Social and Regional Factors Predict the Likelihood of Admission to a Nursing Home After Acute Hospital Stay in Elderly People with Chronic Health Conditions: A Multilevel Analysis Using Routinely Collected Hospital and Census Data in Switzerland.

Background: If hospitalisation becomes inevitable in the course of a chronic disease, discharge from acute hospital care in elderly individuals is often associated with temporary or persistent frailty, functional limitations and the need for help with daily activities. Thus, acute hospitalisation represents a particularly vulnerable phase of transient dependency on social support and health care. This study examines how social and regional inequality affect the decision for an institutionalisation after acute hospital discharge in Switzerland. Methods: The current analysis uses routinely collected inpatient data from all Swiss acute hospitals that was linked on the individual level with Swiss census data. The study sample included N=60,209 patients 75 years old and older living still at a private home and being hospitalised due to a chronic health condition in N=199 hospitals between 2010 and 2016. Random intercept multilevel logistic regression was used to assess the impact of social and regional factors on the odds of a nursing home admission after hospital discharge. Results: Results show that 7.8% of all patients were admitted directly to a nursing home after hospital discharge. We found significant effects of education level, insurance class, living alone and language regions on the odds of nursing home admission in a model adjusted for age, gender, nationality, health status, year of hospitalisation and hospital-level variance. The language regions moderated the effect of education and insurance class but not of living alone.Conclusion: Acute hospital discharge in elderly is a critical moment of transient dependency. Social and health care should work closely and coordinated together for a well-supported hospital discharge to avoid unnecessary institutionalisations of socially disadvantaged patients.