Decreasing Hospital Length of Stay: Effects on Daily Functioning in Older Adults

Objectives To examine the effects of decreasing hospital length of stay ( HLOS ) on change in functioning from prehospital admission to posthospital discharge in older cohorts. Design Cohort‐sequential design. Setting Nationwide, older population‐based Longitudinal Aging Study Amsterdam ( LASA ). Participants Individuals aged 68 and older with any hospital admission according to national medical registry data: two 10‐year age groups (68–77 (younger‐old) and 78–87 (older‐old)) in two periods (1996–99 (Period 1) and 2006–09 (Period 2)) (N = 1,212). Measurements HLOS was the main independent variable in multinomial logistic models, dichotomized as 1 to 5 days (short) and 6 days or longer (long). Outcomes were change scores in mobility and activities in daily living ( ADL s). Respondents who died during the 3‐year period were assigned to a third outcome category. Results Results for both age groups showed more hospital admissions and shorter median HLOS in Period 2 than Period 1 ( P < .05). Lower odds of decline in physical functioning were found in respondents with short HLOS than in those with long HLOS (for mobility: odds ratio ( OR ) = 0.36, 95% confidence interval ( CI ) = 0.23–0.54 (younger‐old) and OR = 0.47, 95% CI = 0.30–0.72 (older‐old); for ADL s: OR = 0.30, 95% CI = 0.19–0.48 (younger‐old) and OR = 0.30, 95% CI = 0.18–0.53 (older‐old)). Adjusting for confounders did not significantly change these estimates. Period did not modify these associations. Conclusion Because the associations of HLOS with change in mobility and ADL s were the same in both periods, hospitalized older adults had neither advantage nor disadvantage from the decrease in HLOS . In addition, in both age groups, a greater percentage experienced the better functional outcomes and lower mortality associated with short admissions, which suggests an advantage of the decrease in HLOS .