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Cruz-Ávila HA, Ramírez-Alatriste F, Martínez-García M, Hernández-Lemus E. Comorbidity patterns in cardiovascular diseases: the role of life-stage and socioeconomic status. Front Cardiovasc Med 2024; 11:1215458. [PMID: 38414921 PMCID: PMC10897012 DOI: 10.3389/fcvm.2024.1215458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 01/29/2024] [Indexed: 02/29/2024] Open
Abstract
Cardiovascular diseases stand as a prominent global cause of mortality, their intricate origins often entwined with comorbidities and multimorbid conditions. Acknowledging the pivotal roles of age, sex, and social determinants of health in shaping the onset and progression of these diseases, our study delves into the nuanced interplay between life-stage, socioeconomic status, and comorbidity patterns within cardiovascular diseases. Leveraging data from a cross-sectional survey encompassing Mexican adults, we unearth a robust association between these variables and the prevalence of comorbidities linked to cardiovascular conditions. To foster a comprehensive understanding of multimorbidity patterns across diverse life-stages, we scrutinize an extensive dataset comprising 47,377 cases diagnosed with cardiovascular ailments at Mexico's national reference hospital. Extracting sociodemographic details, primary diagnoses prompting hospitalization, and additional conditions identified through ICD-10 codes, we unveil subtle yet significant associations and discuss pertinent specific cases. Our results underscore a noteworthy trend: younger patients of lower socioeconomic status exhibit a heightened likelihood of cardiovascular comorbidities compared to their older counterparts with a higher socioeconomic status. By empowering clinicians to discern non-evident comorbidities, our study aims to refine therapeutic designs. These findings offer profound insights into the intricate interplay among life-stage, socioeconomic status, and comorbidity patterns within cardiovascular diseases. Armed with data-supported approaches that account for these factors, clinical practices stand to be enhanced, and public health policies informed, ultimately advancing the prevention and management of cardiovascular disease in Mexico.
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Affiliation(s)
- Héctor A Cruz-Ávila
- Graduate Program in Complexity Sciences, Autonomous University of México City, México City, Mexico
- Immunology Department, National Institute of Cardiology 'Ignacio Chávez', México City, Mexico
| | | | - Mireya Martínez-García
- Immunology Department, National Institute of Cardiology 'Ignacio Chávez', México City, Mexico
| | - Enrique Hernández-Lemus
- Computational Genomics Division, National Institute of Genomic Medicine, México City, Mexico
- Center for Complexity Sciences, Universidad Nacional Autónoma de México, México City, Mexico
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Rönneikkö J, Huhtala H, Finne-Soveri H, Valvanne J, Jämsen E. The role of geriatric syndromes in predicting unplanned hospitalizations: a population-based study using Minimum Data Set for Home Care. BMC Geriatr 2023; 23:696. [PMID: 37884888 PMCID: PMC10605458 DOI: 10.1186/s12877-023-04408-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 10/15/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND The predictive accuracies of screening instruments for identifying home-dwelling old people at risk of hospitalization have ranged from poor to moderate, particularly among the oldest persons. This study aimed to identify variables that could improve the accuracy of a Minimum Data Set for Home Care (MDS-HC) based algorithm, the Detection of Indicators and Vulnerabilities for Emergency Room Trips (DIVERT) Scale, in classifying home care clients' risk for unplanned hospitalization. METHODS In this register-based retrospective study, factors associated with hospitalization among home care clients aged ≥ 80 years in the City of Tampere, Finland, were analyzed by linking MDS-HC assessments with hospital discharge records. MDS-HC determinants associated with hospitalization within 180 days after the assessment were analyzed for clients at low (DIVERT 1), moderate (DIVERT 2-3) and high (DIVERT 4-6) risk of hospitalization. Then, two new variables were selected to supplement the DIVERT algorithm. Finally, area under curve (AUC) values of the original and modified DIVERT scales were determined using the data of MDS-HC assessments of all home care clients in the City of Tampere to examine if addition of the variables related to the oldest age groups improved the accuracy of DIVERT. RESULTS Of home care clients aged ≥ 80 years, 1,291 (65.4%) were hospitalized at least once during the two-year study period. Unplanned hospitalization occurred following 15.9%, 22.8%, and 33.9% MDS-HC assessments with DIVERT group 1, 2-3 and 4-6, respectively. Infectious diseases were the most common diagnosis within each DIVERT groups. Many MDS-HC variables not included in the DIVERT algorithm were associated with hospitalization, including e.g. poor self-rated health and old fracture (other than hip fracture) (p 0.001) in DIVERT 1; impaired cognition and decision-making, urinary incontinence, unstable walking and fear of falling (p < 0.001) in DIVERT 2-3; and urinary incontinence, poor self-rated health (p < 0.001), and decreased social interaction (p 0.001) in DIVERT 4-6. Adding impaired cognition and urinary incontinence to the DIVERT algorithm improved sensitivity but not accuracy (AUC 0.64 (95% CI 0.62-0.65) vs. 0.62 (0.60-0.64) of the original DIVERT). More admissions occurred among the clients with higher scores in the modified than in the original DIVERT scale. CONCLUSIONS Certain geriatric syndromes and diagnosis groups were associated with unplanned hospitalization among home care clients at low or moderate risk level of hospitalization. However, the predictive accuracy of the DIVERT could not be improved. In a complex clinical context of home care clients, more important than existence of a set of risk factors related to an algorithm may be the various individual combinations of risk factors.
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Affiliation(s)
- Jukka Rönneikkö
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | | | - Jaakko Valvanne
- Faculty of Medicine and Health Technology and Gerontology Research Center (GEREC), Tampere University, Tampere, Finland
| | - Esa Jämsen
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Geriatrics, Helsinki University Hospital, Helsinki, Finland
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Bandeira-de Oliveira M, Aparicio-González T, Del Cura-González I, Suárez-Fernández C, Rodríguez-Barrientos R, Barrio-Cortes J. Adjusted morbidity groups and survival: a retrospective cohort study of primary care patients with chronic conditions. BMC PRIMARY CARE 2023; 24:103. [PMID: 37081395 PMCID: PMC10120109 DOI: 10.1186/s12875-023-02059-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 04/12/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Chronic conditions are one of the main determinants of frailty, functional disability, loss of quality of life and the number one cause of death worldwide. This study aimed to describe the survival of patients with chronic conditions who were followed up in primary care according to the level of risk by adjusted morbidity groups and to analyse the effects of sex, age, clinician and care factors on survival. METHODS This was a longitudinal observational study of a retrospective cohort of patients with chronic conditions identified by the adjusted morbidity group stratifier of the electronic medical records in a primary health centre of the Region of Madrid, which has an assigned population of 18,107 inhabitants. The follow-up period was from June 2015 to June 2018. A description of survival according to the Kaplan-Meier method and Cox proportional hazards multivariate regression model was used to analyse the effects of sex, age, clinician and care factors. RESULTS A total of 9,866 patients with chronic conditions were identified; 77.4% (7,638) had a low risk, 18.1% (1,784) had a medium risk, and 4.5% (444) had a high risk according to the adjusted morbidity groups. A total of 477 patients with chronic conditions died (4.8%). The median survival was 36 months. The factors associated with lower survival were age over 65 years (hazard ratio [HR] = 1.3; 95% confidence interval [CI] = 1.1-1.6), receiving palliative care (HR = 3.4; 95% CI = 2.6-4.5), high versus low risk level (HR = 2.4; 95% CI = 1.60-3.7), five chronic conditions or more (HR = 1.5; 95% CI = 1.2-2), complexity index (HR = 1.01; 95% CI = 1.02-1.04) and polymedication (HR = 2.6; 95% CI = 2.0-3.3). CONCLUSIONS There was a gradual and significant decrease in the survival of patients with chronic conditions according to their level of risk as defined by adjusted morbidity groups. Other factors, such as older age, receiving palliative care, high number of chronic conditions, complexity, and polymedication, had a negative effect on survival. The adjusted morbidity groups are useful in explaining survival outcomes and may be valuable for clinical practice, resource planning and public health research.
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Affiliation(s)
| | | | - Isabel Del Cura-González
- Research Unit. Primary Care Management, Madrid, Spain
- Gregorio Marañón Health Research Institute, Madrid, Spain
- Department of Medical Specialties and Public Health, Rey Juan Carlos University, Madrid, Spain
- Research Network on Chronicity, Primary Care and Prevention and Health Promotion, Carlos III Health Institute, Madrid, Spain
| | - Carmen Suárez-Fernández
- University Hospital of La Princesa, Madrid, Spain
- Department of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Ricardo Rodríguez-Barrientos
- Research Unit. Primary Care Management, Madrid, Spain
- Gregorio Marañón Health Research Institute, Madrid, Spain
- Research Network on Chronicity, Primary Care and Prevention and Health Promotion, Carlos III Health Institute, Madrid, Spain
| | - Jaime Barrio-Cortes
- Research Unit. Primary Care Management, Madrid, Spain.
- Gregorio Marañón Health Research Institute, Madrid, Spain.
- Research Network on Chronicity, Primary Care and Prevention and Health Promotion, Carlos III Health Institute, Madrid, Spain.
- Foundation for Biosanitary Research and Innovation in Primary Care, Madrid, Spain.
- Faculty of Health, Camilo José Cela University, Madrid, Spain.
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Harber-Aschan L, Darin-Mattsson A, Fratiglioni L, Calderón-Larrañaga A, Dekhtyar S. Socioeconomic differences in older adults' unplanned hospital admissions: the role of health status and social network. Age Ageing 2023; 52:7127659. [PMID: 37079867 PMCID: PMC10118263 DOI: 10.1093/ageing/afac290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND the socioeconomic distribution of unplanned hospital admissions in older adults is poorly understood. We compared associations of two life-course measures of socioeconomic status (SES) with unplanned hospital admissions while comprehensively accounting for health, and examined the role of social network in this association. METHODS in 2,862 community-dwelling adults aged 60+ in Sweden, we derived (i) an aggregate life-course SES measure grouping individuals into Low, Middle or High SES based on a summative score, and (ii) a latent class measure that additionally identified a Mixed SES group, characterised by financial difficulties in childhood and old age. The health assessment combined measures of morbidity and functioning. The social network measure included social connections and support components. Negative binomial models estimated the change in hospital admissions over 4 years in relation to SES. Stratification and statistical interaction assessed effect modification by social network. RESULTS adjusting for health and social network, unplanned hospitalisation rates were higher for the latent Low SES and Mixed SES group (incidence rate ratio [IRR] = 1.38, 95% confidence interval [CI]: 1.12-1.69, P = 0.002; IRR = 2.06, 95% CI: 1.44-2.94, P < 0.001; respectively; ref: High SES). Mixed SES was at a substantially greater risk of unplanned hospital admissions among those with poor (and not rich) social network (IRR: 2.43, 95% CI: 1.44-4.07; ref: High SES), but the statistical interaction test was non-significant (P = 0.493). CONCLUSION socioeconomic distributions of older adults' unplanned hospitalisations were largely driven by health, although considering SES dynamics across life can reveal at-risk sub-populations. Financially disadvantaged older adults might benefit from interventions aimed at improving their social network.
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Affiliation(s)
- Lisa Harber-Aschan
- Demography Unit, Department of Sociology, Stockholm University, Universitetsvägen 10, 114 18 Stockholm, Sweden
- Stockholm University Demography Unit, Stockholm University, Stockholm, Sweden
| | - Alexander Darin-Mattsson
- Demography Unit, Department of Sociology, Stockholm University, Universitetsvägen 10, 114 18 Stockholm, Sweden
| | - Laura Fratiglioni
- Demography Unit, Department of Sociology, Stockholm University, Universitetsvägen 10, 114 18 Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Amaia Calderón-Larrañaga
- Demography Unit, Department of Sociology, Stockholm University, Universitetsvägen 10, 114 18 Stockholm, Sweden
| | - Serhiy Dekhtyar
- Demography Unit, Department of Sociology, Stockholm University, Universitetsvägen 10, 114 18 Stockholm, Sweden
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de Godoi Rezende Costa Molino C, Woll L, Wieczorek M, Abderhalden LA, Lanz P, Schaer DJ, Spahn DR, Orav EJ, Egli A, Bischoff-Ferrari HA. Association between iron deficiency and hospitalization rate in community-dwelling older adults: A 3-year prospective observational study of DO-HEALTH. Am J Clin Nutr 2023; 117:12-21. [PMID: 36789930 DOI: 10.1016/j.ajcnut.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/31/2022] [Accepted: 11/08/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Iron deficiency (ID) is associated with negative health outcomes in older adults. However, data on the impact of ID on the number of hospitalizations and length of hospital stay (LOS) is lacking. OBJECTIVE To explore the associations between baseline ID and the number of hospitalizations and between baseline ID and at least one LOS ≥5 days in community-dwelling older adults. METHODS This is a secondary observational analysis of a randomized controlled trial including 2157 community-dwelling adults aged ≥70 years without major diseases at baseline. The main exposure was defined as ID (soluble transferrin receptor [sTfR] concentrations >28.1 nmol/L) at baseline. The primary outcome was the number of hospitalizations over a 3-year follow-up. The secondary outcome was having at least one LOS ≥5 days over the study period among individuals with one or more hospitalizations. Interaction between ID and anemia (hemoglobin <130 g/L for men and <120 g/L for women) was also investigated. RESULTS Baseline sTfR concentration was determined in 2141 participants (median age 74.0 years). At 3 year, 1497 hospitalizations were reported with an incidence rate of hospitalization of 0.26 per person-year (95% CI: 0.24, 0.28). Overall, baseline ID was associated with a 24% increased incidence rate of hospitalization (incidence rate ratio: 1.24; 95% CI: 1.05, 1.45) over 3 years. This association was independent of anemia status at baseline since the interaction between ID and anemia at baseline was not significant. Moreover, ID was not significantly associated with having a LOS ≥5 days (OR: 1.40; 95% CI: 1.00, 1.97) among participants with at least one hospitalization over 3 years. CONCLUSIONS ID is associated with increased hospitalization rate and not associated with LOS ≥5 days among generally healthy older adults. Efforts to minimize ID in older adults may improve overall health and optimize healthcare costs.
