Predictors for unplanned hospital admissions in community dwelling adults: A dynamic cohort study

BACKGROUND

Polypharmacy and inappropriate medication use are associated with unplanned hospital admissions. Targeted interventions might reduce the hospitalization risk. Yet, it remains unclear which patient profiles derive the largest benefit from such interventions.

OBJECTIVE

The aim of this study was to determine independent risk factors, among which polypharmacy, for unplanned hospital admissions in a cohort of community dwelling adults.

METHODS

A retrospective study was performed using a large general practice registry and an insurance database in Flanders, Belgium. Community dwelling adults aged 40 years or older with data for 2013-2015 were included. The index date was the last general practitioner contact in 2014. Determinants were collected during the preceding year. Unplanned hospital admissions were determined during the year after the index date. Univariable logistic regression models were fitted on each risk factor for an unplanned hospital admission as the primary outcome. Two multivariable models were derived.

RESULTS

In total, 40411 patients were included and 2126 (5.26%) experienced an unplanned hospital admission. Mean age was 58.3 (±12.3) years. The two models identified the following determinants for an unplanned hospital admission: excessive polypharmacy, older age, male sex, number of comorbidities, atrial fibrillation, chronic obstructive pulmonary disease or stroke, low hemoglobin, use of hypnotics, antipsychotics, antidepressants or antiepileptics and prior hospital and general practitioner visits. Prior hospital visits was the largest determinant.

CONCLUSIONS

In our study we identified and confirmed the presence of known determinants for unplanned hospital admissions in community dwelling adults, most of which align with a geriatric phenotype. Our findings can inform the allocation of interventions aiming to reduce unplanned hospital admissions.

Trends and regional variations in prescriptions dispensed to stimulate uterine contractions at the end of pregnancy in Belgium: A community-based study from 2003 to 2018

PURPOSE

To investigate trends and regional variations in uterotonics dispensed around birth between 2003 and 2018 in Belgium.

METHODS

Data, including outpatient and inpatient prescriptions were extracted from a nationally representative prescription database. The prevalence of uterotonics dispensed during a period including the 7 days before birth, the delivery day and the 7 days after birth was computed over three 4-year-long study periods from 2003 to 2018. The trends between periods and associations between the use of at least one uterotonic and maternal age, region of residence, delivery type and social status were assessed using logistic regression.

RESULTS

In total, 31 675 pregnancies were included in the study. The proportion of pregnancies exposed to at least one uterotonic decreased significantly from 92.9% (95%CI, 92.3-93.4) in 2003-2006 to 91.4% (95%CI, 90.7-92.0) in 2015-2018 for vaginal births and from 95.5% (95%CI, 94.5-96.4) to 93.7% (95%CI, 92.6-94.7) for caesarean sections. However, for vaginal births, the proportion of oxytocin increased from 84.5% (95%CI, 83.7-85.2) to 89% (95%CI 88.3-89.7). A significant association was found between uterotonic agent use and maternal age, region of residence, and delivery type. The dispensation of some uterotonic agents differed significantly between the regions.

CONCLUSIONS

The proportion of pregnancies exposed to at least one uterotonic was high across the study period but decreased slightly between 2003 and 2018. Important variations in uterotonic use between regions highlight the need for improved national guidance.

Polypharmacy and excessive polypharmacy in community-dwelling middle aged and aged adults between 2011 and 2015

AIMS

We aimed to assess the prevalence, components and evolution of polypharmacy and to evaluate risk factors associated with polypharmacy.

METHODS

A retrospective dynamic cohort study was performed, using a primary healthcare database comprising Flemish community-dwelling adults aged ≥40 years between 2011 and 2015. Polypharmacy and excessive polypharmacy were defined as the use of 5-9 or minimum 10 different medications during 1 year, respectively. Temporal changes were analysed using an autoregressive error model. Risk factors for polypharmacy were evaluated using logistic regression.

RESULTS

In total, 68 426 patients were included in the analysis. The prevalence of polypharmacy was 29.5% and 16.1% for excessive polypharmacy in 2015. The age-standardised prevalence rate of patients using minimum five medications increased with 1.3% per year (95% confidence interval (CI): 0.1968-2.4279). The mean number of unplanned hospital admissions was 0.07 (standard deviation (SD) 0.33) for polypharmacy patients and 0.19 (SD 0.53) for excessive polypharmacy patients. Four risk factors were found to be significantly correlated with polypharmacy: age (odds ratio (OR) 1.015; 95% CI: 1.013-1.017), female gender (OR 1.161; 95% CI: 1.108-1.216), number of chronic diseases (OR 1.126; 95% CI: 1.114-1.139) and number of general practitioner contacts (OR 1.283; 95% CI: 1.274-1.292).

