The objective of the study was to develop and validate predictors of 30-day hospital readmission using readily available administrative data and to compare prediction models that use alternate comorbidity classifications. A retrospective cohort study was designed; the models were developed in a two-thirds random sample and validated in the remaining one-third sample. The study cohort consisted of 29,292 adults aged 65 or older who were admitted from July 2002 to June 2004 to any of seven acute care hospitals in the Dallas-Fort Worth metropolitan area affiliated with the Baylor Health Care System. Demographic variables (age, sex, race), health system variables (insurance, discharge location, medical vs surgical service), comorbidity (classified by the Elixhauser classification or the High-Risk Diagnoses in the Elderly Scale), and geographic variables (distance from patient's residence to hospital and median income) were assessed by estimating relative risk and risk difference for 30-day readmission. Population-attributable risk was calculated. Results showed that age 75 or older, male sex, African American race, medical vs surgical service, Medicare with no other insurance, discharge to a skilled nursing facility, and specific comorbidities predicted 30-day readmission. Models with demographic, health system, and either comorbidity classification covariates performed similarly, with modest discrimination (C statistic, 0.65) and acceptable calibration (Hosmer-Lemeshow χ² = 6.08; P > 0.24). Models with demographic variables, health system variables, and number of comorbid conditions also performed adequately. Discharge to long-term care (relative risk, 1.94; 95% confidence interval, 1.80- 2.09) had the highest population-attributable risk of 30-day readmission (12.86%). A 25% threshold of predicted probability of 30-day readmission identified 4.1 % of patients ≥65 years old as priority patients for improved discharge planning. We conclude that elders with a high risk of 30-day hospital readmission can be identified early in their hospital course.
Approximately one quarter of all hospitalized patients over age 75 years have a secondary diagnosis of dementia. A unique hospital-wide program to encourage appropriate communication techniques with patients who have dementia was provided to all departments of a hospital. Evaluation indicated improvement in some communication techniques. Additional education is needed to disperse the information to as many staff as possible and to sustain the change.
<h4></h4> <p>The goals of this study were to obtain a profile of older adults who are treated in the emergency department, examine their length of stay and contributing factors, and determine nurses’ knowledge and perception of care provided to older adults. The records of 206 older adults were reviewed. Emergency department nurses completed the Geriatric Institutional Assessment Profile, which measures knowledge of older adult care. The majority of older patients were community-dwelling women who required urgent care. The most common reason for the emergency department visit was a fall. Mean time older adults spent in the emergency department was longer than 5 hours, and nearly half were admitted to the hospital. Nurses scored lowest in pressure ulcer prevention and appropriate urinary catheter usage. Emergency department nurses are challenged to combine gerontological knowledge that focuses on basic care of older adults with their knowledge and skills in dealing with emergency situations.</p>
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