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Affiliation(s)
- Caroline de Godoi Rezende Costa Molino
- Center on Aging and Mobility, University Hospital Zurich, Zurich City Hospital-Waid and University of Zurich, Zurich, Switzerland; Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Laurence Woll
- Center on Aging and Mobility, University Hospital Zurich, Zurich City Hospital-Waid and University of Zurich, Zurich, Switzerland; Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Maud Wieczorek
- Center on Aging and Mobility, University Hospital Zurich, Zurich City Hospital-Waid and University of Zurich, Zurich, Switzerland; Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Lauren A Abderhalden
- Center on Aging and Mobility, University Hospital Zurich, Zurich City Hospital-Waid and University of Zurich, Zurich, Switzerland; Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Patricia Lanz
- Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Dominik J Schaer
- Clinic for Internal Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Donat R Spahn
- Institute of Anesthesiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - E John Orav
- Department of Biostatistics, Harvard School of Public Health, Boston, USA
| | - Andreas Egli
- Center on Aging and Mobility, University Hospital Zurich, Zurich City Hospital-Waid and University of Zurich, Zurich, Switzerland; Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Heike A Bischoff-Ferrari
- Center on Aging and Mobility, University Hospital Zurich, Zurich City Hospital-Waid and University of Zurich, Zurich, Switzerland; Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland; University Clinic for Aging Medicine, Zurich City Hospital-Waid, Zurich, Switzerland.
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Rodwell J. Health Need Factors Are the Key Drivers of Hospitalization among the Elderly Living Alone: An Analysis of Longitudinal Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15315. [PMID: 36430031 PMCID: PMC9690483 DOI: 10.3390/ijerph192215315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 06/16/2023]
Abstract
Elderly people living alone are a large and growing proportion of the population of many developed economies. The elderly, particularly those living alone, are more likely to be hospitalized overnight, with consequent substantial health and financial costs. A widely used model of health service utilization is augmented with social issues that may specifically delineate some of the issues associated with living alone. A longitudinal survey of elderly (aged 65 and over) living alone in Australia with three time points over four years was analyzed using logistic regressions for overnight hospitalization. The main set of data (n = 672) had an average age of 75.91 years and was 70.2% female. The health need factors of self-rated general health and illness severity, along with comorbidity, were the key drivers of hospitalization. There were some individuals with prioritized access to hospitalization due to forms of health funding. The social issues did not independently stand out as drivers of overnight hospitalization, but the complexity of the inter-relationships between issues when studying the health of the elderly began to arise. The results enhance our understanding of health services utilization, within the context of a relatively universal health care system.
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Affiliation(s)
- John Rodwell
- Department of Management & Marketing, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
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Fernández Bosch A, del Campo Giménez M, Hermida Lazcano I, Rodríguez Marín Y, Camarena Navarro L, Párraga Martínez I. Influencia de la pluripatología y comorbilidad en el ingreso hospitalario en una cohorte de pacientes de una unidad de continuidad asistencial Primaria-Interna. REVISTA CLÍNICA DE MEDICINA DE FAMILIA 2022. [DOI: 10.55783/150206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Objetivo: estimar la frecuencia de pluripatología y comorbilidad en pacientes seguidos en una unidad de continuidad asistencial Primaria-Interna, así como conocer sus características clínicas y la relación entre pluripatología y comorbilidad con el ingreso hospitalario.
Diseño: estudio observacional retrospectivo de casos y controles.
Emplazamiento: Unidad de Continuidad Asistencial de Atención Primaria y Medicina Interna (UCAPI) del Complejo Hospitalario Universitario de Albacete.
Participantes: Se analizaron 1.591 pacientes atendidos en una unidad de continuidad asistencial Primaria-Interna (292 con algún ingreso hospitalario en el último año y 1.299 sin ingresos).
Mediciones principales: edad, sexo, problemas de salud, índice de Charlson, consumo de medicamentos y utilización de servicios sanitarios los 3 años previos.
Resultados: del total de la muestra, un 18,4% (IC 95%:16,4-20,3) eran casos con algún ingreso. Presentaba pluripatología un 23,3% (IC 95%: 21,1-25,4) y comorbilidad (índice de Charlson ≥ 2) un 32,6% (IC 95%: 30,2-34,9). Fueron variables asociadas de forma independiente a ingreso hospitalario la pluripatología (OR: 2,51; IC 95%: 1,64-3,83; p < 0,001), comorbilidad (índice de Charlson ≥ 2) (OR: 1,81; IC 95%:1,18-2,78; p = 0,006), tener más de tres problemas de salud (OR: 1,49; IC 95%: 1,07-2,07; p = 0,017), contar con mayor número de consultas de Atención Primaria (AP) (OR: 1,01; IC 95%: 1,00-1,02; p = 0,005), de hospital (1,03; IC 95%: 1,01-1,05), p < 0,001) y realizar más visitas a urgencias hospitalarias (OR: 1,12, IC 95%: 1,07-1,17).
Conclusiones: casi una cuarta parte de los pacientes seguidos en una unidad de continuidad asistencial entre Medicina interna y de Familia presenta pluripatología y un tercio, comorbilidad. La presencia de pluripatología y comorbilidad son características relacionadas con el ingreso hospitalario, junto con la mayor utilización de servicios sanitarios.
Palabras clave: multimorbilidad, comorbilidad, hospitalización, utilización de servicios de salud.
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Affiliation(s)
- Alba Fernández Bosch
- Especialista en Medicina Familiar y Comunitaria. CS Plaza Segovia. Gerencia de Atención Primaria Hospital Dr. Peset. Valencia (España)
| | - María del Campo Giménez
- Especialista en Medicina Familiar y Comunitaria. Consultorio de Ledaña. CS de Iniesta. Gerencia de Atención Integrada de Albacete. Albacete (España)
| | - Ignacio Hermida Lazcano
- Médica internista. Servicio de Medicina Interna. Unidad de Continuidad Asistencial Primaria-Interna (UCAPI). Gerencia de Atención Integrada de Albacete. Albacete (España)
| | - Yulema Rodríguez Marín
- Especialista en Medicina Interna. Hospital de Hellín. Gerencia de Atención Integrada de Hellín. Albacete (España)
| | - Lucía Camarena Navarro
- Medicina Interna. Hospital de Villarrobledo. Gerencia de Atención Integrada de Villarrobledo. Albacete (España)
| | - Ignacio Párraga Martínez
- Especialista en Medicina Familiar y Comunitaria. CS Zona VIII de Albacete. Gerencia de Atención Integrada de Albacete. Facultad de Medicina de Albacete, Universidad de Castilla-La Mancha. Albacete (España)
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Fernández Bosch A, del Campo-Giménez M, Hermida-Lazcano I, Rodríguez-Marín Y, Camarena Navarro L, Párraga-Martínez I. Influencia de la pluripatología y comorbilidad en el ingreso hospitalario en una cohorte de pacientes de una unidad de continuidad asistencial Primaria-Interna. REVISTA CLÍNICA DE MEDICINA DE FAMILIA 2022. [DOI: 10.55783/rcmf.150206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objetivo: estimar la frecuencia de pluripatología y comorbilidad en pacientes seguidos en una unidad de continuidad asistencial Primaria-Interna, así como conocer sus características clínicas y la relación entre pluripatología y comorbilidad con el ingreso hospitalario.
Diseño: estudio observacional retrospectivo de casos y controles.
Emplazamiento: Unidad de Continuidad Asistencial de Atención Primaria y Medicina Interna (UCAPI) del Complejo Hospitalario Universitario de Albacete.
Participantes: Se analizaron 1.591 pacientes atendidos en una unidad de continuidad asistencial Primaria-Interna (292 con algún ingreso hospitalario en el último año y 1.299 sin ingresos).
Mediciones principales: edad, sexo, problemas de salud, índice de Charlson, consumo de medicamentos y utilización de servicios sanitarios los 3 años previos.
Resultados: del total de la muestra, un 18,4% (IC 95%:16,4-20,3) eran casos con algún ingreso. Presentaba pluripatología un 23,3% (IC 95%: 21,1-25,4) y comorbilidad (índice de Charlson ≥ 2) un 32,6% (IC 95%: 30,2-34,9). Fueron variables asociadas de forma independiente a ingreso hospitalario la pluripatología (OR: 2,51; IC 95%: 1,64-3,83; p < 0,001), comorbilidad (índice de Charlson ≥ 2) (OR: 1,81; IC 95%:1,18-2,78; p = 0,006), tener más de tres problemas de salud (OR: 1,49; IC 95%: 1,07-2,07; p = 0,017), contar con mayor número de consultas de Atención Primaria (AP) (OR: 1,01; IC 95%: 1,00-1,02; p = 0,005), de hospital (1,03; IC 95%: 1,01-1,05), p < 0,001) y realizar más visitas a urgencias hospitalarias (OR: 1,12, IC 95%: 1,07-1,17).
Conclusiones: casi una cuarta parte de los pacientes seguidos en una unidad de continuidad asistencial entre Medicina interna y de Familia presenta pluripatología y un tercio, comorbilidad. La presencia de pluripatología y comorbilidad son características relacionadas con el ingreso hospitalario, junto con la mayor utilización de servicios sanitarios.
Palabras clave: multimorbilidad, comorbilidad, hospitalización, utilización de servicios de salud.
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Affiliation(s)
- Alba Fernández Bosch
- Especialista en Medicina Familiar y Comunitaria. CS Plaza Segovia. Gerencia de Atención Primaria Hospital Dr. Peset. Valencia (España)
| | - María del Campo-Giménez
- Especialista en Medicina Familiar y Comunitaria. Consultorio de Ledaña. CS de Iniesta. Gerencia de Atención Integrada de Albacete. Albacete (España)
| | - Ignacio Hermida-Lazcano
- Médica internista. Servicio de Medicina Interna. Unidad de Continuidad Asistencial Primaria-Interna (UCAPI). Gerencia de Atención Integrada de Albacete. Albacete (España)
| | - Yulema Rodríguez-Marín
- Especialista en Medicina Interna. Hospital de Hellín. Gerencia de Atención Integrada de Hellín. Albacete (España)
| | - Lucía Camarena Navarro
- Medicina Interna. Hospital de Villarrobledo. Gerencia de Atención Integrada de Villarrobledo. Albacete (España)
| | - Ignacio Párraga-Martínez
- Especialista en Medicina Familiar y Comunitaria. CS Zona VIII de Albacete. Gerencia de Atención Integrada de Albacete. Facultad de Medicina de Albacete, Universidad de Castilla-La Mancha. Albacete (España)
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Bloomfield K, Wu Z, Tatton A, Calvert C, Peel N, Hubbard R, Jamieson H, Hikaka J, Boyd M, Bramley D, Connolly MJ. An interRAI derived frailty index predicts acute hospitalizations in older adults residing in retirement villages: A prospective cohort study. PLoS One 2022; 17:e0264715. [PMID: 35235598 PMCID: PMC8890727 DOI: 10.1371/journal.pone.0264715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 02/11/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives The development of frailty tools from electronically recorded healthcare data allows frailty assessments to be routinely generated, potentially beneficial for individuals and healthcare providers. We wished to assess the predictive validity of a frailty index (FI) derived from interRAI Community Health Assessment (CHA) for outcomes in older adults residing in retirement villages (RVs), elsewhere called continuing care retirement communities. Design Prospective cohort study. Setting and participants 34 RVs across two district health boards in Auckland, Aotearoa New Zealand (NZ). 577 participants, mean age 81 years; 419 (73%) female; 410 (71%) NZ European, 147 (25%) other European, 8 Asian (1%), 7 Māori (1%), 1 Pasifika (<1%), 4 other (<1%). Methods interRAI-CHA FI tool was used to stratify participants into fit (0–0.12), mild (>0.12–0.24), moderate (>0.24–0.36) and severe (>0.36) frail groups at baseline (the latter two grouped due to low numbers of severely frail). Primary outcome was acute hospitalization; secondary outcomes included long-term care (LTC) entry and mortality. The relationship between frailty and outcomes were explored with multivariable Cox regression, estimating hazard ratios (HRs) and 95% confidence intervals (95%CIs). Results Over mean follow-up of 2.5 years, 33% (69/209) of fit, 58% (152/260) mildly frail and 79% (85/108) moderate-severely frail participants at baseline had at least one acute hospitalization. Compared to the fit group, significantly increased risk of acute hospitalization were identified in mildly frail (adjusted HR = 1.88, 95%CI = 1.41–2.51, p<0.001) and moderate-severely frail (adjusted HR = 3.52, 95%CI = 2.53–4.90, p<0.001) groups. Similar increased risk in moderate-severely frail participants was seen in LTC entry (adjusted HR = 5.60 95%CI = 2.47–12.72, p<0.001) and mortality (adjusted HR = 5.06, 95%CI = 1.71–15.02, p = 0.003). Conclusions and implications The FI derived from interRAI-CHA has robust predictive validity for acute hospitalization, LTC entry and mortality. This adds to the growing literature of use of interRAI tools in this way and may assist healthcare providers with rapid identification of frailty.
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Affiliation(s)
- Katherine Bloomfield
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
- Waitematā District Health Board, Auckland, New Zealand
- * E-mail:
| | - Zhenqiang Wu
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Annie Tatton
- Waitematā District Health Board, Auckland, New Zealand
| | | | - Nancye Peel
- Centre for Health Services Research, University of Queensland, Brisbane, Queensland, Australia
| | - Ruth Hubbard
- Centre for Health Services Research, University of Queensland, Brisbane, Queensland, Australia
| | - Hamish Jamieson
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Joanna Hikaka
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Michal Boyd
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Dale Bramley
- Waitematā District Health Board, Auckland, New Zealand
| | - Martin J. Connolly
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
- Waitematā District Health Board, Auckland, New Zealand
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10
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Jeppestøl K, Vitelli V, Kirkevold M, Bragstad LK. Factors Associated With Care Trajectory Following Acute Functional Decline in Older Home Nursing Care Patients: A Prospective Observational Study. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2022. [DOI: 10.1177/10848223211034774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Health policies and previous research highlight the importance of early identification and treatment of clinical deterioration in older patients to prevent frailty, higher levels of care, and mortality. This study explores older home nursing care patients’ care trajectories and factors associated with clinical response (type and level of intervention) from the health care services, final level of community care and death within 3 months after an incidence of acute functional decline. This observational study with a prospective, descriptive design includes a sample of 135 older home nursing care patients with acute functional decline. Demographic, health-related, and clinical characteristics were analyzed and prediction models for care trajectories were fitted using Bayesian generalized mixed models. Age ranged from 65 to 100, with a median age of 85. Hospital admission were registered for 13.33% ( T1) and 8.77% ( T2) of the participants. Nine patients (6.7%) were transferred to a higher level of community care, and 11 patients (8.1%) died. Frequent transitions between levels of care characterized care trajectories for patients experiencing more severe functional decline. Age, living in a private home, and increased Modified Early Warning Scores (MEWS) were associated with level of clinical responses throughout the care trajectory. Living in a private home was associated with the patients’ final level of community care. Female gender, hospital admission, and increased MEWS scores were associated with death. Health care personnel must be vigilant when MEWS scores rise even slightly, as this might be an indication of acute functional decline with possible increased risk of mortality.
