Identifying Key Predictors of Appropriate Discharge Destinations for Older Inpatients in Acute Care: Scoping Review.

Background: Postacute care (PAC) services are important to ensure functional recovery and provide adequate care for geriatric inpatients in acute care. The choice between different PAC options can be challenging, and predictors for the most appropriate among diverse discharge options are warranted. Objective: We conducted a scoping review to identify predictors of appropriate discharge destinations for older adults (≥65 y) in acute care transitioning to different PAC settings and extract the most relevant predictors for different PAC settings as well as a generalizable set of predictor domains. Methods: The databases of Medline, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, CINAHL, and Emcare were systematically searched for English or German literature published until February 25, 2022. A total of 3 researchers screened, extracted, and categorized the data according to domains, discharge destinations, mean age, and health care systems origin, focusing on predictors that increase the likelihood of a discharge destination (positive predictors). The Jaccard index was calculated to compare the similarity between different possible domain combinations and existing literature. Results: Of 22,382 records screened, 171 quantitative and 10 qualitative studies were included. After separating combined discharge destinations, we found 1047 predictors for different discharge destinations including nursing home (n=297, 28%), skilled nursing facility (n=223, 21%), inpatient rehabilitation (n=206, 20%), home with (n=97, 9%) or without (n=74, 7%) support, assisted living (n=63, 6%), and early inpatient rehabilitation (n=21, 2%). Of all positive predictors (n=723), age was the most frequently reported predictor (80/723, 11%). Geriatric syndromes were found more often in patients 80 years or older (121/192, 63%) and in non-US studies (174/285, 61%). The top reported predictors for discharge to nursing homes were diagnosed dementia (9/297, 3%) and deficits in instrumental activities of daily living (ADL; 10/297, 3%); for discharge to rehabilitation, the top predictors were longer length of stay (11/205, 5%) and existent cardiopulmonary disease (10/205, 5%); and for back home without support, the top predictors were good ADL (10/74, 14%) and mobility assessments (9/74, 12%). Among 20 predictor domains, 8 were most concordant with the literature: cognitive impairment, ADL, demographics, social support, hospitalization data, multimorbidity, mobility, and primary diagnosis. Conclusions: This scoping review provides a comprehensive overview of predictors for appropriate discharge decisions in older adults in acute care, stratified by destination, age, study origin, and the predictor domains most concordant with the literature. The results will be valuable to inform the choice of features for clinical decision support systems, including the training of machine learning algorithms.