Risk of Hospital Readmission among Older Patients Discharged from the Rehabilitation Unit in a Rural Community Hospital: A Retrospective Cohort Study

Abstract

Rehabilitation for hospitalized older people can improve their independence for performing activities of daily living (ADL), but determining its appropriateness can be challenging because of inherent limitations in their ADL and short life expectancy. Thus, we aimed to clarify the benefit of rehabilitation among older Japanese patients. We retrospectively evaluated consecutive older patients (age > 65 years) admitted to the rehabilitation unit of a rural community hospital between 1 April 2016 and 31 March 2020. The primary outcome measure was readmission for acute conditions. Of the 732 patients evaluated, 311 patients (42.5%) were readmitted. Readmission was significantly associated with body mass index (BMI) (p < 0.001), dependent condition (p < 0.001), higher cognitive domain scores in the functional independence measure (FIM) (p = 0.019), and polypharmacy (p = 0.026). The most frequent cause of readmission was pyelonephritis (11.9%), followed by pneumonia (10.9%), compression fracture (10.6%), heat stroke (8.4%), and cerebral stroke (8.0%). In conclusion, older Japanese patients discharged from rehabilitation units have lower readmission rates than those previously reported. Thus, better nutritional control, a multidisciplinary approach to the management of cognitive dysfunction, and a decrease in polypharmacy could be associated with improved outcomes among discharged older patients.

Recognition of Anemia in Elderly People in a Rural Community Hospital

“…Factors related to prognosis in the elderly are diverse. It is possible that age is not the only factor defining prognosis and the rate of discharge to home, and may be associated with rehabilitation and social factors in the elderly [ 27 ]. Appropriate assessment and treatment based on the recognition of anemia may improve the prognosis of elderly people.…”

The Contribution of Temporal Flat Lateral Position on the Mortality and Discharge Rates of Older Patients with Severe Dysphagia

“…In Japan, patients requiring longer time for recovery can be transferred from acute care units to comprehensive care or rehabilitation units in community hospitals [20]. The duration of hospitalization of older patients in Japan is approximately 120 days [20], and in this study, the length of hospital stay could not be shorter as the eating disability limited the discharge of patients with severe dysphagia. The reacquisition of the patients' eating ability is important as it may allow them to be discharged and return to their previous situations in their communities, thus ensuring sustainable, comprehensive care [38].…”

“…Healthcare systems in different counties can control the length of hospitalization [37]. In Japan, patients requiring longer time for recovery can be transferred from acute care units to comprehensive care or rehabilitation units in community hospitals [20]. The duration of hospitalization of older patients in Japan is approximately 120 days [20], and in this study, the length of hospital stay could not be shorter as the eating disability limited the discharge of patients with severe dysphagia.…”

“…The hospital staff comprised 27 physicians, 197 nurses, 7 pharmacists, 15 clinical technicians, 37 therapists (22, 12, and 3 physical, occupational, and speech therapists, respectively), 4 nutritionists, and 34 clerks. Unnan City only has one recovery rehabilitation unit [20].…”

The Relationship between the Presence of White Nails and Mortality among Rural, Older, Admitted Patients: A Prospective Cohort Study

“…Patients were regularly followed up at Unnan City Hospital or other medical institutions in Unnan City from 1 April 2020 to 30 June 2021. All readmissions were performed at the Unnan City Hospital [ 16 ].…”