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Affiliation(s)
- Kristin Jeppestøl
- Tvedestrand Municipality, Tvedestrand, Norway
- University of Oslo, Faculty of Medicine, Oslo, Norway
| | | | - Marit Kirkevold
- University of Oslo, Faculty of Medicine, Oslo, Norway
- Oslo Metropolitan University, Faculty of Health Sciences, Oslo, Norway
| | - Line K. Bragstad
- University of Oslo, Faculty of Medicine, Oslo, Norway
- Oslo Metropolitan University, Faculty of Health Sciences, Oslo, Norway
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11
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Long term impact of Hurricane Sandy on hospital admissions of older adults. Soc Sci Med 2022; 293:114659. [PMID: 34954672 PMCID: PMC8810733 DOI: 10.1016/j.socscimed.2021.114659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 08/05/2021] [Accepted: 12/14/2021] [Indexed: 01/03/2023]
Abstract
RATIONALE In the weeks and months following a disaster, acute illness and injuries requiring hospital admission increase. It is not known whether disaster exposure is associated with increased risk for hospitalization in the years after a disaster. OBJECTIVE We examined the extent to which disaster exposure is associated with hospitalization two years after Hurricane Sandy. The analyses fill a clinical gap in our understanding of long-term physical health consequences of disaster exposure by identifying older adults at greatest risk for hospitalization two years after disaster exposure. METHOD Survey data from a longitudinal panel study collectedbefore and after Hurricane Sandy were linked with Medicare inpatient files in order to assess the impact of Hurricane Sandy on hospital admissions two years following the hurricane. RESULTS We found that people who reported experiencing a lot of fear and distress in the midst of Hurricane Sandy were at an increased risk of being hospitalized two years after the hurricane [Hazard Ratio = 1.75; 95% CI (1.12-2.73)]. Findings held after controlling for pre-disaster demographics, social risks, chronic conditions, hospitalizations during the year before the hurricane, and decline in physical functioning. CONCLUSIONS These findings are the first to show that disaster exposure increases the risk for hospital admissions two years after a disaster. Controlling for known risk factors for hospitalization, older adults who experience high levels of fear and distress during a disaster are more likely to be hospitalized two years following the disaster than older adults who do not have this experience.
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12
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Bloomfield K, Wu Z, Broad JB, Tatton A, Calvert C, Hikaka J, Boyd M, Peri K, Bramley D, Higgins AM, Connolly MJ. Factors associated with healthcare utilization and trajectories in retirement village residents. J Am Geriatr Soc 2021; 70:754-765. [PMID: 34910296 DOI: 10.1111/jgs.17602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 11/01/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND To study healthcare utilization and trajectories, and associated factors, in older adults in retirement villages (RVs), also known as continuing care retirement communities. METHODS Prospective cohort study of 578 cognitively intact residents from 34 RVs in Auckland, New Zealand (NZ). MEASUREMENT InterRAI-Community Health Assessment (includes core items that may trigger functional supplement (FS) completion in those with higher needs, and generates clinical assessment protocols (CAPs) in those with potential unmet needs). OUTCOMES time to acute hospitalization, long-term care (LTC), and death during average 2.5 years follow-up. RESULTS Three hundred seven (53%) residents had acute hospitalizations, 65 (11%) moved to LTC, and 51 (9%) died over a mean of 2.5 years. Factors associated with increased risk of acute hospitalization included CAP-falls (high risk) triggered, number of comorbidities, not having left RV in 2 weeks prior, moderate/severe hearing impairment, CAP-cardiorespiratory conditions triggered, acute hospitalization in year prior and age, with significant hazard ratios (HR) ranging between 1.03 and 2.90. Factors associated with reduced risk of hospitalization included other (non-NZ) European ethnicity (HR 0.73, 95% CI 0.55-0.98, p = 0.04), presence of on-site clinic (HR 0.62, 95% CI 0.45-0.85, p = 0.003), no influenza vaccination (HR 0.56, 95% CI 0.38-0.83, p = 0.004). Factors associated with LTC transition included FS triggered (HR 3.84, 95% CI 1.92-7.66, p < 0.001), CAP-instrumental activities of daily living (IADL) (HR 2.62, 95% CI 1.22-5.62, p = 0.01), CAP-social relationship triggered (HR 2.00, 95% CI 1.13-3.55, p = 0.02), and age (HR 1.13, 95% CI 1.07-1.18 p < 0.001). Factors associated with mortality included number of comorbidities (HR 3.75, 95% CI 1.54-9.10, p = 0.004 for 3-5 comorbidities), CAP-IADL triggered (HR 3.05, 95% CI 1.30-7.16, p = 0.01), and age (HR 1.11, 95% CI 1.05-1.18, p < 0.001). CONCLUSION A large proportion of cognitively intact RV residents are admitted to hospital in mean 2.5 years of follow-up. Multiple factors were associated with acute hospitalization risk. On-site clinics were associated with reduced risk and should be considered in RV development.
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Affiliation(s)
- Katherine Bloomfield
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.,Older Adults' Health, Waitematā District Health Board, Auckland, New Zealand
| | - Zhenqiang Wu
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Joanna B Broad
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Annie Tatton
- Older Adults' Health, Waitematā District Health Board, Auckland, New Zealand
| | - Cheryl Calvert
- Community and Long Term Conditions, Auckland District Health Board, Auckland, New Zealand
| | - Joanna Hikaka
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.,Older Adults' Health, Waitematā District Health Board, Auckland, New Zealand
| | - Michal Boyd
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Kathy Peri
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Dale Bramley
- Older Adults' Health, Waitematā District Health Board, Auckland, New Zealand
| | - Ann-Marie Higgins
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Martin J Connolly
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.,Older Adults' Health, Waitematā District Health Board, Auckland, New Zealand
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13
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Seidenfeld J, Stechuchak KM, Coffman CJ, Mahanna EP, Gladney MN, Hastings SN. Exploring differential response to an emergency department-based care transition intervention. Am J Emerg Med 2021; 50:640-645. [PMID: 34879480 DOI: 10.1016/j.ajem.2021.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/13/2021] [Accepted: 09/13/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To identify multivariable subgroups of patients with differential responses to a nurse-delivered care transition intervention after an emergency department (ED) visit in a randomized controlled trial (RCT) using an emerging data-driven method. DESIGN Secondary analysis of RCT. PARTICIPANTS 512 individuals enrolled in an RCT of a nurse-delivered care transition intervention after an ED visit. All 512 participants were included in a pre-specified subgroup analysis, and 451 of these had sufficient complete case data to be included in a model-based recursive (MoB) partitioning analysis. METHODS The primary outcome was having at least one ED visit in 30 days after the index ED visit. Two analytical methods explored heterogeneity of treatment effects: data driven model-based recursive partitioning (MoB) using 37 candidate baseline variables, and a contextual point of comparison with prespecified subgroups defined by ED super-user status (≥ 3 ED visits in previous 6 months or not), sex (male/female), and age, individually examined via treatment arm by subgroup interaction terms in logistic regression models. Internal validation of the MoB analysis via bootstrap resampling with an optimism corrected c-statistic was conducted to provide a bias-corrected estimate. RESULTS MoB detected treatment effect heterogeneity in a single subgroup, marital status. Unmarried patients randomized to the intervention had a repeat ED use rate of 22% compared to 34% in the usual care group; married patients randomized to the intervention had a 27% ED return rate compared to 12% in the usual care group. Internal validation demonstrated an optimism corrected c-statistic of 0.54. No treatment-by-covariate subgroup interactions were identified among the 3 prespecified subgroups. CONCLUSION Although exploratory, the results of the MoB analysis suggest that patient factors related to social relationships such as marital status may be important contributors to differential response to a care transition intervention after an ED visit. These were characteristics that the investigators had not anticipated or planned to examine in the individual prespecified subgroup analysis. Data-driven methods can yield unexpected findings and contribute to a more complete understanding of differential treatment effects in subgroup analysis, which can inform further work on development of effective care transition interventions in the ED setting.
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Affiliation(s)
- Justine Seidenfeld
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA; Division of Emergency Medicine, Duke University School of Medicine, Durham, NC, USA.
| | - Karen M Stechuchak
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA
| | - Cynthia J Coffman
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Elizabeth P Mahanna
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA
| | - Micaela N Gladney
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA
| | - Susan N Hastings
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA; Department of Medicine, Duke University School of Medicine, Durham, NC, USA; Geriatric Research, Education, and Clinical Center, Durham VA Health Care System, Durham, NC, USA; Center for the Study of Human Aging and Development, Duke University School of Medicine, Durham, NC, USA; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
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14
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Segaux L, Broussier A, Oubaya N, Leissing-Desprez C, Laurent M, Naga H, Fromentin I, David JP, Bastuji-Garin S. Several frailty parameters highly prevalent in middle age (50-65) are independent predictors of adverse events. Sci Rep 2021; 11:8774. [PMID: 33888851 PMCID: PMC8062562 DOI: 10.1038/s41598-021-88410-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 04/09/2021] [Indexed: 12/26/2022] Open
Abstract
Although frailty can arise in middle age, very few studies have investigated frailty before 65 years. Our objectives were to assess the prevalence of frailty parameters in middle-aged individuals and probe the association with future adverse events. We performed cross-sectional and longitudinal analyses of community-dwelling individuals aged 50 to 65 (n = 411, median age: 59.0) having undergone a multidomain geriatric assessment (2010–2015) in an outpatient clinic in the greater Paris area of France (SUCCEED cohort). The primary outcome was a composite measure of adverse events (non-accidental falls, fractures, unplanned hospitalizations, death), recorded in 2016/2017. Multivariable logistic regression models were built to identify independent predictors. Six frailty parameters were highly prevalent (> 20%): low activity (40.1%), exhaustion (31.3%), living alone (28.5%), balance impairment (26.8%), weakness (26.7%), and executive dysfunction (23.2%). Female sex (odds ratio: 2.67 [95% confidence interval: 1.17–6.11]), living alone (2.39 [1.32–4.33]), balance impairment (2.09 [1.16–3.78]), executive dysfunction (2.61, [1.18–5.77]), and exhaustion (2.98 [1.65–5.39]) were independent predictors of adverse events. Many frailty parameters are already altered in middle-aged individuals and are predictive of adverse health events. Our findings highlight a possible need for frailty screening and preventive programs targeting middle-aged individuals.
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Affiliation(s)
- Lauriane Segaux
- Univ Paris Est Creteil, INSERM, IMRB, 94010, Creteil, France. .,Clinical Research Unit (URC Mondor), AP-HP, Hôpitaux Henri-Mondor, 94010, Creteil Cedex, France.
| | - Amaury Broussier
- Univ Paris Est Creteil, INSERM, IMRB, 94010, Creteil, France.,Departments of Geriatric Medicine, AP-HP, Hôpitaux Henri-Mondor, 94010, Creteil, France.,Departments of Geriatric Medicine, AP-HP, Hôpitaux Henri-Mondor, 94450, Limeil-Brévannes, France
| | - Nadia Oubaya
- Univ Paris Est Creteil, INSERM, IMRB, 94010, Creteil, France.,Department of Public Health, AP-HP, Hôpitaux Henri-Mondor, 94010, Creteil, France
| | - Claire Leissing-Desprez
- Univ Paris Est Creteil, INSERM, IMRB, 94010, Creteil, France.,Departments of Geriatric Medicine, AP-HP, Hôpitaux Henri-Mondor, 94010, Creteil, France.,Departments of Geriatric Medicine, AP-HP, Hôpitaux Henri-Mondor, 94450, Limeil-Brévannes, France
| | - Marie Laurent
- Univ Paris Est Creteil, INSERM, IMRB, 94010, Creteil, France.,Departments of Geriatric Medicine, AP-HP, Hôpitaux Henri-Mondor, 94010, Creteil, France.,Departments of Geriatric Medicine, AP-HP, Hôpitaux Henri-Mondor, 94450, Limeil-Brévannes, France
| | - Henri Naga
- Departments of Geriatric Medicine, AP-HP, Hôpitaux Henri-Mondor, 94010, Creteil, France.,Departments of Geriatric Medicine, AP-HP, Hôpitaux Henri-Mondor, 94450, Limeil-Brévannes, France
| | - Isabelle Fromentin
- Departments of Geriatric Medicine, AP-HP, Hôpitaux Henri-Mondor, 94010, Creteil, France.,Departments of Geriatric Medicine, AP-HP, Hôpitaux Henri-Mondor, 94450, Limeil-Brévannes, France
| | - Jean-Philippe David
- Univ Paris Est Creteil, INSERM, IMRB, 94010, Creteil, France.,Departments of Geriatric Medicine, AP-HP, Hôpitaux Henri-Mondor, 94010, Creteil, France.,Departments of Geriatric Medicine, AP-HP, Hôpitaux Henri-Mondor, 94450, Limeil-Brévannes, France
| | - Sylvie Bastuji-Garin
- Univ Paris Est Creteil, INSERM, IMRB, 94010, Creteil, France.,Clinical Research Unit (URC Mondor), AP-HP, Hôpitaux Henri-Mondor, 94010, Creteil Cedex, France.,Department of Public Health, AP-HP, Hôpitaux Henri-Mondor, 94010, Creteil, France
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15
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Harvey G, Pham CT, Inacio MC, Laver K, Lynch EA, Jorissen RN, Karnon J, Bourke A, Forward J, Maddison J, Whitehead C, Rupa J, McNamara C, Crotty M. An integrated knowledge translation approach to address avoidable rehospitalisations and unplanned admissions for older people in South Australia: implementation and evaluation program plan. Implement Sci Commun 2021; 2:36. [PMID: 33827707 PMCID: PMC8025566 DOI: 10.1186/s43058-021-00141-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/22/2021] [Indexed: 12/20/2022] Open
Abstract
Background Repeated admission to hospital can be stressful for older people and their families and puts additional pressure on the health care system. While there is some evidence about strategies to better integrate care, improve older patients’ experiences at transitions of care, and reduce preventable hospital readmissions, implementing these strategies at scale is challenging. This program of research comprises multiple, complementary research activities with an overall goal of improving the care for older people after discharge from hospital. The program leverages existing large datasets and an established collaborative network of clinicians, consumers, academics, and aged care providers. Methods The program of research will take place in South Australia focusing on people aged 65 and over. Three inter-linked research activities will be the following: (1) analyse existing registry data to profile individuals at high risk of emergency department encounters and hospital admissions; (2) evaluate the cost-effectiveness of existing ‘out-of-hospital’ programs provided within the state; and (3) implement a state-wide quality improvement collaborative to tackle key interventions likely to improve older people’s care at points of transitions. The research is underpinned by an integrated approach to knowledge translation, actively engaging a broad range of stakeholders to optimise the relevance and sustainability of the changes that are introduced. Discussion This project highlights the uniqueness and potential value of bringing together key stakeholders and using a multi-faceted approach (risk profiling; evaluation framework; implementation and evaluation) for improving health services. The program aims to develop a practical and scalable solution to a challenging health service problem for frail older people and service providers.
