Risk factors for hospital readmission of elderly patients

Abstract

Background: The aim of this study was to identify which factors were associated with a risk of hospital readmission within 3 months after discharge of a sample of elderly patients admitted to internal medicine and geriatric wards. Methods: Of the 1178 patients aged 65 years or more and discharged from one of the 66 wards of the 'Registry Politerapie SIMI (REPOSI)' during 2010, 766 were followed up by phone interview 3 months after discharge and were included in this analysis. Univariate and multivariate logistic regression models were used to evaluate the association of several variables with rehospitalization within 3 months from discharge. Results: Nineteen percent of patients were readmitted at least once within 3 months after discharge. By univariate analysis in-hospital clinical adverse events (AEs), a previous hospital admission, number of diagnoses and drugs, comorbidity and severity index (according to Cumulative Illness Rating Scale-CIRS), vascular and liver diseases with a level of impairment at discharge of 3 or more at CIRS were significantly associated with risk of readmission. Multivariate logistic regression analysis showed that only AEs during hospitalization, previous hospital admission, and vascular and liver diseases were significantly associated with the likelihood of readmission.Conclusions: The results demonstrate the need for increased medical attention towards elderly patients discharged from hospital with characteristics such as AEs during the hospitalization, previous admission, vascular and liver diseases.

Adherence to antibiotic treatment guidelines and outcomes in the hospitalized elderly with different types of pneumonia

“…Perhaps an adequate antibiotic therapy may affect less clinical outcomes and mortality in complex elderly patients with multimorbidity and polypharmacy than in younger population. [9,21,22]. Data on the impact of comorbidities and combination therapies in the outcome of pneumonias in the elderly are still controversial and need to be further investigated.…”

Hospitalization of the Elderly: Spirituality, Risk of Dependence, Risk of Falls and Readmission

“…Nos pacientes com estes antecedentes clínicos, há que se ajudar a evitar reinternamentos, através de educação para a saúde; e, também, ponderar a possibilidade/capacidade da família cuidar em casa ou encontrar uma alternativa. Estas ações devem envolver a pessoa idosa e sua família, ponderando a sua situação clínica e emocional www.sp-ps.pt As correlações mostram a idade como variável índex, influenciando as outras variáveis (Campbell, Seymour, & Primrose 2004;Eliopoulos, 2005;Franchi., 2013;Kamasaki & Diogo, 2007;WHO, 2007): dependência, risco de rutura de cuidados e risco de queda aumentam com a idade; na espiritualidade, a esperança diminui com a idade. Contudo, a espiritualidade não aumenta com a idade, a esperança diminui; provavelmente diminui a esperança associada a melhor saúde; fica por saber se mesmo assim à capacidade para procurar um renovado sentido para a vida (Pinto & Pais-Ribeiro, 2007).…”

“…Este ciclo tende a aumentar o número de readmissões hospitalares (Graf, 2006), pois a hospitalização associa-se a novas incapacidades ou agrava as pré-existentes. Os fatores de risco de readmissão hospitalar são: incapacidade funcional, gravidade da doença, co-morbidades, polimedicação e idade avançada (Campbell, Seymour, & Primrose, 2004;Franchi et al, 2013). Os doentes idosos tendem a ter internamentos mais prolongados, com superior morbilidade e mortalidade nos meses seguintes, sendo que ao final de 6 meses a taxa de mortalidade tende a ser superior a 20% (Ponzetto et al, 2003).…”

Variables determining clinical complexity in hospitalized Internal Medicine patients: a workload analysis

“…Overall, mean CIRS-SI was 1.03 (SD=0.31) and median CIRS-CI was 2 (range 1-5) equivalent to a moderate comorbidity. The mean number of diagnoses at discharge was 5.9 (SD=2.3), the median number of clinical tests performed during hospitalization was 8 (range [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18], and the mean number of medications prescribed at discharge was 8 (SD=3.2).…”

“…13 Comorbidities increase the duration of hospitalization, the need for re-hospitalizations, the incidence of complications and the risk of mortality compared to that of the single disease components. 14 The cumulative illness rating scale (CIRS) was originally designed by Linn et al, to specifically measure comorbidities among hospital inpatients. The CIRS classifies comorbidities by affected organs/systems, and defines for each category a severity grading from 0 to 4: where 0 indicates the absence of the disease, 1=mild, 2=moderate, 3=severe and 4=very severe.…”