Risk Factors of Readmissions in Geriatric Rehabilitation Patients: RESORT

Abstract

To evaluate the risk factors associated with 30-and 90-day hospital readmissions in geriatric rehabilitation inpatients. Design: Observational, prospective longitudinal inception cohort. Setting: Tertiary hospital in Victoria, Australia. Participants: Geriatric rehabilitation inpatients of the REStORing Health of Acutely Unwell AdulTs (RESORT) cohort evalutated by a comprehensive geriatric assessment including potential readmission risk factors (ie, demographic, social support, lifestyle, functional performance, quality of life, morbidity, length of stay in an acute ward). Of 693 inpatients, 11 died during geriatric rehabilitation. The mean age of the remaining 682 inpatients was 82.2AE7.8 years, and 56.7% were women. Interventions: Not applicable. Main Outcome Measures: Thirty-and 90-day readmissions after discharge from geriatric inpatient rehabilitation. Results: The 30-and 90-day unplanned all-cause readmission rates were 11.6% and 25.2%, respectively. Risk factors for 30-and 90-day readmissions were as follows: did not receive tertiary education, lower quality of life, higher Charlson Comorbidity Index and Cumulative Illness Rating Scale (CIRS) scores, and a higher number of medications used in the univariable models. Formal care was associated with increased risk for 90-day readmissions. In multivariable models, CIRS score was a significant risk factor for 30-day readmissions, whereas high fear of falling and CIRS score were significant risk factors for 90-day readmissions. Conclusions: High fear of falling and CIRS score were independent risk factors for readmission in geriatric rehabilitation inpatients. These variables should be included in hospital readmission risk prediction model developments for geriatric rehabilitation inpatients.

Assessment Tools for the Admission of Older Adults to Inpatient Rehabilitation: A Scoping Review

“…The GDS was used to assess mood and any disruptive behaviour that could impinge on rehabilitation compliance and performance. Patients' perceptions, quality of life and motivation were also briefly mentioned using the EQ-5D-3L tool [34,37]. These tests were also a measure of evaluating the social support for patients and their environment.…”

“…The studies illustrate the value of assessing comorbidities, as they are likely to affect GR success [2,30,37,47]. This was mostly assessed using the CCI, which made it possible to score the number of diseases and conditions of the patients under review.…”

“…Six of these articles (16.2%) used a single outcome measure from the physical domain, with other outcome measures from other domains. The single outcome measures used were: POMA [32], the MDS-PAC instrument [9], WHODAS [3], the Short Physical Performance Battery test (SPPB) [37], the Hand-Grip Strength Test (HGS) [38] and the Timed Up and Go test (TUG) [4]. The remaining articles used multiple physical assessments.…”

“…Four studies (10.8%) included nutrition in their assessment. These used the Mini Nutritional Assessment (5.4%, n = 2), the Malnutrition Screening Tool [37] and the Minimum Data Set for Post-Acute Care (MDS-PAC). The latter does not only assess nutrition, but is an instrument that assesses frailty, including domains of "cognition, communication/hearing, vision, mood and behaviour, social functioning, physical functioning (self-performance of ADLs and instrumental activities of daily living (IADLs), continence, disease diagnosis, health conditions, nutrition/hydration status, dental status, skin condition, and medications."…”

“…These instruments were MDS-PAC and GEMS [9,29]. Another two outcome measures were used, assessing abuse, pain and nursing load (2.7%, n = 1 each) [26,37,42]. All these were used as part of a set of assessments.…”