CONCLUSION

The prevalence of polypharmacy increased between 2011 and 2015. Polypharmacy and excessive polypharmacy patients appeared to differ based on our observations of characteristics, drug therapy and outcomes. Age, female gender, number of chronic diseases and number of general practitioner contacts were associated with polypharmacy.

Relationship between peak expiratory flow and incidence of frailty, deaths and falls among nursing home residents: Results of the SENIOR cohort

OBJECTIVE

To correlate peak expiratory flow (PEF) with the incidence of frailty, deaths and falls among nursing home residents.

METHODS

This is a 1-year longitudinal analysis performed on the clinical data of the SENIOR cohort. PEF, measured by peak flow meter, was considered as "low" when the observed value was ≤80% of the theoretical value. Physical capacity was evaluated using Short Physical Performance Battery, balance and gait using Tinetti test and muscle strength using a dynamometer. The incidence of frailty was defined as the transition from a "robust" or "prefrail" status to a "frail" status following Fried's criteria. Deaths and falls were also collected.

RESULTS

Among 646 subjects included at baseline (83.2 ± 9 years and 72.1% women), 297 (45.7%) displayed a low PEF. In this subgroup, physical capacity (p-values from 0.01 to <0.001), muscle strength (p < 0.001), balance and gait score (p < 0.001) were significantly lower compared to subjects displaying normal PEF. Subjects who became frail after one year displayed a lower % of the theoretical PEF value compared to those that did not (88.52 ± 45.06 vs 102.78 ± 50.29, respectively, p = 0.03). After adjustment for potential confounding variables (calf circumference, Tinetti test, SPPB test and handgrip strength), PEF was no longer associated with the occurrence of frailty. There was no association between PEF and mortality and falls.

CONCLUSION

In a nursing home setting, PEF is not an independent factor associated with the incidence of frailty, deaths and falls.

Normative data for isometric strength of 8 different muscle groups and their usefulness as a predictor of loss of autonomy among physically active nursing home residents: the SENIOR cohort

OBJECTIVES

To provide normative values for isometric strength of 8 different muscle groups among nursing home residents and to investigate their predictive value for the decline of autonomy.

METHODS

This is an analysis of the 1-year follow-up of the SENIOR cohort. At baseline, isometric muscle strength of residents has been assessed for 8 muscle groups using the MicroFET2. The cut-off threshold for low relative isometric muscle strength was defined as the lower quartile. The outcome was the 1-year loss of autonomy (i.e. a decrease of ≥1 point on the ADL scale between baseline and 12-month follow-up). Logistic regressions were carried out to assess the predictive value of isometric muscle strength for the loss of autonomy.

RESULTS

204 subjects (83.2±8.99 years, 72.5% women) were included. Threshold values of isometric strength were: knee flexors=0.94, knee extensors=1.07, ankle flexors=0.77, ankle extensors=0.88, hip abductors=0.78, hip extensors=0.79, elbow flexors=0.99 and elbow extensors= 0.71 N/kg. After adjustment for age and sex, the cut-off values for knee extensors (p=0.04) and for ankle extensors (p=0.03) were significantly predictive of loss of autonomy.

CONCLUSIONS

The normative values for knee extensors and ankle extensors are independent predictors for loss of autonomy.

Own attitude toward aging among nursing home residents: results of the SENIOR cohort

BACKGROUND

Stereotypes associated with aging are of great concern as extensive literature emphasizes its deleterious effects on physical and mental health of the elderly.

AIM

To assess the relationship between the attitude toward aging and the frailty status of nursing homes residents.

METHODS

A cross-sectional analysis of the data collected at baseline in the SENIOR cohort was conducted. All subjects received a diagnosis of frailty based on the Fried's criteria. They also responded to the Attitude to Aging Questionnaire (AAQ) and other questions assessing their subjective age, the age at which someone stops being considered young or is considered old and the open-ended Image-of-Aging question to evaluate the relationship between their perception of aging and their frailty status.

RESULTS

272 nursing home residents (83.9 ± 8.19 years; 75% women) participated in this study. Out of them, 54 (19.9%) were frail, 182 (66.9%) were pre-frail, and 36 (13.2%) were robust. According to the AAQ questionnaire, frail subjects have a more negative perception of aging (score of 80.3 ± 10.2 points) than pre-frail subjects (83.6 ± 10.8) and robust subjects (86.5 ± 10.5) (p = 0.02). However, the three groups did not differ in the age that would mark, to their opinion, the end of youth (p = 0.93) or the beginning of old age (p = 0.98). The subjective age, rapported by nursing home residents, was not significantly different according to their frailty status. At least, based on the Open-Ended Image of Aging question, the residents' vision of aging was not different according to the frailty status (p = 0.52).

CONCLUSION

Based on the AAQ, frail subjects have more negative attitude to ageing compared to non-frail ones.