Factors Associated With 30-Day Rehospitalization and Mortality in Older Patients After a Pneumonia Admission

Graversen, Susanne Boel; Pedersen, Henrik Schou; Sandbæk, Annelli; Foss, Catherine H; Ribe, Anette Riisgaard

doi:10.1016/j.jamda.2020.08.025

Cited by 8 publications

(4 citation statements)

References 44 publications

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“…Pain is recognized as an important cause of agitation in persons with dementia, [8] and a substantial increase in the use of opioids among older persons with dementia has been observed in Denmark during the past decades [9]. Use of psycholeptics and opioids may cause respiratory harm due to the sedative effects [10][11][12], which could possibly contribute to poorer outcomes after a pneumonia admission [13].…”

Section: Introductionmentioning

confidence: 99%

Dementia and the risk of short-term readmission and mortality after a pneumonia admission

Graversen

Pedersen²,

Sandbæk

et al. 2021

PLoS ONE

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Background At time of discharge after a pneumonia admission, care planning for older persons with dementia is essential. However, care planning is limited by lack of knowledge on the short-term prognosis. Aim To investigate 30-day mortality and readmission after hospital discharge for pneumonia in persons with versus without dementia, and to investigate how these associations vary with age, time since discharge, and medication use. Methods Using the Danish registries, we investigated 30-day mortality and readmission in persons (+65 years) discharged after pneumonia in 2000–2016 (N = 298,872). Adjusted mortality rate ratios (aMRRs) and incidence rate ratios (aIRRs) were calculated for persons with versus without dementia, and we investigated if these associations varied with use of benzodiazepines, opioids, and antipsychotics, and with age and time since discharge. Results Among 25,948 persons with dementia, 4,524 died and 5,694 were readmitted within 30 days. The risk of 30-day mortality was 129% higher (95% CI 2.21–2.37) in persons with versus without dementia after adjustment for sociodemographic characteristics, admission-related factors, and comorbidities. Further, the highest mortality risk was found in persons with both dementia and use of antipsychotics (aMRR: 3.39, 95% CI 3.19–3.59); 16% of deaths in this group could not be explained by the independent effect of each exposure. In those with dementia, the highest aMRRs were found for the youngest and for the first days after discharge. The risk of 30-day readmission was 7% higher (95% CI 1.04–1.10) in persons with versus without dementia. In those with dementia, the highest aIRRs were found for the first days after discharge. Conclusions Dementia was associated with higher short-term mortality after pneumonia, especially in users of antipsychotics, and with slightly higher readmission, especially in the first days after discharge. This is essential knowledge in the care planning for persons with dementia who are discharged after a pneumonia admission.

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Section: Introductionmentioning

confidence: 99%

Dementia and the risk of short-term readmission and mortality after a pneumonia admission

Graversen

Pedersen²,

Sandbæk

et al. 2021

PLoS ONE

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“…Hence, it is important to find ways to prevent the incidence and progression of LRTI in older adults. Previous studies on risk factors associated with LRTI-caused readmission had the following limitations: (1) the duration of follow-up was short, as numerous studies focused on readmission and death within the first 30 days of discharge from the hospital [16][17][18][19][20][21][22], (2) the impact of anemia on LRTI-caused readmission and death was not analyzed. e researchers paid more attention to the effects of nutritional status [7,8], comorbidities [9], gender [2,10], and swallowing dysfunction [11] on LRTI-caused readmission, (3) previous studies on LRTI-caused readmissions have been primarily conducted with patients in the age range of 18-79 years.…”

Section: Discussionmentioning

confidence: 99%

“…Lack of iron is the most common cause of anemia, falling under the category of nutritional deficiency-based anemia. Other nutrition-related etiologies include folate and/or Vitamin B 12 deficiency [ 18 ]. The common cause of hemorrhage-induced anemia in older adults can be attributed to the administration of various types of medications (e.g., acetylsalicylic acid and standard (or direct) oral anticoagulants) and gastrointestinal diseases (including cancer) [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of Anemia on Readmission and Death in Octogenarian Patients with Lower Respiratory Tract Infections: A Retrospective Cohort Study

