High Mortality and Impairment Rates Among Older Adults in Long-Term Acute Care Hospitals

Long-term acute care hospitals (LTACHs) provide critical, multidisciplinary care for medically complex patients, but survival rates and long-term functional outcomes remain poor, according to a study published in JAMA Network Open.

“More accurate estimates of long-term functional and cognitive outcomes are necessary because families of patients cared for in an LTACH have overly optimistic expectations of recovery, and an unmet need for prognostic information to guide decision-making,” explained Snigdha Jain, MD, MHS, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine in New Haven, Connecticut, and coauthors.

The researchers analyzed data from 396 patients across 167 LTCHs between 2003 and 2016. They found that 79% of participants either died or survived with severe impairment within 2.5 years of hospitalization. The median age of participants was 75 years, with 51% being women. The most common diagnosis was respiratory illness, affecting 38% of patients. Furthermore, 54% of patients had a prolonged intensive care unit (ICU) stay, and 41% required mechanical ventilation during acute or LTACH hospitalization.

Patients who died or survived with severe impairment were typically older (median age 76) and had lower incomes compared with those who survived with no or mild impairment. Pre-existing functional and cognitive impairments were strong predictors of adverse outcomes. Specifically, 94% of patients with severe impairment before LATCH hospitalization experienced death or severe impairment afterward. In contrast, only 67% of patients with no prior impairment faced similar outcomes.

Risk factors such as a higher Lee index score, which indicates worse survival prognosis, were associated with a threefold increase in the likelihood of death or severe impairment. Severe impairment before LTACH hospitalization increased this risk more than fourfold.

“Our study highlights that baseline survival prognosis and functional and cognitive status should be considered in decision-making for middle-aged and older adults and their caregivers faced with the decision of prolonged acute care,” concluded the study authors.

Reference

Jain S, Gan S, Nguyen OK, et al. Survival, function, and cognition after hospitalization in long-term acute care hospitals. JAMA Netw Open. 2024;7(5):e2413309. doi:10.1001/jamanetworkopen.2024.13309