Risk factors for hospital readmission in older adults within 30 days of discharge – a comparative retrospective study

Abstract

Background The area of hospital readmission in older adults within 30 days of discharge is extensively researched but few studies look at the whole process. In this study we investigated risk factors related, not only to patient characteristics prior to and events during initial hospitalisation, but also to the processes of discharge, transition of care and follow-up. We aimed to identify patients at most risk of being readmitted as well as processes in greatest need of improvement, the goal being to find tools to help reduce early readmissions in this population. Methods This comparative retrospective study included 720 patients in total. Medical records were reviewed and variables concerning patient characteristics prior to and events during initial hospital stay, as well as those related to the processes of discharge, transition of care and follow-up, were collected in a standardised manner. Either a Student’s t-test, χ2-test or Fishers’ exact test was used for comparisons between groups. A multiple logistic regression analysis was conducted to identify variables associated with readmission. Results The final model showed increased odds of readmission in patients with a higher Charlson Co-morbidity Index (OR 1.12, p-value 0.002), excessive polypharmacy (OR 1.66, p-value 0.007) and living in the community with home care (OR 1.61, p-value 0.025). The odds of being readmitted within 30 days increased if the length of stay was 5 days or longer (OR 1.72, p-value 0.005) as well as if being discharged on a Friday (OR 1.88, p-value 0.003) or from a surgical unit (OR 2.09, p-value 0.001). Conclusion Patients of poor health, using 10 medications or more regularly and living in the community with home care, are at greater risk of being readmitted to hospital within 30 days of discharge. Readmissions occur more often after being discharged on a Friday or from a surgical unit. Our findings indicate patients at most risk of being readmitted as well as discharging routines in most need of improvement thus laying the ground for further studies as well as targeted actions to take in order to reduce hospital readmissions within 30 days in this population.

Medication-related hospital readmissions within 30 days of discharge—A retrospective study of risk factors in older adults

“…The data in this study were retrieved from a larger study. The method of data collection has been previously described in detail [ 9 ].…”

“…Older adults often suffer from several comorbidities thus leading to the use of multiple medications, both known risk factors concerning hospital readmission within 30 days of discharge [ 8 , 9 ]. This increased risk may be due to polypharmacy increasing the risk of medication errors [ 10 ] and medication-related problems such as adverse drug reactions [ 11 ] or drug-drug interactions [ 11 , 12 ].…”

“…We have previously shown that the odds of all-cause readmission to hospital, within 30 days of discharge, increase, in older adults (≥ 65 years), if living in the community dependent on home care [ 9 ]. This suggests that frailty and lack of supervision could affect the rate of all-cause readmission.…”

Malnutrition and depression as predictors for 30-day unplanned readmission in older patient: a prospective cohort study to develop 7-point scoring system

“…Our finding related to polypharmacy supports the result of a previous study, in which polypharmacy (daily administration of ≥5 medications) did not significantly increase the risk of readmission of older adults in Sweden. The previous study found the significant increase in risk of readmission only in older adults with excessive polypharmacy, defined as taking ≥10 drugs on a daily basis (OR, 1.66; p = 0.007) [ 10 ]. Polypharmacy was more related to very early readmission (day 0–1 post-discharge) than risk factors for 30-day readmission [ 35 ].…”

“…A previous study used a 6-item Geriatric Brief Assessment (GBA) to predict 1-year readmission with C score of 0.58–0.61 [ 8 ]. Frailty [ 9 ], excessive polypharmacy[ 10 ], and caregiver burden[ 11 ] were previously suggested to be risk factors for readmission among older adults. Despite the existing evidence, few studies have explored the role of CGA in a scoring system to predict 30-day unplanned readmission in the older adult population.…”