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Affiliation(s)
- Gillian Harvey
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Clarabelle T Pham
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
| | - Maria C Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Kate Laver
- Division of Rehabilitation, Aged and Palliative Care, College of Medicine and Public Health, Flinders Medical Centre, Flinders University, Adelaide, Australia
| | - Elizabeth A Lynch
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Robert N Jorissen
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Jonathan Karnon
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
| | - Alice Bourke
- Department of Geriatric and Rehabilitation Medicine, Royal Adelaide Hospital, Adelaide, Australia
| | - John Forward
- Aged Care, Rehabilitation and Palliative Care Division, Northern Adelaide Local Health Network, Adelaide, Australia
| | - John Maddison
- Medical Services, Northern Adelaide Local Health Network, Adelaide, Australia
| | - Craig Whitehead
- Division of Rehabilitation, Aged and Palliative Care, College of Medicine and Public Health, Flinders Medical Centre, Flinders University, Adelaide, Australia
| | - Jesmin Rupa
- Division of Rehabilitation, Aged and Palliative Care, College of Medicine and Public Health, Flinders Medical Centre, Flinders University, Adelaide, Australia.
| | - Carmel McNamara
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Maria Crotty
- Division of Rehabilitation, Aged and Palliative Care, College of Medicine and Public Health, Flinders Medical Centre, Flinders University, Adelaide, Australia
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16
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Bertola A, Damanti S, Scotti R, Di Lucca G, Bozzolo E, Tresoldi M. A cascade of complications in a hospitalized frail older patient: is a better management possible? JOURNAL OF GERONTOLOGY AND GERIATRICS 2021. [DOI: 10.36150/2499-6564-n340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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17
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Strong and sustainable primary healthcare is associated with a lower risk of hospitalization in high risk patients. Sci Rep 2021; 11:4349. [PMID: 33623130 PMCID: PMC7902818 DOI: 10.1038/s41598-021-83962-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 02/09/2021] [Indexed: 11/12/2022] Open
Abstract
In 2004, Germany introduced a program based on voluntary contracting to strengthen the role of general practice care in the healthcare system. Key components include structured management of chronic diseases, coordinated access to secondary care, data-driven quality improvement, computerized clinical decision-support, and capitation-based reimbursement. Our aim was to determine the long-term effects of this program on the risk of hospitalization of specific categories of high-risk patients. Based on insurance claims data, we conducted a longitudinal observational study from 2011 to 2018 in Baden-Wuerttemberg, Germany. Patients were assigned to one or more of four open cohorts (in 2011, elderly, n = 575,363; diabetes mellitus, n = 163,709; chronic heart failure, n = 82,513; coronary heart disease, n = 125,758). Adjusted for key patient characteristics, logistic regression models were used to compare the hospitalization risk of the enrolled patients (intervention group) with patients receiving usual primary care (control group). At the start of the study and throughout long-term follow-up, enrolled patients in the four cohorts had a lower risk of all-cause hospitalization and ambulatory, care-sensitive hospitalization. Among patients with chronic heart failure and coronary heart disease, the program was associated with significantly reduced risk of cardiovascular-related hospitalizations across the eight observed years. The effect of the program also increased over time. Over the longer term, the results indicate that strengthening primary care could be associated with a substantial reduction in hospital utilization among high-risk patients.
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18
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Camacho-Conde JA, Galán-López JM. Depression and Cognitive Impairment in Institutionalized Older Adults. Dement Geriatr Cogn Disord 2021; 49:107-120. [PMID: 32634807 DOI: 10.1159/000508626] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/11/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In the last three decades, the relationship between depression and cognition in geriatric patients has been a popular topic among researchers and clinicians. Clinical and epidemiological research has focused on the identification of risk factors that could be modified in pre-dementia syndromes, at a preclinical and early clinical stage of dementia disorders, with specific attention to the role of depression. The objective of this work was to determine the relationship between depressive disorder and cognitive deterioration in institutionalized older adults. METHODS In this descriptive, correlational study, data were gathered from two nursing homes in the province of Jaen (Spain), from a random sample of 140 older adults (70 nondependent and 70 dependent). The variables were measured using comprehensive geriatric assessment, the Cambridge Cognitive Test (CAMCOG), and the Geriatric Depression Scale (GDS). RESULTS Depression was correlated with cognitive level in the nondependent older adult sample (r = -0.471, p = 0.004). Age was inversely associated with the score obtained in the CAMCOG of the nondependent older adult sample (r = -0.352, p = 0.038). The functional capacity in several activities of daily living was correlated with the score obtained in the CAMCOG in each of the two groups. Depression was more prevalent in the dependent than in the nondependent older adults (82.85 vs. 57.14%). No association was observed between institutionalization time and the score obtained on the cognitive and affective scales (GDS and CAMCOG) in both groups (GDS-nondependent, r = -0.209, p = 0.234; CAMCOG-nondependent, r = 0.007, p = 0.967; GDS-dependent, r = 0.251, p = 0.152; CAMCOG-dependent, r = -0.021, p = 0.907). CONCLUSION Depressive symptomatology is associated with cognitive deterioration. Depression is prevalent in institutions that care for older, more dependent adults.
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19
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Hajat C, Siegal Y, Adler-Waxman A. Clustering and Healthcare Costs With Multiple Chronic Conditions in a US Study. Front Public Health 2021; 8:607528. [PMID: 33553094 PMCID: PMC7859629 DOI: 10.3389/fpubh.2020.607528] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/02/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: To investigate healthcare costs and contributors to costs for multiple chronic conditions (MCCs), common clusters of conditions and their impact on cost and utilization. Methods: This was a cross-sectional analysis of US financial claims data representative of the US population, including Medicare, Medicaid, and Commercial insurance claims in 2015. Outcome measures included healthcare costs and contributors; ranking of clusters of conditions according to frequency, strength of association and unsupervised (k-means) analysis; the impact of clustering on costs and contributors to costs. Results: Of 1,878,951 patients, 931,045(49.6%) had MCCs, 56.5% weighted to the US population. Mean age was 53.0 years (SD16.7); 393,121(42.20%) were male. Mean annual healthcare spending was $12,601, ranging from $4,385 (2 conditions) to $33,874 (11 conditions), with spending increasing by 22-fold for inpatient services, 6-fold for outpatient services, 4.5-fold for generic drugs, and 4.2-fold for branded drugs. Cluster ranking using the 3 methodologies yielded similar results: highest ranked clusters included metabolic syndrome (12.2% of US insured patients), age related diseases (7.7%), renal failure (5.6%), respiratory disorders (4.5%), cardiovascular disease(CVD) (4.3%), cancers (4.1-4.3%), mental health-related clusters (1.0-1.5%), and HIV/AIDS (0.2%). Highest spending was in HIV/AIDS clusters ($48,293), mental health-related clusters ($38,952-$40,637), renal disease ($38,551), and CVD ($37,155); with 89.9% of spending on outpatient and inpatient care combined, and 10.1% on medication. Conclusion and Relevance: Over 57% of insured patients in the US may have MCCs. MCC Clustering is frequent and is associated with healthcare utilization. The findings favor health system redesign toward a multiple condition approach for clusters of chronic conditions, alongside other cost-containment measures for MCCs.
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Affiliation(s)
- Cother Hajat
- Public Health Institute, United Arab Emirates (UAE) University, Al Ain, United Arab Emirates
| | - Yakir Siegal
- Deloitte Consulting LLP, New York, NY, United States
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Fisher KA, Griffith LE, Gruneir A, Upshur R, Perez R, Favotto L, Nguyen F, Markle-Reid M, Ploeg J. Effect of socio-demographic and health factors on the association between multimorbidity and acute care service use: population-based survey linked to health administrative data. BMC Health Serv Res 2021; 21:62. [PMID: 33435978 PMCID: PMC7805153 DOI: 10.1186/s12913-020-06032-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 12/20/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND This study explores how socio-demographic and health factors shape the relationship between multimorbidity and one-year acute care service use (i.e., hospital, emergency department visits) in older adults in Ontario, Canada. METHODS We linked multiple cycles (2005-2006, 2007-2008, 2009-2010, 2011-2012) of the Canadian Community Health Survey (CCHS) to health administrative data to create a cohort of adults aged 65 and older. Administrative data were used to estimate one-year service use and to identify 12 chronic conditions used to measure multimorbidity. We examined the relationship between multimorbidity and service use stratified by a range of socio-demographic and health variables available from the CCHS. Logistic and Poisson regressions were used to explore the association between multimorbidity and service use and the role of socio-demographic factors in this relationship. RESULTS Of the 28,361 members of the study sample, 60% were between the ages of 65 and 74 years, 57% were female, 72% were non-immigrant, and over 75% lived in an urban area. Emergency department visits and hospitalizations consistently increased with the level of multimorbidity. This study did not find strong evidence of moderator or interaction effects across a range of socio-demographic factors. Stratified analyses revealed further patterns, with many being similar for both services - e.g., the odds ratios were higher at all levels of multimorbidity for men, older age groups, and those with lower household income. Rurality and immigrant status influenced emergency department use (higher in rural residents and non-immigrants) but not hospitalizations. Multimorbidity and the range of socio-demographic variables remained significant predictors of service use in the regressions. CONCLUSIONS Strong evidence links multimorbidity with increased acute care service use. This study showed that a range of factors did not modify this relationship. Nevertheless, the factors were independently associated with acute care service use, pointing to modifiable risk factors that can be the focus of resource allocation and intervention design to reduce service use in those with multimorbidity. The study's results suggest that optimizing acute care service use in older adults requires attention to both multimorbidity and social determinants, with programs that are multifactorial and integrated across the health and social service sectors.
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Affiliation(s)
- Kathryn A. Fisher
- School of Nursing, McMaster University, HSC 2J36, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada
| | - Lauren E. Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, CRL Building, First Floor, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada
| | - Andrea Gruneir
- Department of Family Medicine, University of Alberta, 6-10 University TerraceEdmonton, AB T6G 2T4, Edmonton, Alberta T6G 2R3 Canada
- ICES, 2075 Bayview Ave, Toronto, Ontario M4N 3M5 Canada
| | - Ross Upshur
- Division of Clinical Public Health, Dalla Lana School of Public Health, 155 College St. Room 690, Toronto, ON M5T 3M7 University of Toronto, Toronto, Ontario Canada
| | - Richard Perez
- Institute for Clinical Evaluative Sciences (ICES), McMaster University, HSC 4N43, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada
| | - Lindsay Favotto
- Institute for Clinical Evaluative Sciences (ICES), McMaster University, HSC 4N43, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada
| | - Francis Nguyen
- Institute for Clinical Evaluative Sciences (ICES), McMaster University, HSC 4N43, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada
| | - Maureen Markle-Reid
- School of Nursing, McMaster University, HSC 2J36, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, CRL Building, First Floor, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada
| | - Jenny Ploeg
- School of Nursing, McMaster University, HSC 2J36, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada
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21
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Camacho-Conde JA, Galán-López JM. The Relationship Between Depression and Cognitive Deterioration in Elderly Persons. PSICOLOGIA: TEORIA E PESQUISA 2021. [DOI: 10.1590/0102.3772e37413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract The objective of this research is to describe the relationship between depressive disorder and cognitive deterioration in residentialized elderly people. This is a descriptive and correlational study with 70 elderly. The variables have been assessed with a Psychosocial Variables Questionnaire, CAMCOG and GDS. Depression was significantly correlated with cognitive level in the non-assisted elderly sample (r=0.471, p=0.004). Participants’ age is negatively associated with the score obtained in the CAMCOG of non-assisted sample (r=-0.352, p=0.038). Depression is more frequent in institutions that care for older people when they are more dependent.
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Shirakawa T, Sonoo T, Ogura K, Fujimori R, Hara K, Goto T, Hashimoto H, Takahashi Y, Naraba H, Nakamura K. Institution-Specific Machine Learning Models for Prehospital Assessment to Predict Hospital Admission: Prediction Model Development Study. JMIR Med Inform 2020; 8:e20324. [PMID: 33107830 PMCID: PMC7655472 DOI: 10.2196/20324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/24/2020] [Accepted: 09/16/2020] [Indexed: 12/23/2022] Open
Abstract
Background Although multiple prediction models have been developed to predict hospital admission to emergency departments (EDs) to address overcrowding and patient safety, only a few studies have examined prediction models for prehospital use. Development of institution-specific prediction models is feasible in this age of data science, provided that predictor-related information is readily collectable. Objective We aimed to develop a hospital admission prediction model based on patient information that is commonly available during ambulance transport before hospitalization. Methods Patients transported by ambulance to our ED from April 2018 through March 2019 were enrolled. Candidate predictors were age, sex, chief complaint, vital signs, and patient medical history, all of which were recorded by emergency medical teams during ambulance transport. Patients were divided into two cohorts for derivation (3601/5145, 70.0%) and validation (1544/5145, 30.0%). For statistical models, logistic regression, logistic lasso, random forest, and gradient boosting machine were used. Prediction models were developed in the derivation cohort. Model performance was assessed by area under the receiver operating characteristic curve (AUROC) and association measures in the validation cohort. Results Of 5145 patients transported by ambulance, including deaths in the ED and hospital transfers, 2699 (52.5%) required hospital admission. Prediction performance was higher with the addition of predictive factors, attaining the best performance with an AUROC of 0.818 (95% CI 0.792-0.839) with a machine learning model and predictive factors of age, sex, chief complaint, and vital signs. Sensitivity and specificity of this model were 0.744 (95% CI 0.716-0.773) and 0.745 (95% CI 0.709-0.776), respectively. Conclusions For patients transferred to EDs, we developed a well-performing hospital admission prediction model based on routinely collected prehospital information including chief complaints.
