Risk factors for hospital readmissions in elderly patients: a systematic review

Abstract

Population ageing is associated with an increase in hospital admissions. Defining the factors that affect the risk of hospital readmission could identify individuals at high risk and enable targeted interventions to be designed. This aim of this study was to identify the risk factors for hospital readmission in elderly people. A systematic review of the literature published in English or Spanish was performed by electronically searching EMBASE, MEDLINE, CINAHL, SCI and SSCI. Some keywords were aged, elder, readmission, risk, etc. Selection criteria were: prospective cohort studies with suitable statistical analysis such as logistic regression, that explored the relationship between the risk of readmission with clinical, socio-demographic or other factors in elderly patients (aged at least 75 years) admitted to hospital. Studies that fulfilled these criteria were reviewed and data were extracted by two reviewers. We assessed the methodological quality of the studies and prepared a narrative synthesis. We included 12 studies: 11 were selected from 1392 articles identified from the electronic search and one additional reference was selected by manual review. Socio-demographic factors were only explanatory in a few models, while prior admissions and duration of hospital stay were frequently relevant factors in others. Morbidity and functional disability were the most common risk factors. The results demonstrate the need for increased vigilance of elderly patients who are admitted to hospital with specific characteristics that include previous hospital admissions, duration of hospital stay, morbidity and functional disability.

Risk factors for hospital readmission of elderly patients

“…This study showed that readmitted patients suffered of more chronic illnesses with a higher severity index, consumed more drugs, and were often hospitalized in the 6 months prior to the index hospitalization, developed an AE during index hospitalization and had vascular or liver diseases. These findings are broadly consistent with other observations, showing that previous hospital admission, morbidity/comorbidity and also functional disability and length of hospital stay were common risk factors in people aged ≥ 75 years [9]. In some studies, the duration of hospital stay (defined as longer than the 90th percentile of hospital stays or than median or than 3 days) was associated with a higher risk of short term readmission [12,[19][20][21], most likely indicative of the severity of the basic illness.…”

“…In other studies readmission was mostly related to age, comorbidities and the type of chronic illnesses [5,6,8,9], the role of age being explained by the fact that older people have more chronic diseases and a lower mean functional status [5].…”

The Impact of Disability and Social Determinants of Health on Condition-Specific Readmissions beyond Medicare Risk Adjustments: A Cohort Study

“…We had hypothesized that disability limitations measured as ADL limitations would be significant predictors of readmission for all the cohorts, supported by literature data. [10][11][12][13][14][15][16][17][18][19][39][40][41][42] Although ADL limitations were significant predictors of readmission for pneumonia using the HRS-CMS and ACS-HCUP data sets, this was not demonstrated for the heart failure or acute myocardial infarction cohorts. Cognitive impairment did not predict readmission in any cohort for either data set, perhaps because the diagnosis of dementia is part of the standard CMS risk adjustment already applied.…”

“…7 However, an increasing body of literature reveals that patient disability and social determinants of health impact readmission risk and vary across hospital populations, contributing to higher readmission penalties for safety-net hospitals-and generating increasing interest in studying risk adjustment for sociodemographic factors. 1,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] To provide a better understanding of the extent to which the addition of patient disability and social determinants of health would impact the current risk adjustment models used by CMS, the objective of our study was to assess how measures of disability and social determinants of health were associated Electronic supplementary material The online version of this article (doi:10.1007/s11606-016-3869-x) contains supplementary material, which is available to authorized users.…”

Professional Language Interpretation and Inpatient Length of Stay and Readmission Rates

“…We used the same patient characteristics included in models examining length of stay in logistic regression models with readmission within 30 days as the dependent variable. In addition, since length of stay (LOS) is associated with readmission within 30 days, 12 we also included LOS as an additional covariate in the logistic regression model.…”