Care trajectories of chronically ill older adult patients discharged from hospital: a quantitative cross-sectional study using health insurance claims data

Abstract

Background For older adults, a good transition from hospital to the primary or long-term care setting can decrease readmissions. This paper presents the 6-month post-discharge healthcare utilization of older adults and describes the numbers of readmissions and deaths for the most frequently occurring aftercare arrangements as a starting point in optimizing the post-discharge healthcare organization. Methods This cross-sectional study included older adults insured with the largest Dutch insurance company. We described the utilization of healthcare within 180 days after discharge from their first hospital admission of 2015 and the most frequently occurring combinations of aftercare in the form of geriatric rehabilitation, community nursing, long-term care, and short stay during the first 90 days after discharge. We calculated the proportion of older adults that was readmitted or had died in the 90–180 days after discharge for the six most frequent combinations. We performed all analyses in the total group of older adults and in a sub-group of older adults who had been hospitalized due to a hip fracture. Results A total of 31.7% of all older adults and 11.4% of the older adults with a hip fracture did not receive aftercare. Almost half of all older adults received care of a community nurse, whereas less than 5% received long-term home care. Up to 18% received care in a nursing home during the 6 months after discharge. Readmissions were lowest for older adults with a short stay and highest in the group geriatric rehabilitation + community nursing. Mortality was lowest in the total group of older aldults and subgroup with hip fracture without aftercare. Conclusions The organization of post-discharge healthcare for older adults may not be organized sufficiently to guarantee appropriate care to restore functional activity. Although receiving aftercare is not a clear predictor of readmissions in our study, the results do seem to indicate that older adults receiving community nursing in the first 90 days less often die compared to older adults with other types of aftercare or no aftercare. Future research is necessary to examine predictors of readmissions and mortality in both older adult patients discharged from hospital.

Mortality of older acutely admitted medical patients after early discharge from emergency departments: a nationwide cohort study

“…Community nursing has been associated with lower mortality after discharge. Unfortunately, we did not have data about community nursing in our study [ 9 ].…”

“…We have previously published a 30-day mortality rate of 3 % among elderly acutely admitted medical patients who were discharged within 24 h [ 8 ]. However, more research on the safety of early discharge and predictors of adverse events after discharge of older patients is needed [ 9 ]. Clinicians should pay attention to patients with characteristics associated with increased risk of mortality during the planning of early discharge of acutely admitted old patients.…”

Psychometric Evaluation of the Making it CLEAR Questionnaire: A Resilience Measure for Older Adults

“…In particular, it would be pertinent for this research to assess the ability of the items to predict hospital readmission within 6 months of initial discharge, given that hospital admission is considered a health risk for older adults and up to 50% of older adults discharged from acute hospital care are readmitted within 6 months ( de Man et al, 2019 ).…”

Baseline conditions and nutritional state upon hospitalization are the greatest risks for mortality for cardiovascular diseases and for several classes of diseases: a retrospective study

“…In addition to age, which is a universal strong and unmodifiable risk factor for mortality in men and women 1 – 18 , additional risk factors have been identified for selected diseases, such as heart failure (CHF) 5 , 19 , 20 , sepsis and acute and chronic pulmonary diseases 3 , 6 , 9 , 14 , surgery 8 , 10 , hip fractures 17 , and stroke 6 , 7 , 12 . For instance, in CHF and hip fracture, male sex is important 5 , 17 ; in the elderly, pre-admission conditions are a major risk factor for long-term mortality, as well as admission to an intensive care unit (ICU), type of admission (emergency vs. elective), presence of comorbidities, diabetes, and chronic kidney disease 1 , 2 , 4 , 9 , 11 , 13 , 15 , 18 , 20 . In patients with acute and chronic pulmonary diseases, male sex, comorbidities, long in-stay, creatinine, and albumin are risk factors 3 , 6 , 9 , 14 .…”

“…Even though it might be logical to assume that the same risk factors apply to all the above conditions as well as to other diseases, this has not been demonstrated. For patients admitted for neurological diseases, better long-term survival has also been associated with full assistance after discharge, and social factors have been shown to predict mortality, mainly mediated by poor assistance after discharge 11 , 15 .…”