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Affiliation(s)
- Toru Shirakawa
- Department of Public Health, Graduate School of Medicine, Osaka University, Suita, Japan.,TXP Medical Co, Ltd, Chuo-ku, Japan
| | - Tomohiro Sonoo
- TXP Medical Co, Ltd, Chuo-ku, Japan.,Department of Emergency Medicine, Hitachi General Hospital, Hitachi, Japan
| | - Kentaro Ogura
- TXP Medical Co, Ltd, Chuo-ku, Japan.,Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Ryo Fujimori
- TXP Medical Co, Ltd, Chuo-ku, Japan.,Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Konan Hara
- TXP Medical Co, Ltd, Chuo-ku, Japan.,Department of Public Health, The University of Tokyo, Bunkyo-ku, Japan
| | - Tadahiro Goto
- TXP Medical Co, Ltd, Chuo-ku, Japan.,Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo-ku, Japan
| | - Hideki Hashimoto
- Department of Emergency Medicine, Hitachi General Hospital, Hitachi, Japan
| | - Yuji Takahashi
- Department of Emergency Medicine, Hitachi General Hospital, Hitachi, Japan
| | - Hiromu Naraba
- Department of Emergency Medicine, Hitachi General Hospital, Hitachi, Japan
| | - Kensuke Nakamura
- Department of Emergency Medicine, Hitachi General Hospital, Hitachi, Japan.,Department of Emergency Medicine, The University of Tokyo, Bunkyo-ku, Japan
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Amjad H, Mulcahy J, Kasper JD, Burgdorf J, Roth DL, Covinsky K, Wolff JL. Do Caregiving Factors Affect Hospitalization Risk Among Disabled Older Adults? J Am Geriatr Soc 2020; 69:129-139. [PMID: 32964422 DOI: 10.1111/jgs.16817] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/17/2020] [Accepted: 08/07/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND/OBJECTIVES Hospitalization is common among older adults with disability, many of whom receive help from a caregiver and have dementia. Our objective was to evaluate the association between caregiver factors and risk of hospitalization and whether associations differ by dementia status. DESIGN Longitudinal observational study. SETTING The 1999 and 2004 National Long-Term Care Survey and the 2011 and 2015 National Health and Aging Trends Study, linked caregiver surveys, and Medicare claims. PARTICIPANTS A total of 2,589 community-living Medicare fee-for-service beneficiaries, aged 65 years or older (mean age = 79 years; 63% women; 31% with dementia), with self-care or mobility disability and their primary family or unpaid caregiver. MEASUREMENTS Self-reported characteristics of older adults and their caregivers were assessed from older adult and caregiver survey interviews. Older adult hospitalization over the subsequent 12 months was identified in Medicare claims. Multivariable Cox proportional hazards models adjusted for older adult characteristics and were stratified by dementia status. RESULTS In this nationally representative cohort, 38% of older adults with disabilities were hospitalized over 12 months following interview. Increased hospitalization risk was associated with having a primary caregiver who helped with healthcare tasks (adjusted hazard ratio (aHR) = 1.22; 95% confidence interval (CI) = 1.05-1.40), reported physical strain (aHR = 1.21; 95% CI = 1.04-1.42), and provided more than 40 hours of care weekly (aHR = 1.26; 95% CI = 1.04-1.54 vs ≤20 hours). Having a caregiver who had helped for 4 years or longer (vs <1 year) was associated with 38% lower risk of hospitalization (aHR = 0.62; 95% CI = 0.49-0.79). Older adults with and without dementia had similar rates of hospitalization (39.5% vs 37.3%; P = .4), and caregiving factors were similarly associated with hospitalization regardless of older adults' dementia status. CONCLUSION Select caregiving characteristics are associated with hospitalization risk among older adults with disability. Hospitalization risk reduction strategies may benefit from understanding and addressing caregiving circumstances.
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Affiliation(s)
- Halima Amjad
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - John Mulcahy
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.,Roger C. Lipitz Center for Integrated Health Care, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Judith D Kasper
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.,Roger C. Lipitz Center for Integrated Health Care, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Julia Burgdorf
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.,Roger C. Lipitz Center for Integrated Health Care, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - David L Roth
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ken Covinsky
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA
| | - Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.,Roger C. Lipitz Center for Integrated Health Care, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Determinants of Overnight Stay in Health Centres and Length of Admission: A Study of Canadian Seniors. Can J Aging 2020; 39:533-544. [PMID: 32089138 DOI: 10.1017/s0714980819000771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This study examines the influence of chronic health conditions and socio-economic status on overnight admission and length of stay among Canadian seniors. Incremental multivariate logistic and zero-inflated negative binomial regression models assessed the relationship between selected predictors, overnight admission, and duration of stay. The findings show that all chronic health conditions and socio-economic factors examined were significantly associated with overnight hospital admission. However, seniors with cardiovascular health conditions, the very old, and seniors living in lower-income households had a greater risk of longer stays. Canadian seniors diagnosed with hypertension, cancer, diabetes, and stroke had greater risk of longer overnight hospital stays. Seniors aged 75 to 79 years, 80 years or older, and those living in lower-income households (≤ $39,999) were more likely to have a longer overnight hospital stay. Findings suggest that improving seniors' health and socio-economic status may reduce the risk of overnight admission and longer stays of hospitalisation.
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25
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Ruiz JG, Rodriguez-Suarez M, Tang F, Aparicio-Ugarriza R, Ferri-Guerra J, Mohammed NY, Mintzer MJ. Depression but not frailty contributed to a higher risk for all-cause hospitalizations in male older veterans. Int J Geriatr Psychiatry 2020; 35:37-44. [PMID: 31608502 DOI: 10.1002/gps.5212] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 09/15/2019] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Frailty is a state of vulnerability to stressors resulting in higher morbidity, mortality, and utilization in older adults. Depression and frailty often coexist, suggesting a bidirectional relationship that may increase the effects of each individual condition on clinical outcomes and health-care utilization in older adults. OBJECTIVE To determine the effects of concurrent frailty and depression on all-cause hospitalizations. METHODS/DESIGN Prospective cohort study, conducted at a Veterans Affairs (VA) Medical Center. The participants were male, community-dwelling veterans 65 years and older. From 4 January through 30 December 2016, a 46-item frailty index was generated from data obtained from the VA electronic health record. Trained staff conducted in-depth reviews of electronic health records ascertaining depression status. Patients were followed through 31 December 2017 for all-cause hospitalizations following the initial assessment of frailty. After adjusting for covariates, the association of frailty and depression with all-cause hospitalizations was determined with the Andersen-Gill model, accounting for repeated hospitalizations. RESULTS Five hundred fifty-three male patients were part of the study, mean age 76.3 (SD = 8.2) years. One hundred eighty-one patients (32.7%) had depression diagnoses. During a median follow-up period of 530 days (interquartile range [IQR] = 245), 123 patients (22.2%) had 240 hospitalizations. Frailty status was not associated with future hospitalizations (adjusted hazard ratio [HR] = 1.61; 95% CI, 95-2.74; P > .05). Depression was associated with higher all-cause hospitalizations (adjusted HR = 1.57; 95% CI, 1.09-2.26); P = .0157). CONCLUSIONS Depression but not frailty was significantly associated with higher rates of all-cause hospitalization. Implementing interventions that target older adults with both frailty and depression may reduce the burden of both conditions and reduce hospitalizations.
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Affiliation(s)
- Jorge G Ruiz
- Miami VA Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Miami, FL.,Miller School of Medicine, University of Miami, Miami, FL
| | - Mercedes Rodriguez-Suarez
- Miller School of Medicine, University of Miami, Miami, FL.,Mental Health Service, Miami VA Healthcare System, Miami, FL
| | - Fei Tang
- Research Service, Miami VA Healthcare System, Miami, FL
| | - Raquel Aparicio-Ugarriza
- Miami VA Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Miami, FL.,Miller School of Medicine, University of Miami, Miami, FL
| | - Juliana Ferri-Guerra
- Miami VA Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Miami, FL.,Miller School of Medicine, University of Miami, Miami, FL
| | - Nadeem Y Mohammed
- Miami VA Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Miami, FL.,Miller School of Medicine, University of Miami, Miami, FL
| | - Michael J Mintzer
- Miami VA Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Miami, FL.,Miller School of Medicine, University of Miami, Miami, FL.,Herbert Wertheim College of Medicine, Florida International University, Miami, FL
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Tyagi S, Koh GCH, Luo N, Tan KB, Hoenig H, Matchar DB, Yoong J, Chan A, Lee KE, Venketasubramanian N, Menon E, Chan KM, De Silva DA, Yap P, Tan BY, Chew E, Young SH, Ng YS, Tu TM, Ang YH, Kong KH, Singh R, Merchant RA, Chang HM, Yeo TT, Ning C, Cheong A, Ng YL, Tan CS. Dyadic approach to post-stroke hospitalizations: role of caregiver and patient characteristics. BMC Neurol 2019; 19:267. [PMID: 31684922 PMCID: PMC6829975 DOI: 10.1186/s12883-019-1510-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 10/22/2019] [Indexed: 01/06/2023] Open
Abstract
Aim To study the association of caregiver factors and stroke patient factors with rehospitalizations over the first 3 months and subsequent 3–12 months post-stroke in Singapore. Methods Patients with stroke and their caregivers were recruited in the Singapore Stroke Study, a prospective yearlong cohort. While caregiver and patient variables were taken from this study, hospitalization data were extracted from the national claims database. We used Poisson modelling to perform bivariate and multivariable analysis with counts of hospitalization as the outcome. Results Two hundred and fifty-six patient with stroke and caregiver dyads (N = 512) were analysed, with patients having spouse (60%), child (29%), sibling (4%) and other (7%) as their caregivers. Among all participants, 89% of index strokes were ischemic, 57% were mild in severity and more than half (59%) of the patients had moderate or severe disability post-stroke as measured on the Modified Rankin Scale. Having social support in the form of a foreign domestic worker for general help of caregiver reduced the hospitalization rate over 3 months post-stroke by 66% (IRR: 0.342; 95% CI: 0.180, 0.651). Compared to having a spousal caregiver, those with a child caregiver had an almost three times greater rate of hospitalizations over 3–12 months post-stroke (IRR: 2.896; 95% CI: 1.399, 5.992). Higher reported caregiving burden at the 3-month point was associated with the higher subsequent rate of hospitalization. Conclusion Recommendations include the adoption of a dyadic or holistic approach to post-stroke care provision by healthcare practitioners, giving due importance to both patients with stroke and their caregivers, integrating caregivers in the healthcare system to extend the care continuum to include informal care in the community and provision of timely support for caregivers.
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Affiliation(s)
- Shilpa Tyagi
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Gerald C H Koh
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore.
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Kelvin B Tan
- Policy Research & Economics Office, Ministry of Health, Singapore, Singapore
| | - Helen Hoenig
- Physical Medicine and Rehabilitation Service, Durham VA Medical Centre, Durham, USA
| | - David B Matchar
- Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Joanne Yoong
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Angelique Chan
- Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Kim En Lee
- Lee Kim En Neurology Pte Ltd, Singapore, Singapore
| | | | - Edward Menon
- St. Andrew's Community Hospital, Singapore, Singapore
| | | | - Deidre Anne De Silva
- National Neuroscience Institute, Singapore General Hospital campus, Singapore, Singapore
| | - Philip Yap
- Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | | | - Effie Chew
- Department of Rehabilitation Medicine, National University Hospital, Singapore, Singapore
| | - Sherry H Young
- Department of Rehabilitation Medicine, Changi General Hospital, Singapore, Singapore
| | - Yee Sien Ng
- Department of Rehabilitation Medicine, Singapore General Hospital, Singapore, Singapore
| | - Tian Ming Tu
- Department of Neurology, National Neuroscience Institute, Neurology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Yan Hoon Ang
- Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Keng He Kong
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Rajinder Singh
- Department of Neurology, National Neuroscience Institute, Neurology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Reshma A Merchant
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hui Meng Chang
- National Neuroscience Institute, Singapore General Hospital campus, Singapore, Singapore
| | - Tseng Tsai Yeo
- Department of Neurosurgery, National University Hospital, Singapore, Singapore
| | - Chou Ning
- Department of Neurosurgery, National University Hospital, Singapore, Singapore
| | - Angela Cheong
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Yu Li Ng
- Policy Research & Economics Office, Ministry of Health, Singapore, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
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Jiang M, Yang G, Fang L, Wan J, Yang Y, Wang Y. Factors associated with healthcare utilization among community-dwelling elderly in Shanghai, China. PLoS One 2018; 13:e0207646. [PMID: 30507929 PMCID: PMC6277110 DOI: 10.1371/journal.pone.0207646] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 11/04/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the factors associated with the health status of older Chinese people living in the community, in order to inform strategies to expand access to healthcare. METHODS Two-phase stratified cluster sampling was applied; 2000 older people participated in this study. Face-to-face interviews were conducted in Shanghai between June and August, 2011. Descriptive analysis was used to examine the respondents' characteristics. Based on Andersen's healthcare utilization model, a chi-squared test and multiple logistic regression were performed to examine the influences of predisposing, enabling, need, and contextual factors on healthcare utilization. RESULTS We found that 44.5% of the older people in the sample had good self-reported health status, while 12.8% were poor, 14.5% had visited hospitals or clinics as outpatients in the previous two weeks, and 16.5% had been hospitalized in the previous year. Logistic regression analysis revealed that outpatient health services were more likely to be used by women and those whose income was from friends or social relief, who had poor to good self-reported health status, who were experiencing declining health, who engaged in volunteer activities, and who had chronic diseases. Meanwhile, hospitalization was more likely among those in the older age groups, those with pension income, living in outer suburbs, with poor self-reported health status, experiencing difficulty with activities of daily living and outdoor activities, or having a chronic disease. CONCLUSIONS The results showed the impact of economic status, health status, demographic and social characteristics, and other factors on the health service utilization of elderly people living in the community in Shanghai. Need variables were the strongest predictors of health service use, although contextual factors also contributed.
