Risk factors of readmission after geriatric hospital care: An interRAI-based cohort study in Finland

The risk of rehospitalization within 30 days of discharge in older adults with malnutrition: A meta-analysis

INTRODUCTION

Malnutrition is a global health problem associated with higher rehospitalization risk, subsequently increasing the risks of adverse complications, and mortality in older individuals. Nevertheless, studies investigating this are still scarce, and even fewer reviewed and aggregated. A number of studies have recently assessed the correlation of malnourishment with rehospitalization among older adults.

OBJECTIVE/AIM

This systematic review and meta-analysis aimed to elaborate the correlation between malnutrition and 30-day rehospitalization in older adults.

METHODS

Systematic review was conducted on literatures from Cochrane, ScienceDirect, SpringerLink, Oxford Academic, and MEDLINE according to PRISMA Guideline, investigating the correlation of malnutrition in older adults with rehospitalization, using Malnutrition, Older Adults, and Rehospitalization as keywords. Meta-analysis was done using RevMan, with random-effect analysis model. P values of ≤0.05 were considered statistically significant with results reported as risk ratios (RR), mean differences (MD), 95 % confidence intervals (CI) and I2 statistics.

RESULTS

Seven literatures were analysed, consisting of 19,340 patients aged 65 or older undergoing hospitalization. Subjects were assessed with screening tools to identify malnutrition. Malnourished subjects are compared to others with normal nutrition; in cohort studies with follow-up period ranging from 3 to 16 months. Malnutrition significantly increased the risks of rehospitalization within 30 days (RR 1.73 [95 % CI 1.10-2.72], p = 0.02, I2 = 56 %), overall rehospitalization at all times (RR 1.33 [95 % CI 1.16-1.52], p < 0.0001, I2 = 75 %), and overall mortality (RR 2.66 [95 % CI 1.09-6.50], p = 0.03, I2 = 94 %).

CONCLUSION

Malnutrition exhibited significant consequences in older patients regarding the rate of rehospitalization and mortality based on this meta-analysis. Further research is highly encouraged to verify this finding.

Social Services Post-discharge and Their Association With Readmission in a 2016 Swedish Geriatric Cohort

OBJECTIVES

To describe the social services received by a 2016 Swedish cohort after discharge from inpatient geriatric care and to analyze the association between level of social services post-discharge and 30-day readmission.

DESIGN

Observational, closed-cohort study.

SETTING AND PARTICIPANTS

All patients admitted to 1 of 3 regionally operated inpatient geriatric care settings in Region Stockholm, Sweden, in 2016 (n = 7453).

METHODS

Individual-level data from medical records and population registries were linked using unique personal identification numbers. Descriptive statistics were reported for 4 levels of municipal social services post-discharge: long-term care, 1 to 50 home help hours per month, >50 home help hours per month, and no home help. Multinomial logistic regression was performed to analyze the association between level of social services post-discharge and 3 outcomes within 30 days: readmission, death without readmission, or neither readmission nor death.

RESULTS

Results show that almost 11% of patients were discharged to long-term care and 54% received municipal home help services. Individuals with no municipal home help or with 1 to 50 hours per month were more likely to be readmitted within 30 days compared with those in long-term care. Living with more than 50 hours of help was not associated with an increased likelihood of 30-day readmission.

CONCLUSIONS AND IMPLICATIONS

Patients who received inpatient geriatric care are significant users of municipal social services post-discharge. Living in long-term care or with extensive home help appears to be a protective factor in preventing readmission compared with more limited or no home help services. Care transitions for this frail patient group require careful social care planning. Supporting individuals discharged with fewer social service hours may help reduce readmissions.

Older patients acutely admitted and readmitted to the same geriatric department: a descriptive cohort study of primary diagnoses and health characteristics

PURPOSE

Advancing age is associated with increased risk for acute admissions and readmissions. The societal challenges of ageing populations have made the prevention of readmissions come into focus. Readmission may be perceived as the result of inadequate treatment during index admission but may also be caused by the onset of new disease following a generally impaired health of geriatric patients. We aimed at comparing the diagnoses at index and readmission to illuminate this issue.

METHODS

This is a descriptive, retrospective cohort study of patients acutely admitted and readmitted (within 30 days from discharge) to the same geriatric ward (November 1, 2017-April 30, 2018). Electronic medical records were scrutinised manually for discharge diagnoses and patient characteristics.

RESULTS

Readmission rate was 10.7% (98 of 918 unique admissions). Mean age was 85.6 (men 56%). About 75% were readmitted with a new acute disease unrelated to index admission, most commonly pneumonia (27%), other infections (22%), and dehydration (14%). The health characteristics were long index length-of-stay (median 7; IQR 5-11), high Charlson Comorbidity Index (CCI ≥ 3, n = 49 (50%), polypharmacy (≥ 5 prescriptions) (94%), and hospitalisations 12 months prior to index admission (57%).

KEY CONCLUSIONS

The majority of readmitted geriatric patients have contracted a new acute condition. Although being characterised by several adverse health characteristics, prospective studies comparing readmitted and non-readmitted geriatric patients are needed. Still, increasing the awareness of early recognition of acute disease onset in geriatric patients is warranted.