 20.86(±3.97)kg/m².
A levin tube was inserted in 63% of the cases. Albumin was less than 3.0g/dL(49.8%), and the hemoglobin level was less than 11.0g/dL(51.5%).
Arterial blood gas analysis results at admission were 53.5% above a pH of 7.45, 65.4% below a PO2 of 85, and 49.4% below a PCO2 of 35mmHg; HCO3 was 23-29 mEq/L(36.9%).
SaO2 of 94% or more accounted for 68.1% of the cases.
3) When comparing the length of stay on a 15-day basis according to the general characteristics of the subjects, there were only significant differences in the type of departure, besides sex, age, and number of medications taken. Most patients were in ICU less than 15 days, 56.9% in all rooms and 62.5% in all rooms over 15 days(χ²=46.08, p〈0.01).
4) The clinical characteristics of the subjects were significantly different depending on the state of consciousness, infection, and white blood cell count. Regarding hospitalization, 47.7% of ICU patients remained there for less than 15 days. Drowsiness lasting more than 15 days was reported for 35.4% of the patients(χ²=21.87, p〈0.01).
Regarding the presence or absence of infection, 77.9% of the patients were not in ICU for 15 days or less, and 58.3% of the patients were infected in ICU for more than 15days (χ²=24.51, p〈0.01). The most common white blood cell count in patients with an ICU duration of 15days or less was applicable in 57.9% of the cases; for those whose stay in ICU exceeded 15days, the common leukocyte count was applicable 79.2% of the cases(χ²=7.37, p〈0.01).
5) Consciousness state, type of departure, infection, ventilator application, tracheotomy tube, central line, levin tube, and white blood cell count were all factors affecting hospitalization in ICU for either less than 15 days or more than 15 days.
Factors affecting the duration of an ICU stay in long-care term hospitals were the type of departure, infection status, or presence of a central line(OR=2.822, CI=1.003-7.940, p=0.049).
Conclusion: Factors affecting the length of hospitalization in ICU among elderly patients were the type of departure and the presence of an infection or central line.
Malnutrition and reduced immune function foster susceptibility to Multi-drug resistant organism.
Albumin and hemoglobin levels are clinical indicators of the nutritional status of the elderly.
There is a need for the development of thorough nutritional management guidelines for elderly patients.
In addition, improvements in the environments of nursing facilities should occur simultaneously with the development of infection control guidelines suitable for such facilities.