Chen

Cao

et al. 2022

International Journal of Clinical Practice

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Objectives. Lower respiratory tract infection (LRTI) in the octogenarian population is a highly prevalent disorder associated with increased mortality rates. Anemia is a common disorder in older adults and is often left untreated. We investigated whether anemia was a risk factor for LRTI-caused readmission and death in octogenarian patients. Design. A retrospective cohort study was designed. Participants. Old patients (age: ≥80 years) hospitalized at the Department of Geriatrics to undergo treatment for LRTIs were included. A total of 215 patients (mean age: 88.73 years; 77.2% men) were studied. The patients were divided into two groups (anemia and non-anemia) based on the hemoglobin level. They were followed up for 1 year after discharge or until mortality event. The primary follow-up outcome was LRTI-caused readmission and/or death. Results. The risk of readmission due to LTRI within 1 year of discharge was 2.308 times higher in the anemia group than the risk for the non-anemia group. The number of patients experiencing ≥2 readmissions in the anemia group was significantly higher than that in the non-anemia group (35 (23.5%) vs. 2 (3%), P < 0.001 ). To prevent readmission of one case, only 2.65 cases with anemia needed to be treated. Furthermore, the risk of LRTI-related deaths was 6.644 times higher in the anemia group than the risk for the non-anemia group. To prevent death of one case, only 3.9 cases with anemia needed to be treated. Statistic results revealed that hemoglobin was an independent protective factor for LRTI-caused readmission (logistic regression method, OR, 0.969; 95% CI, 0.950–0.989) and deaths (Cox regression method, β, −0.037, HR, 0.964; 95% CI, 0.934–0.994). Conclusions. Anemia is a widely prevalent and relevant risk factor associated with LRTI-caused readmission and death within 1 year of discharge in octogenarian patients. Trial Registration. This trial is registered with NCT05355324.

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“…Analyses were adjusted for age and sex. Additionally, analyses were adjusted for co-morbidity (CCI score) and cognitive impairment as they are associated with both muscle strength [ 30 , 31 ] and readmission, institutionalisation and mortality [ 32 , 33 ]. Effect modification of sex was tested by introducing interaction terms.…”

Section: Methodsmentioning

confidence: 99%

Handgrip strength rather than chair stand test should be used to diagnose sarcopenia in geriatric rehabilitation inpatients: REStORing health of acutely unwell adulTs (RESORT)

et al. 2022

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Background according to the revised sarcopenia definition proposed by the European Working Group on Sarcopenia in Older People (EWGSOP2) and revised definition of the Asian Working Group for Sarcopenia (AWGS2019), handgrip strength (HGS) and chair stand test (CST) can be used interchangeably as initial diagnostic measures. Objective to assess the agreement between sarcopenia prevalence, using either HGS or CST, and their association with adverse outcomes in geriatric rehabilitation inpatients. Methods REStORing health of acutely unwell adulTs is an observational, longitudinal cohort of geriatric rehabilitation inpatients. Cohen’s kappa (κ) was used to assess the agreement between sarcopenia prevalence (no, probable and confirmed and severe sarcopenia) according to EWGSOP2 and AWGS2019 using either HGS or CST. Associations between HGS and CST and readmission, institutionalisation and mortality were assessed by binomial regression. Results patients (n = 1,250, 57% females) had a median age of 83.1 years (interquartile range: [77.5–88.3]). There was no agreement between probable sarcopenia prevalence using HGS or CST for EWGSOP2 and AWGS2019, respectively (HGS: 70.9% and 76.2%; CST: 95.5% and 98.4%; κ = 0.08 and 0.02). Agreement between confirmed and severe sarcopenia prevalence using either HGS or CST was strong to almost perfect. HGS was associated with 3-month institutionalisation and 3-month and 1-year mortality, whereas CST was not associated. Conclusions HGS and CST cannot be used interchangeably as diagnostic measures for probable sarcopenia in geriatric rehabilitation inpatients. CST is not useful to predict adverse outcomes in geriatric rehabilitation inpatients.

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Factors Associated With 30-Day Rehospitalization and Mortality in Older Patients After a Pneumonia Admission

Cited by 8 publications

References 44 publications

Dementia and the risk of short-term readmission and mortality after a pneumonia admission

Dementia and the risk of short-term readmission and mortality after a pneumonia admission

Effect of Anemia on Readmission and Death in Octogenarian Patients with Lower Respiratory Tract Infections: A Retrospective Cohort Study

Handgrip strength rather than chair stand test should be used to diagnose sarcopenia in geriatric rehabilitation inpatients: REStORing health of acutely unwell adulTs (RESORT)

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