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Elderly/Long-term Care

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Very elderly patients are more likely to need skilled nursing care after coronary bypass surgery

Coronary artery bypass graft (CABG) surgery can improve function and reduce symptoms of disease in people aged 80 years and older. However, after CABG surgery, these elderly patients are at higher risk for admission to a skilled nursing facility or readmission to the hospital than patients aged 65 to 69 years.

Researchers, supported in part by the Agency for Healthcare Research and Quality (HS11540), used Michigan Medicare data to retrospectively study skilled care requirements of elderly Medicare patients who underwent CABG from 1997 to 1998. Their analyses indicate that patients aged 80 years and older were 3 times more likely than those aged 65 to 69 to require admission to a skilled nursing facility within 100 days after hospital discharge. Patients aged 75 to 79 were 2.2 times more likely, and those aged 70 to 74 were 1.5 times more likely, to require similar admissions after CABG surgery than those aged 65 to 69.

Researchers also found that the time spent in skilled care facilities significantly increased with age, ranging from an average stay of 13.3 days for those aged 65 to 69, 16.9 days for those aged 70 to 74, 19.6 days for those aged 75 to 79, and 22.9 days for those 80 and older. Overall, 50 percent of patients aged 80 and older required some skilled care after hospital discharge following CABG surgery, and 27 percent stayed longer than 30 days at skilled nursing facilities. Very elderly patients may require more skilled nursing care than younger elderly persons following CABG surgery due to their higher risk of postoperative complications, prevalence of cognitive dysfunction after the surgery, and poorer social support systems, such as the absence of an independent spouse to assist them, suggest the researchers.

See "Skilled care requirements for elderly patients after coronary artery bypass grafting," by Brahmajee K. Nallamothu, M.D., M.P.H., Mary A.M. Rogers, Ph.D., M.S., Sanjay Saint, M.D., M.P.H., and others in the July 2005 Journal of the American Geriatric Society 53, pp. 1133-1137.

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