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Affiliation(s)
- Man Jiang
- School of Public Health, Fudan University, Shanghai, China
| | - Guang Yang
- Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Lvying Fang
- School of Public Health, Fudan University, Shanghai, China
| | - Jin Wan
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yinghua Yang
- Management Department, Shanghai Municipal Center For Disease Control & Prevention, Shanghai, China
| | - Ying Wang
- School of Public Health/Key Lab of Health Technology Assessment, National Health and Family Planning Commission of the People's Republic of China, Fudan University, Shanghai, China
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Hajat C, Stein E. The global burden of multiple chronic conditions: A narrative review. Prev Med Rep 2018; 12:284-293. [PMID: 30406006 PMCID: PMC6214883 DOI: 10.1016/j.pmedr.2018.10.008] [Citation(s) in RCA: 390] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/21/2018] [Accepted: 10/14/2018] [Indexed: 01/19/2023] Open
Abstract
Globally, approximately one in three of all adults suffer from multiple chronic conditions (MCCs). This review provides a comprehensive overview of the resulting epidemiological, economic and patient burden. There is no agreed taxonomy for MCCs, with several terms used interchangeably and no agreed definition, resulting in up to three-fold variation in prevalence rates: from 16% to 58% in UK studies, 26% in US studies and 9.4% in Urban South Asians. Certain conditions cluster together more frequently than expected, with associations of up to three-fold, e.g. depression associated with stroke and with Alzheimer's disease, and communicable conditions such as TB and HIV/AIDS associated with diabetes and CVD, respectively. Clusters are important as they may be highly amenable to large improvements in health and cost outcomes through relatively simple shifts in healthcare delivery. Healthcare expenditures greatly increase, sometimes exponentially, with each additional chronic condition with greater specialist physician access, emergency department presentations and hospital admissions. The patient burden includes a deterioration of quality of life, out of pocket expenses, medication adherence, inability to work, symptom control and a high toll on carers. This high burden from MCCs is further projected to increase. Recommendations for interventions include reaching consensus on the taxonomy of MCC, greater emphasis on MCCs research, primary prevention to achieve compression of morbidity, a shift of health systems and policies towards a multiple-condition framework, changes in healthcare payment mechanisms to facilitate this change and shifts in health and epidemiological databases to include MCCs.
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Affiliation(s)
| | - Emma Stein
- Yale School of Public Health, United States of America
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Tyagi S, Koh GCH, Nan L, Tan KB, Hoenig H, Matchar DB, Yoong J, Finkelstein EA, Lee KE, Venketasubramanian N, Menon E, Chan KM, De Silva DA, Yap P, Tan BY, Chew E, Young SH, Ng YS, Tu TM, Ang YH, Kong KH, Singh R, Merchant RA, Chang HM, Yeo TT, Ning C, Cheong A, Ng YL, Tan CS. Healthcare utilization and cost trajectories post-stroke: role of caregiver and stroke factors. BMC Health Serv Res 2018; 18:881. [PMID: 30466417 PMCID: PMC6251229 DOI: 10.1186/s12913-018-3696-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 11/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is essential to study post-stroke healthcare utilization trajectories from a stroke patient caregiver dyadic perspective to improve healthcare delivery, practices and eventually improve long-term outcomes for stroke patients. However, literature addressing this area is currently limited. Addressing this gap, our study described the trajectory of healthcare service utilization by stroke patients and associated costs over 1-year post-stroke and examined the association with caregiver identity and clinical stroke factors. METHODS Patient and caregiver variables were obtained from a prospective cohort, while healthcare data was obtained from the national claims database. Generalized estimating equation approach was used to get the population average estimates of healthcare utilization and cost trend across 4 quarters post-stroke. RESULTS Five hundred ninety-two stroke patient and caregiver dyads were available for current analysis. The highest utilization occurred in the first quarter post-stroke across all service types and decreased with time. The incidence rate ratio (IRR) of hospitalization decreased by 51, 40, 11 and 1% for patients having spouse, sibling, child and others as caregivers respectively when compared with not having a caregiver (p = 0.017). Disability level modified the specialist outpatient clinic usage trajectory with increasing difference between mildly and severely disabled sub-groups across quarters. Stroke type and severity modified the primary care cost trajectory with expected cost estimates differing across second to fourth quarters for moderately-severe ischemic (IRR: 1.67, 1.74, 1.64; p = 0.003), moderately-severe non-ischemic (IRR: 1.61, 3.15, 2.44; p = 0.001) and severe non-ischemic (IRR: 2.18, 4.92, 4.77; p = 0.032) subgroups respectively, compared to first quarter. CONCLUSION Highlighting the quarterly variations, we reported distinct utilization trajectories across subgroups based on clinical characteristics. Caregiver availability reducing hospitalization supports revisiting caregiver's role as potential hidden workforce, incentivizing their efforts by designing socially inclusive bundled payment models for post-acute stroke care and adopting family-centered clinical care practices.
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Affiliation(s)
- Shilpa Tyagi
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549 Singapore
| | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549 Singapore
| | - Luo Nan
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549 Singapore
| | - Kelvin Bryan Tan
- Policy Research & Economics Office, Ministry of Health, Singapore, Singapore
| | - Helen Hoenig
- Physical Medicine and Rehabilitation Service, Durham VA Medical Centre, Durham, USA
| | - David B. Matchar
- Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Joanne Yoong
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549 Singapore
| | - Eric A. Finkelstein
- Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Kim En Lee
- Lee Kim En Neurology Pte Ltd, Singapore, Singapore
| | | | - Edward Menon
- St. Andrew’s Community Hospital, Singapore, Singapore
| | | | - Deidre Anne De Silva
- National Neuroscience Institute, Singapore General Hospital campus, Singapore, Singapore
| | - Philip Yap
- Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | | | - Effie Chew
- Department of Rehabilitation Medicine, National University Hospital, Singapore, Singapore
| | - Sherry H. Young
- Department of Rehabilitation Medicine, Changi General Hospital, Singapore, Singapore
| | - Yee Sien Ng
- Department of Rehabilitation Medicine, Singapore General Hospital, Singapore, Singapore
| | - Tian Ming Tu
- Department of Neurology, National Neuroscience Institute, Neurology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Yan Hoon Ang
- Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Keng Hee Kong
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Rajinder Singh
- Department of Neurology, National Neuroscience Institute, Neurology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Reshma A. Merchant
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hui Meng Chang
- National Neuroscience Institute, Singapore General Hospital campus, Singapore, Singapore
| | - Tseng Tsai Yeo
- Department of Neurosurgery, National University Hospital, Singapore, Singapore
| | - Chou Ning
- Department of Neurosurgery, National University Hospital, Singapore, Singapore
| | - Angela Cheong
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549 Singapore
| | - Yu Li Ng
- Policy Research & Economics Office, Ministry of Health, Singapore, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549 Singapore
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Gjestsen MT, Brønnick K, Testad I. Characteristics and predictors for hospitalizations of home-dwelling older persons receiving community care: a cohort study from Norway. BMC Geriatr 2018; 18:203. [PMID: 30176794 PMCID: PMC6122216 DOI: 10.1186/s12877-018-0887-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Older persons are substantial consumers of both hospital- and community care, and there are discussions regarding the potential for preventing hospitalizations through high quality community care. The present study report prevalence and factors associated with admissions to hospital for community-dwelling older persons (> 67 years of age), receiving community care in a Norwegian municipality. METHODS This was a cohort study of 1531 home-dwelling persons aged ≥67 years, receiving community care. We retrospectively scrutinized admissions to hospital for the study cohort over a one-year period in 2013. The frequency of admissions was evaluated with regard to association with age (age groups 67-79 years, 80-89 years and ≥ 90 year) and gender. The hospital admission incidence was calculated by dividing the number of admissions by the number of individuals included in the study cohort, stratified by age and gender. The association between age and gender as potential predictors and hospitalization (outcome) was first examined in univariate analyses followed by multinomial regression analyses in order to investigate the associations between age and gender with different causes of hospitalization. RESULTS We identified a total of 1457 admissions, represented by 739 unique individuals, of which 64% were women, and an estimated mean age of 83 years. Mean admission rate was 2 admissions per person-year (95% confidence interval (CI): 1.89-2.11). The admission rate varied with age, and hospital incidents rates were higher for men in all age groups. The overall median length of stay was 4 days. The most common reason for hospitalization was the need for further medical assessment (23%). We found associations between increasing age and hospitalizations due to physical general decline, and associations between male gender and hospitalizations due to infections (e.g., airways infections, urinary tract infections). CONCLUSIONS We found the main reasons for hospitalizations to be related to falls, infections and general decline/pain/unspecified dyspnea. Men were especially at risk for hospitalization as they age. Our study have identified some clinically relevant factors that are vital in understanding what health care personnel in community care need to be especially aware of in order to prevent hospitalizations for this population.
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Affiliation(s)
- Martha Therese Gjestsen
- Centre for age-related medicine (SESAM), Stavanger University Hospital, Stavanger, Norway
- University of Stavanger, Faculty of Health Sciences, Centre for Resilience in Healthcare (SHARE), Stavanger, Norway
| | - Kolbjørn Brønnick
- Centre for Clinical Research in Psychosis (TIPS), Stavanger University Hospital, Stavanger, Norway
- University of Stavanger, Faculty of Health Sciences, Stavanger, Norway
| | - Ingelin Testad
- Centre for age-related medicine (SESAM), Stavanger University Hospital, Stavanger, Norway
- University of Exeter Medical School, Exeter, Devon UK
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Dahlberg L, Agahi N, Schön P, Lennartsson C. Planned and Unplanned Hospital Admissions and Their Relationship with Social Factors: Findings from a National, Prospective Study of People Aged 76 Years or Older. Health Serv Res 2018; 53:4248-4267. [PMID: 29952093 PMCID: PMC6232498 DOI: 10.1111/1475-6773.13001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To examine the relationship between social factors and planned and unplanned hospital admissions among older people. DATA SOURCES/STUDY SETTING 2011 data from the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) and data from the Swedish National Patient Register until December 31, 2012. STUDY DESIGN The study had a prospective design. Data were analyzed via Cox proportional hazard regressions with variables entered as blocks (social factors, sociodemographic and ability factors, health factors). DATA COLLECTION Data were collected via interviews with people aged 76+ (n = 931). PRINCIPAL FINDINGS Living in institutions was negatively associated with planned admissions (hazard ratio (HR): 0.29; confidence interval (CI): 0.09-0.88), while being in receipt of home help was positively associated with unplanned admissions (HR: 1.57; CI: 1.15-2.14). Low levels of social contacts and social activity predicted unplanned admissions in bivariate analyses only. Higher ability to deal with public authorities was positively associated with planned admissions (HR: 1.77; CI: 1.13-2.78) and negatively associated with unplanned admissions, although the latter association was only significant in the bivariate analysis. CONCLUSIONS Hospital admissions are not only due to health problems but are also influenced by the social care situation and by the ability to deal with public authorities.
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Affiliation(s)
- Lena Dahlberg
- Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Neda Agahi
- Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden
| | - Pär Schön
- Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden
| | - Carin Lennartsson
- Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden
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Rönneikkö JK, Jämsen ER, Mäkelä M, Finne-Soveri H, Valvanne JN. Reasons for home care clients' unplanned Hospital admissions and their associations with patient characteristics. Arch Gerontol Geriatr 2018; 78:114-126. [PMID: 29957266 DOI: 10.1016/j.archger.2018.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Unplanned hospitalizations and emergency room visits occur frequently among home care clients The aim of this study was to identify typical discharge diagnoses and their associations with patient characteristics among a total of 6812 Finnish home care clients aged ≥63 years who were hospitalized within one year of their first home care assessment. METHODS A register-based study based on Resident Assessment Instrument-Home Care (RAI-HC) assessments and nationwide hospital discharge records. The RAI-HC assessments were linked to the hospital discharge records of the participants' first unplanned hospitalization. Univariate and multivariable regression analyses were used to evaluate the association of RAI-HC determinants with discharge diagnoses. RESULTS The most common reason for the first hospitalization was an infectious disease (21%; n = 1446). When hospitalizations were classified according to the main diagnosis, chronic skin ulcers, functional impairment and daily urinary incontinence were associated with hospitalization due to infectious diseases; impaired cognitive capacity, Alzheimer's disease or other dementia and polypharmacy (protective effect) were associated with hospitalizations due to dementia; age of ≥90 years, congestive heart failure, coronary artery disease and using ≥10 drugs with hospitalizations due to heart diseases; and moderate or strong pain with hospitalization due to musculoskeletal disorders. Previous falls, female sex and an earlier hip fracture were associated with injury-related hospitalizations. Feelings of loneliness increased the odds of hospitalization due to geriatric symptoms without a specific diagnosis. CONCLUSION Patient characteristics and geriatric syndromes identified using RAI-HC predict the reasons for future hospitalizations among new home care clients.
