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Background  The study objectives were to identify the main predictive factors for long hospital stays and to propose new and improved methods of risk assessment.    Methods  This prospective cohort study was conducted in the clinics and surgical wards of a tertiary hospital and involved 523 elderly patients over 60 years of age. Demographic, clinical, functional, and cognitive characteristics assessed between 48 and 72 h after admission were analyzed to investigate correlations with lengths of stay greater than 10 days. Univariate and multivariate analyses were performed, and in the final model, long-term probability scores were estimated for each variable.    Results  Of the 523 patients studied, 33 (6.3%) remained hospitalized for more than 10 days. Multiple regression analysis revealed that both the presence of diabetes and the inability to perform chair-to-bed transfers (Barthel Index) remained significant risk predictors. Diabetes doubled the risk of prolonged hospital stays, while a chair-to-bed transfer score of 0 or 5 led to an eight-fold increase in risk.  Conclusions:  In this study, we propose an easy method that can be used, after external validation, to screen for long-term risk (using diabetes and bed/chair transfer) as a first step in identifying hospitalized elderly patients who will require comprehensive assessment to guide prevention plans and rehabilitation programs.    Electronic supplementary material  The online version of this article (10.1186/s12877-019-1104-4) contains supplementary material, which is available to authorized users.

Impaired chair-to-bed transfer ability leads to longer hospital stays among elderly patients