Impact of diabetes on hospital admission and length of stay among a general population aged 45 year or more: a record linkage study

Abstract

BackgroundThe increased prevalence of diabetes and its significant impact on use of health care services, particularly hospitals, is a concern for health planners. This paper explores the risk factors for all-cause hospitalisation and the excess risk due to diabetes in a large sample of older Australians.MethodsThe study population was 263,482 participants in the 45 and Up Study. The data assessed were linked records of hospital admissions in the 12 months following completion of a baseline questionnaire. All cause and ambulatory care sensitive admission rates and length of stay were examined. The associations between demographic characteristics, socioeconomic status, lifestyle factors, and health and wellbeing and risk of hospitalisation were explored using zero inflated Poisson (ZIP) regression models adjusting for age and gender. The ratios of adjusted relative rates and 95% confidence intervals were calculated to determine the excess risk due to diabetes.ResultsPrevalence of diabetes was 9.0% (n = 23,779). Age adjusted admission rates for all-cause hospitalisation were 631.3 and 454.8 per 1,000 participant years and the mean length of stay was 8.2 and 7.1 days respectively for participants with and without diabetes. In people with and without diabetes, the risk of hospitalisation was associated with age, gender, household income, smoking, BMI, physical activity, and health and wellbeing. However, the increased risk of hospitalisation was attenuated for participants with diabetes who were older, obese, or had hypertension or hyperlipidaemia and enhanced for those participants with diabetes who were male, on low income, current smokers or who had anxiety or depression.ConclusionsThis study is one of the few studies published to explore the impact of diabetes on hospitalisation in a large non-clinical population, the 45 and Up Study. The attenuation of risk associated with some factors is likely to be due to correlation between diabetes and factors such as age and obesity. The increased risk in association with other factors such as gender and low income in participants with diabetes is likely to be due to their synergistic influence on health status and the way services are accessed.

Adherence support strategies for exercise interventions in people with mild cognitive impairment and dementia: A systematic review

“…; 2 of the 6 communities also offered a structured walking programme 2–3 times a wkIndividual and situational factors influencing physical activityGroup setting, reminders from staff and through centrally located bulletin board, planning of exercise to fit into daily routine, tailoring and supervision discussedAdherence: n/aEvaluation: focus groups: group setting desirable as it also provided the opportunity to socialize; planning exercise and using reminders seen as important; individualized home exercise and supervision with a motivational leader desirable; most preferred type of exercise was walkingFairhall et al (2012), AustraliaRCTCommunity setting; intervention group: n  = 120; mean age = 83.4 (SD = 5.8); 67% women; mean MMSE = 26.6 (SD = 2.6)12 months multifactorial interdisciplinary and individually tailored intervention targeting frailty. This included 10 home based 45–60 min physiotherapy sessionsMobility related disability in terms of satisfaction and performanceGoal setting and ongoing review of goals by PT for mobility goals; assessment of barriers to goal attainment; PT identified barriers and organized additional services to help overcome barriers; components to achieve goals were practiced at home, then in target environment with decreasing degree of assistanceAdherence: median global level of adherence as estimated by the physiotherapists: 25%–50% of intervention program;Evaluation: percentage of participants completing goal focused aspect of intervention: 50%; physiotherapist organized additional services depending on barriers such as provision, modification or advice about equipment (for 40% of participants), referral to services for care of older people (for 41% of participants) or to medical care (for 30% of participants)Lindelof et al (2012), SwedenQualitative, InterviewsResidential care setting; total n  = 9; mean age = 89 (73–91); 66% women; MMSE 23 (Phillips and Flesner, 2013, Cox et al, 2013, Resnick et al, 2009, Rosenberg et al, 2012, Wu et al, 2015, Frederiksen et al, 2014, Olsen et al, 2015, Vidoni et al, 2016, Fairhall et al, 2012, Kerse et al, 2008, Lindelof et al, 2012, Smith et al, 2017); 3 diagnosed with dementia3 months of high intensity group based exercise intervention with 5 sessions lasting 45 min each held in every 2 week period prior to the interviewsViews on participating in the exercise, motivation; experience of positive and negative effects of the exerciseSupport from exercise supervisor (close supervision for exercises by 2 PTs); group setting;Adherence: n/aEvaluation: interviews: supervisors were perceived as confidence inspiring and encouraging and therefore seen as exercise facilitators; group exercise provided opportunity to socialize, which subsequently increased self-confidence – created a “sense of togetherness”Rosenberg et al (2012), USAFeasibility study using a single cohort designRetirement facility setting, total n  = 87; mean age = 84.1 (range 69–98); 76% women; included pe...…”

Use of a Publicly Available Database to Determine the Impact of Diabetes on Length of Hospital Stay for Elective Orthopedic Procedures in California

“…3 Once admitted to the hospital, individuals with diabetes have longer lengths of stay (LOS), are at risk for more complications during an admission, and their overall costs are greater than their nondiabetic counterparts. 3,4 There also is an excess burden of diabetes for hospitalized patients within specific racial and ethnic groups, especially those of Latino descent compared to non-Hispanic whites. 3 In 2012, the estimated cost of diabetes care in the United States was $245 billion, with hospital inpatient care accounting for 43% of the total medical cost.…”

Utility of the Hospital Admission Risk Programme diabetes risk calculator in identifying patients with type 2 diabetes at risk of unplanned hospital presentations

“…1 The management of patients with T2D is therefore complex and despite best medical outpatient care, they may have frequent unplanned contact with the acute hospital system acutely, generating significant direct and indirect health costs. 4,5 Furthermore, these factors are also important contributors towards the subsequent length of hospital stay. 3 Multiple factors have been identified that predict the likelihood of unplanned presentation or admission to hospital for patients with diabetes.…”

“…2 In fact, the direct costs of hospital-based services are substantial and are large drivers of the global costs of managing diabetes. 4,5 Of note, a study in the United States demonstrated that the majority of patients with T2D were hospitalised for nondiabetes-related reasons and older age, use of insulin and previous hospital admission(s) were associated with a greater likelihood of hospitalisation overall. These not only include specific aspects of medical management but additional factors, such as age, gender, household income, lifestyle, general health and well-being.…”

“…These not only include specific aspects of medical management but additional factors, such as age, gender, household income, lifestyle, general health and well-being. 4,5 Furthermore, these factors are also important contributors towards the subsequent length of hospital stay. 4,5 Of note, a study in the United States demonstrated that the majority of patients with T2D were hospitalised for nondiabetes-related reasons and older age, use of insulin and previous hospital admission(s) were associated with a greater likelihood of hospitalisation overall.…”