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Affiliation(s)
| | - Esa R Jämsen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Gerontology, Finland; Research Center (GEREC), Universities of Jyväskylä and Tampere, Finland, Hatanpää hospital, Finland; Service Line of General Practice and Geriatrics, Tampere, Finland
| | - Matti Mäkelä
- National Institute for Health and Welfare, Helsinki, Finland
| | | | - Jaakko N Valvanne
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Gerontology, Finland; Research Center (GEREC), Universities of Jyväskylä and Tampere, Finland, Hatanpää hospital, Finland; Promotion of Senior Citizens' Welfare, City of Tampere, Finland, Tampere University Hospital, Tampere, Finland
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Santiago LM, Gobbens RJJ, van Assen MALM, Carmo CN, Ferreira DB, Mattos IE. Predictive validity of the Brazilian version of the Tilburg Frailty Indicator for adverse health outcomes in older adults. Arch Gerontol Geriatr 2018; 76:114-119. [PMID: 29494871 DOI: 10.1016/j.archger.2018.02.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 01/29/2018] [Accepted: 02/16/2018] [Indexed: 01/14/2023]
Abstract
PURPOSE This study aimed to determine the predictive value of the Brazilian Tilburg Frailty Indicator (TFI) for adverse health outcomes (falls, hospitalization, disability and death), in a follow-up period of twelve months. METHODS This longitudinal study was carried out with a sample of people using primary health care services in Rio de Janeiro, Brazil. At baseline the sample consisted of 963 people aged 60 years and older. A subset of all respondents participated again one year later (n = 640, 66.6% response rate). We used the TFI, the Katz's scale for assessing ADL disability and the Lawton Scale for assessing IADL disability. Falls, hospitalization and death were also assessed using a questionnaire. RESULTS The prevalence of frailty was 44.2% and the mean score of the TFI was 4.4 (SD = 3.0). There was a higher risk of loss in functional capacity in ADL (OR = 3.03, CI95% 1.45-6.29) and in IADL (OR = 1.51, CI95% 1.05-2.17), falls (OR = 2.08, CI95% 1.21-3.58), hospitalization (OR = 1.83, CI95% 1.10-3.06), and death (HR = 2.73, CI95% 1.04-7.19) for frail when compared to non-frail elderly, in the bivariate analyses. Controlling for the sociodemographic variables, the frailty domains together improved the prediction of hospitalization, falls and loss in functional capacity in ADL, but not loss in functional capacity in IADL. CONCLUSION The TFI is a good predictor of adverse health outcomes among elderly users of primary care services in Brazil and appears an adequate and easy to administer tool for monitoring their health conditions.
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Affiliation(s)
- Lívia Maria Santiago
- Federal University of Rio de Janeiro, Faculty of Medicine, Rua Rodolpho Paulo Rocco, 255/room 9E11, Cidade Universitária, Zip Code 21941- 913, Rio de Janeiro, RJ, Brazil; National School of Public Health/Oswaldo Cruz Foundation, Department of Epidemiology and Quantitative Methods, Rua Leopoldo Bulhões, 1480/room 817b, Manguinhos, Zip Code 21041-210, Rio de Janeiro, RJ, Brazil.
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, De Boelelaan 1109, 1081 HV, Amsterdam, The Netherlands; Zonnehuisgroep Amstelland, Groenelaan 7, 1186 AA, Amstelveen, The Netherlands; Department of General Practice, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium.
| | - Marcel A L M van Assen
- Department of Methodology and Statistics, Tilburg School of Social and Behavioral Sciences, Warandelaan 2, 90153, Tilburg University, Tilburg, The Netherlands; Department of Sociology, Utrecht University, Padualaan 14, 3584 CH, Utrecht, The Netherlands.
| | - Cleber Nascimento Carmo
- National School of Public Health/Oswaldo Cruz Foundation, Department of Epidemiology and Quantitative Methods, Rua Leopoldo Bulhões, 1480/room 817b, Manguinhos, Zip Code 21041-210, Rio de Janeiro, RJ, Brazil.
| | - Daniele Bittencourt Ferreira
- National School of Public Health/Oswaldo Cruz Foundation, Department of Epidemiology and Quantitative Methods, Rua Leopoldo Bulhões, 1480/room 817b, Manguinhos, Zip Code 21041-210, Rio de Janeiro, RJ, Brazil.
| | - Inês Echenique Mattos
- National School of Public Health/Oswaldo Cruz Foundation, Department of Epidemiology and Quantitative Methods, Rua Leopoldo Bulhões, 1480/room 817b, Manguinhos, Zip Code 21041-210, Rio de Janeiro, RJ, Brazil.
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Pimouguet C, Rizzuto D, Lagergren M, Fratiglioni L, Xu W. Living alone and unplanned hospitalizations among older adults: a population-based longitudinal study. Eur J Public Health 2017; 27:251-256. [PMID: 28339511 DOI: 10.1093/eurpub/ckw150] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The association of living alone with hospitalization among the general elderly population has been rarely investigated, and the influence of common disorders on this association remains unknown. Methods We used data on participants in the Swedish National study on Aging and Care in Kungsholmen ( n = 3130). Risk and number of unplanned hospitalizations and length of hospital stays were studied over a period of 2 years. We used Cox proportional hazard models to estimate hazard ratios (HRs) of incident hospitalization and zero-inflated negative binomial regression models adjusted for potential confounders to estimate incident rate ratios (IRR) of the number of hospitalizations and total length of stay associated with living alone. Results A total of 1768 participants (56.5%) lived alone. Five hundred and sixty-one (31.7%) of those who lived alone had at least one unplanned hospitalization. In the multivariate analyses, living alone was significantly associated with the risk of unplanned hospitalization (HR = 1.21, 95% confidence interval [CI] 1.01-1.45) and the number of hospitalizations (IRR = 1.35, 95% CI 1.04-1.76) but not with the length of hospital stays. In stratified analyses, the association between living alone and unplanned hospitalizations remained statistically significant only among men (HR = 1.52, 95% CI 1.17-1.99). Conclusions Living alone is associated with higher risks of unplanned hospitalization in elderly, especially for men.
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Affiliation(s)
- Clément Pimouguet
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Debora Rizzuto
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Marten Lagergren
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Weili Xu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
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Mittal R, Tan CS, Tham WY, Seong LPS, Tan TL, Koh GCH. Trend and predictors of unplanned hospitalization of older patients during the first year after admission into a home medical service. Home Health Care Serv Q 2017; 36:145-163. [PMID: 28937939 DOI: 10.1080/01621424.2017.1381868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The primary aim was to determine the trend and predictors of unplanned hospitalization of home medical patients. Records of 1,069 patients were obtained from the medical records. Out of 1,069, we analyzed 512 patients who had utilized services across all four quarters in the first year of admission. There was a significant decline in unplanned hospitalization between the first two quarters. The potential risk factors were the male gender, IRR (95% CI), 1.29 (0.99-1.67); chronic pulmonary disease, 1.53 (1.08-2.16); dementia, 1.29 (1.00-1.66); ischemic heart disease, 1.33 (1.02-1.74); and history of fractures, 1.49 (1.13-1.96).
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Affiliation(s)
- Rakhi Mittal
- a Saw Swee Hock School of Public Health , National University of Singapore, National University Health System , Singapore
| | - Chuen Seng Tan
- a Saw Swee Hock School of Public Health , National University of Singapore, National University Health System , Singapore
| | | | - Lydia P S Seong
- a Saw Swee Hock School of Public Health , National University of Singapore, National University Health System , Singapore
| | | | - Gerald Choon-Huat Koh
- a Saw Swee Hock School of Public Health , National University of Singapore, National University Health System , Singapore
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Decook L, Chang YH, Slack J, Gastineau D, Leis J, Noel P, Palmer J, Sproat L, Sorror M, Khera N. Association of hematopoietic cell transplantation-specific comorbidity index with resource utilization after allogeneic transplantation. Bone Marrow Transplant 2017; 52:998-1002. [DOI: 10.1038/bmt.2017.70] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/02/2017] [Accepted: 03/06/2017] [Indexed: 11/09/2022]
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Rönneikkö JK, Mäkelä M, Jämsen ER, Huhtala H, Finne-Soveri H, Noro A, Valvanne JN. Predictors for Unplanned Hospitalization of New Home Care Clients. J Am Geriatr Soc 2016; 65:407-414. [DOI: 10.1111/jgs.14486] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Matti Mäkelä
- National Institute for Health and Welfare; Helsinki Finland
| | - Esa R. Jämsen
- School of Medicine; University of Tampere; Tampere Finland
- Gerontology Research Center; Universities of Jyväskylä and Tampere; Tampere Finland
- Service Line of General Practice and Geriatrics; Hatanpää Hospital; Tampere Finland
| | - Heini Huhtala
- School of Health Sciences; University of Tampere; Tampere Finland
| | | | - Anja Noro
- Department of Social and Health Services; Ministry of Social Affairs and Health; Helsinki Finland
| | - Jaakko N. Valvanne
- School of Medicine; University of Tampere; Tampere Finland
- Gerontology Research Center; Universities of Jyväskylä and Tampere; Tampere Finland
- Promotion of Senior Citizens’ Welfare; City of Tampere Finland
- Tampere University Hospital; Tampere Finland
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Prevalence, characteristics, and acute care utilization of disabled older adults with an absence of help for activities of daily living: Findings from a nationally representative survey. Arch Gerontol Geriatr 2016; 67:28-33. [DOI: 10.1016/j.archger.2016.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 02/01/2016] [Accepted: 06/09/2016] [Indexed: 11/29/2022]
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Hallgren J, Fransson EI, Kåreholt I, Reynolds CA, Pedersen NL, Dahl Aslan AK. Factors associated with hospitalization risk among community living middle aged and older persons: Results from the Swedish Adoption/Twin Study of Aging (SATSA). Arch Gerontol Geriatr 2016; 66:102-8. [PMID: 27281475 DOI: 10.1016/j.archger.2016.05.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 04/01/2016] [Accepted: 05/12/2016] [Indexed: 11/30/2022]
Abstract
The aims of the present study were to: (1) describe and compare individual characteristics of hospitalized and not hospitalized community living persons, and (2) to determine factors that are associated with hospitalization risk over time. We conducted a prospective study with a multifactorial approach based on the population-based longitudinal Swedish Adoption/Twin Study of Aging (SATSA). A total of 772 Swedes (mean age at baseline 69.7 years, range 46-103, 59.8% females) answered a postal questionnaire about physical and psychological health, personality and socioeconomic factors. During nine years of follow-up, information on hospitalizations and associated diagnoses were obtained from national registers. Results show that 484 persons (63%) had at least one hospital admission during the follow-up period. The most common causes of admission were cardiovascular diseases (25%) and tumors (22%). Cox proportional hazard regression models controlling for age, sex and dependency within twin pairs, showed that higher age (HR=1.02, p<0.001) and more support from relatives (HR=1.09, p=0.028) were associated with increased risk of hospitalization, while marital status (unmarried (HR=0.75, p=0.033) and widow/widower (HR=0.69, p<0.001)) and support from friends (HR=0.93, p=0.029) were associated with lower risk of hospitalization. Social factors were important for hospitalization risk even when medical factors were controlled for in the analyses. Number of diseases was not a risk in the final regression model. Hospitalization risk was also different for women and men and within different age groups. We believe that these results might be used in future interventions targeting health care utilization.
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Affiliation(s)
- Jenny Hallgren
- Institute of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - Eleonor I Fransson
- Department of Natural Science and Biomedicine, School of Health and Welfare, Jönköping University, Jönköping, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm 551 11, Sweden
| | - Ingemar Kåreholt
- Institute of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden; Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Chandra A Reynolds
- Department of Psychology, University of Southern California, Riverside, USA
| | - Nancy L Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anna K Dahl Aslan
- Institute of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Phillips CL. Quality of Life in Older Adults Receiving Long-Term Services and Supports: Is It What We Think It Is? J Am Med Dir Assoc 2016; 17:16. [DOI: 10.1016/j.jamda.2015.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 10/15/2015] [Indexed: 11/28/2022]
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Lapi F, Bianchini E, Cricelli I, Trifirò G, Mazzaglia G, Cricelli C. Development and Validation of a Score for Adjusting Health Care Costs in General Practice. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2015; 18:884-895. [PMID: 26409617 DOI: 10.1016/j.jval.2015.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 04/24/2015] [Accepted: 05/29/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To develop and validate the Italian Health Search Morbidity (HSM) Index to adjust health care costs in general practice. METHODS The study population comprised 1,076,311 patients registered in the Health Search CSD Longitudinal Patient Database between January 1, 2008, and December 31, 2010. We randomly selected 538,254 and 538,057 patients to form the development and validation cohorts, respectively. To ensure model convergence, 5% of the aforementioned cohorts were selected randomly to create development and validation samples. The outcome was the total direct health care costs covered by the national health system. Interaction between age and sex, chronic diseases, and acute diseases were entered in a multilevel generalized linear latent mixed model with random intercepts (province of residence and general practitioner) to identify determinants associated with increased or decreased costs. The estimated coefficients were linearly combined to create the HSM Index for individual patients. The score was applied to the validation sample, and measures of predictive accuracy, explained variance, and the observed/predicted ratio were computed to evaluate the model's accuracy. RESULTS The mean yearly cost was €414.57 per patient, and the HSM Index had a median value of 5.08 (25th-75th range 4.44-5.98). The HSM Index explained 50.17% of the variation in costs. Concerning calibration, in 80% of the population, the margin of error in the estimation of costs was around 10%. CONCLUSIONS The HSM Index is a reliable case-mix system that could be implemented in general practice for costs adjustment. This tool should ensure fairer scrutiny of resource use and allocation of budgets among general practitioners.
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Affiliation(s)
- Francesco Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy.
| | - Elisa Bianchini
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Iacopo Cricelli
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Gianluca Trifirò
- Section of Pharmacology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giampiero Mazzaglia
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Claudio Cricelli
- Italian College of General Practitioners and Primary Care, Florence, Italy
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Callahan KE, Lovato JF, Miller ME, Easterling D, Snitz B, Williamson JD. Associations Between Mild Cognitive Impairment and Hospitalization and Readmission. J Am Geriatr Soc 2015; 63:1880-5. [PMID: 26313420 DOI: 10.1111/jgs.13593] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine whether older adults with mild cognitive impairment (MCI), a condition not previously explored as a risk factor, have more hospitalizations and 30-day readmissions than those with normal cognition. DESIGN Post hoc analysis of prospectively gathered data on incident hospitalization and readmission from the Ginkgo Evaluation of Memory Study (GEMS), a randomized, double-blind, placebo-controlled trial designed to assess the effect of Ginkgo biloba on incidence of dementia. SETTING GEMS was conducted in five academic medical centers in the United States. PARTICIPANTS Community-dwelling adults aged 75 and older with normal cognition (n = 2,314) or MCI (n = 428) at baseline cognitive testing (N = 2,742). MEASUREMENTS Index hospitalization and 30-day hospital readmission, adjusted for age, sex, race, education, clinic site, trial assignment status, comorbidities, number of prescription medications, and living with an identified proxy. RESULTS MCI was associated with a 17% greater risk of index hospitalization than normal cognition (adjusted hazard ratio (aHR) = 1.17, 95% confidence interval (CI) = 1.02-1.34)). In participants who lived with a proxy, MCI was associated with a 39% greater risk of index hospitalization (aHR = 1.39, 95% CI = 1.17-1.66). Baseline MCI was not associated with greater odds of 30-day hospital readmission (adjusted odds ratio = 0.90, 95% CI = 0.60-1.36). CONCLUSION MCI may represent a target condition for healthcare providers to coordinate support services in an effort to reduce hospitalization and subsequent disability.
