Does Source of Admission Matter? Hospital Outcomes of Older Adults Requiring Nursing Care Hospitalized in Internal Medicine Departments

Background and Objectives: Older nursing-care patients are a clinically complex population with marked functional dependence, cognitive impairment, nutritional vulnerability, and multimorbidity. Although nursing-home residents are often considered at higher risk for adverse outcomes, many highly dependent older adults receive nursing care at home. Materials and Methods: This single-center retrospective cohort study included 501 nursing-care patients hospitalized between December 2022 and December 2023, of whom 334 were admitted from home and 167 from nursing homes. The primary outcome was in-hospital mortality; secondary outcomes included length of hospital stay, discharge destination, and 90-day post-discharge mortality among patients discharged alive. Longer-term survival analyses were exploratory. Demographic, clinical, functional, nutritional, laboratory, hospitalization, and mortality data were evaluated. Results: The median age was 85 years (IQR, 11), and 63.1% of patients were women. Patients admitted from home were older than those admitted from nursing homes (median 86 vs. 84 years; p = 0.036). Nursing-home patients more frequently presented with fever and infection-related diagnoses and had a higher prevalence of dementia (85.0% vs. 58.1%; p < 0.001), greater pressure-ulcer risk according to the Norton scale (p < 0.001), and greater nutritional vulnerability according to the MNA-mini (p = 0.007). Median length of stay did not differ significantly between groups (p = 0.755). In-hospital mortality was 23.7% in patients admitted from home and 18.6% in those admitted from nursing homes (p = 0.194). Among patients discharged alive, 90-day post-discharge mortality was 24.3% and 28.7%, respectively (p = 0.348). In the extended Cox model for 90-day post-discharge mortality, neither source of admission nor its time-dependent interaction was significantly associated with mortality (source of admission: HR, 0.831; 95% CI, 0.097–7.096; p = 0.865; time-dependent interaction: HR, 1.036; 95% CI, 0.573–1.873; p = 0.907). Conclusions: No statistically significant difference in in-hospital mortality was detected according to source of admission. Nursing-home patients had greater cognitive, nutritional, pressure-ulcer-risk, and infection-related vulnerability. These findings do not establish equivalence between groups and should be interpreted together with individual clinical characteristics.