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Affiliation(s)
- Kathryn E Callahan
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University, Winston-Salem, North Carolina.,Sticht Center on Aging, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - James F Lovato
- Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, North Carolina
| | - Michael E Miller
- Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, North Carolina
| | - Doug Easterling
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University, Winston-Salem, North Carolina
| | - Beth Snitz
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jeff D Williamson
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University, Winston-Salem, North Carolina.,Sticht Center on Aging, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
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Neufeld E, Viau KA, Hirdes JP, Warry W. Predictors of frequent emergency department visits among rural older adults in Ontario using the Resident Assessment Instrument-Home Care. Aust J Rural Health 2015; 24:115-22. [PMID: 26123034 DOI: 10.1111/ajr.12213] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2015] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To describe factors predicting frequent emergency department (ED) use among rural older adults receiving home care services in Ontario, Canada. DESIGN A cross-sectional examination of Ontario hospital administrative data linked to provincial home care data compares frequent ED users (i.e. >4 visits/year) with regular users (i.e. 1-3 visits/year) and no ED use over a 1-year period. Multiple logistic regression analysis was performed using independent variables from home care health assessments. MAIN OUTCOME MEASURES Predictors of frequent ED use among rural older adults receiving home care services using adjusted odds ratios (ORs) and 95% confidence intervals (CI). RESULTS Ontario's rural home care clients visited the ED an average of 4.9 times (SD = 11.9) over a year. Frequent ED users were observed in 170 cases per 1000 home care clients. Congestive heart failure was the most frequently cited reason for frequent ED use; however, it was not a main driver in the adjusted model. Frequent ED use was predicted by younger age (i.e. 60-74 years) (OR = 1.9; 95% CI, 1.7-2.2), a recent ED visit in the last 3 months (OR = 1.5; 95% CI, 1.4-1.7), regularly taking >9 medications (OR = 1.5; 95% CI, 1.3-1.6), and poor self-rated health (OR = 1.4; 95% CI, 1.2-1.5). CONCLUSION Despite popular assumptions, the main drivers for frequent ED use among rural older adults in Ontario included a mix of sociodemographic and clinical characteristics, rather than disease diagnoses.
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Affiliation(s)
- Eva Neufeld
- Centre for Rural and Northern Health Research, Laurentian University, Sudbury, Ontario, Canada
| | - Katelynn A Viau
- Centre for Rural and Northern Health Research, Laurentian University, Sudbury, Ontario, Canada
| | - John P Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Wayne Warry
- Centre for Rural and Northern Health Research, Laurentian University, Sudbury, Ontario, Canada
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Rapp T, Chauvin P, Sirven N. Are public subsidies effective to reduce emergency care? Evidence from the PLASA study. Soc Sci Med 2015; 138:31-7. [PMID: 26043434 DOI: 10.1016/j.socscimed.2015.05.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Elderly people facing dependence are exposed to the financial risk of long lasting care expenditures. This risk is high for people facing cognitive, functional and behavioral problems. In the short-term, dependent elderly people face increased non-medical care expenditures. In the long-term, they face increased medical care expenditures, which are driven by emergency care events such as: emergency hospitalization, emergency medical visits, and emergency institutionalizations. In France, providing public financial assistance has been shown to improve dependent people's access to non-medical care services. However, the impact of public financial assistance on emergency care use has not been explored yet. Our study aims at determining whether financial assistance on non-medical care provision decreases the probability of emergency care rates using data of 1131 French patients diagnosed with Alzheimer's disease, collected between 2003 and 2007. Using instrumental variables to deal with the presence of a potential endogeneity bias, we find that beneficiaries of long-term care subsidies have a significantly lower rate of emergency care than non-beneficiaries. Failing to control for endogeneity problems would lead to misestimate the impact of long-term care subsidies on emergency care rates. Finding that home care subsidies has a protective effect for emergency care confirmed the efficacy of this public policy tool.
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Affiliation(s)
- Thomas Rapp
- LIRAES (EA 4470) & Chaire AGEINOMIX, Université Paris Descartes, Sorbonne Paris Cité, France.
| | - Pauline Chauvin
- LIRAES (EA 4470) & Chaire AGEINOMIX, Université Paris Descartes, Sorbonne Paris Cité, France
| | - Nicolas Sirven
- LIRAES (EA 4470) & Chaire AGEINOMIX, Université Paris Descartes, Sorbonne Paris Cité, France
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Hart CL, McCartney G, Watt GCM. Occupational class differences in later life hospital use by women who survived to age 80: the Renfrew and Paisley prospective cohort study. Age Ageing 2015; 44:515-9. [PMID: 25432982 DOI: 10.1093/ageing/afu184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 10/29/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND population ageing challenges the sustainability of healthcare provision. OBJECTIVE to investigate occupational class differences in hospital use in women aged 80+ years. METHODS a total of 8,353 female residents, aged 45-64, took part in the Renfrew and Paisley prospective cohort study in 1972-76. Information on general and mental health hospital discharges was provided from computerised linkage with the Scottish Morbidity Records data to 31 December 2012. Numbers of admissions and bed-days after the 80th birthday were calculated for all and specific causes. Rate ratios by occupational class were calculated using negative binomial regression analysis, adjusting for age and a range of risk factors. RESULTS four thousand and four hundred and seven (56%) women survived to age 80 and had 17,563 general admissions thereafter, with a mean stay of 19.4 days. There were no apparent relationships with occupational class for all general admissions, but lower occupational class was associated with higher rate ratios for coronary heart disease and stroke and lower rate ratios for cancer. Adjustment for risk factors could not fully explain the raised rate ratios. Bed-day use was higher in lower occupational classes, especially for stroke. There were strong associations with mental health admissions, especially dementia. Compared with the highest occupational class, admission rate ratios for dementia were higher for the lowest occupational class (adjusted rate ratio = 2.60, 95% confidence interval 1.79-3.77). CONCLUSION in this population, there were no socio-economic gradients seen in hospital utilisation for general admissions in old age. However, occupational class was associated with mental health admissions, coronary heart disease, stroke and cancer.
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Affiliation(s)
- Carole L Hart
- Institute of Health and Wellbeing, University of Glasgow, Public Health 1 Lilybank Gardens, Glasgow G12 8RZ, UK
| | - Gerry McCartney
- Public Health Science Directorate, NHS Health Scotland, Glasgow, UK
| | - Graham C M Watt
- Institute of Health and Wellbeing, University of Glasgow, Public Health 1 Lilybank Gardens, Glasgow G12 8RZ, UK
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Relationship between inflammation and oxidative stress and cognitive decline in the institutionalized elderly. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2015; 2015:804198. [PMID: 25874023 PMCID: PMC4383403 DOI: 10.1155/2015/804198] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 02/26/2015] [Indexed: 01/17/2023]
Abstract
Objective. Cognitive impairment reduces quality of life and is related to vascular and neurodegenerative disorders. However, there is also a close relationship between these diseases and oxidative stress. Thus, the purpose of this study was to assess whether inflammation and oxidative damage are associated with low cognitive performance in the elderly with different housing conditions. Methods. The study groups consisted of 32 institutionalized and 25 noninstitutionalized Brazilian elderly subjects. Oxidative damage, inflammation markers, and cognitive function were evaluated. Results. The results demonstrated pronounced oxidative stress in the institutionalized elderly group, which also had a lower antioxidant status compared to noninstitutionalized subjects. High levels of proinflammatory cytokines were also observed in the institutionalized elderly. Furthermore, the raised levels of inflammatory markers were correlated with increased oxidative stress, and both were associated with low cognitive performance. However, based on multiple linear regression analysis, oxidative stress appears to be the main factor responsible for the cognitive decline. Conclusions. The findings suggest that individuals with lower antioxidant status are more vulnerable to oxidative stress, which is associated with cognitive function, leading to reduced life quality and expectancy.
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Subbe CP, Jones S. Predicting speed at traffic lights--the problem with static assessments of frailty. Age Ageing 2015; 44:180-1. [PMID: 25589480 DOI: 10.1093/ageing/afu204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C P Subbe
- Department of Acute Medicine, Ysbyty Gwynedd, Penrhosgarnedd, Bangor LL57 2PW, UK School of Medical Sciences, Bangor University, Bangor, UK
| | - S Jones
- Department of Geriatric Medicine, Ysbyty Gwynedd, Bangor LL57 2PW, UK
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Bähler C, Huber CA, Brüngger B, Reich O. Multimorbidity, health care utilization and costs in an elderly community-dwelling population: a claims data based observational study. BMC Health Serv Res 2015; 15:23. [PMID: 25609174 PMCID: PMC4307623 DOI: 10.1186/s12913-015-0698-2] [Citation(s) in RCA: 282] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 01/12/2015] [Indexed: 12/13/2022] Open
Abstract
Background Chronic conditions and multimorbidity have become one of the main challenges in health care worldwide. However, data on the burden of multimorbidity are still scarce. The purpose of this study is to examine the association between multimorbidity and the health care utilization and costs in the Swiss community-dwelling population, taking into account several sociodemographic factors. Methods The study population consists of 229'493 individuals aged 65 or older who were insured in 2013 by the Helsana Group, the leading health insurer in Switzerland, covering all 26 Swiss cantons. Multimorbidity was defined as the presence of two or more chronic conditions of a list of 22 conditions that were identified using an updated measure of the Pharmacy-based Cost Group model. The number of consultations (total and divided by primary care physicians and specialists), the number of different physicians contacted, the type of physician contact (face-to-face, phone, and home visits), the number of hospitalisations and the length of stay were assessed separately for the multimorbid and non-multimorbid sample. The costs (total and divided by inpatient and outpatient costs) covered by the compulsory health insurance were calculated for both samples. Multiple linear regression modelling was conducted to adjust for influencing factors: age, sex, linguistic region, purchasing power, insurance plan, and nursing dependency. Results Prevalence of multimorbidity was 76.6%. The mean number of consultations per year was 15.7 in the multimorbid compared to 4.4 in the non-multimorbid sample. Total costs were 5.5 times higher in multimorbid patients. Each additional chronic condition was associated with an increase of 3.2 consultations and increased costs of 33%. Strong positive associations with utilization and costs were also found for nursing dependency. Multimorbid patients were 5.6 times more likely to be hospitalised. Furthermore, results revealed a significant age-gender interaction and a socioeconomic gradient. Conclusions Multimorbidity is associated with substantial higher health care utilization and costs in Switzerland. Quantified data on the current burden of multimorbidity are fundamental for the management of patients in health service delivery systems and for health care policy debates about resource allocation. Strategies for a better coordination of multimorbid patients are urgently needed. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0698-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Caroline Bähler
- Department of Health Sciences, Helsana Insurance Group, P.O. Box, 8081, Zürich, Switzerland.
| | - Carola A Huber
- Department of Health Sciences, Helsana Insurance Group, P.O. Box, 8081, Zürich, Switzerland.
| | - Beat Brüngger
- Department of Health Sciences, Helsana Insurance Group, P.O. Box, 8081, Zürich, Switzerland.
| | - Oliver Reich
- Department of Health Sciences, Helsana Insurance Group, P.O. Box, 8081, Zürich, Switzerland.
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Ennis SK, Larson EB, Grothaus L, Helfrich CD, Balch S, Phelan EA. Association of living alone and hospitalization among community-dwelling elders with and without dementia. J Gen Intern Med 2014; 29:1451-9. [PMID: 24893584 PMCID: PMC4238219 DOI: 10.1007/s11606-014-2904-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 01/12/2014] [Accepted: 05/15/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Older persons account for the majority of hospitalizations in the United States.1 Identifying risk factors for hospitalization among elders, especially potentially preventable hospitalization, may suggest opportunities to improve primary care. Certain factors-for example, living alone-may increase the risk for hospitalization, and their effect may be greater among persons with dementia and the old-old (aged 85+). OBJECTIVES To determine the association of living alone and risk for hospitalization, and see if the observed effect is greater among persons with dementia or the old-old. DESIGN Retrospective longitudinal cohort study. PARTICIPANTS 2,636 participants in the Adult Changes in Thought (ACT) study, a longitudinal cohort study of dementia incidence. Participants were adults aged 65+ enrolled in an integrated health care system who completed biennial follow-up visits to assess for dementia and living situation. MAIN MEASURES Hospitalization for all causes and for ambulatory care sensitive conditions (ACSCs) were identified using automated data. KEY RESULTS At baseline, the mean age of participants was 75.5 years, 59 % were female and 36 % lived alone. Follow-up time averaged 8.4 years (SD 3.5), yielding 10,431 approximately 2-year periods for analysis. Living alone was positively associated with being aged 85+, female, and having lower reported social support and better physical function, and negatively associated with having dementia. In a regression model adjusted for age, sex, comorbidity burden, physical function and length of follow-up, living alone was not associated with all-cause (OR = 0.93; 95 % CI 0.84, 1.03) or ambulatory care sensitive condition (ACSC) hospitalization (OR = 0.88; 95 % CI 0.73, 1.07). Among participants aged 85+, living alone was associated with a lower risk for all-cause (OR = 0.76; 95 % CI 0.61, 0.94), but not ACSC hospitalization. Dementia did not modify any observed associations. CONCLUSION Living alone in later life did not increase hospitalization risk, and in this population may be a marker of healthy aging in the old-old.
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Affiliation(s)
- Stephanie K Ennis
- Department of Health Services, School of Public Health, University of Washington, Box 357230, Seattle, WA, 98195, USA,
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Doñate-Martínez A, Garcés Ferrer J, Ródenas Rigla F. Application of screening tools to detect risk of hospital readmission in elderly patients in Valencian Healthcare System (VHS) (Spain). Arch Gerontol Geriatr 2014; 59:408-14. [DOI: 10.1016/j.archger.2014.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 06/11/2014] [Accepted: 06/20/2014] [Indexed: 11/26/2022]
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