Safety of Elderly Fallers: Identifying Associated Risk Factors for 30-Day Unplanned Readmissions Using a Clinical Data Warehouse

El, Asmae; Schwab, C. William; Clementz, Alice; Fernandez, Christine; Hindlet, Patrick

doi:10.1097/pts.0000000000000893

Cited by 4 publications

(7 citation statements)

References 41 publications

(67 reference statements)

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“…These included older age, male gender, comorbidities, higher ISSs, and being on public insurance 5,9,10,19,20 . Our study showed that these factors are quite similar in the elderly population, and therefore, this reinforces need to adjust for patient mix when using hospital readmissions as a metric for performance 8,21 …”

Section: Discussionsupporting

confidence: 54%

Predictors of care discontinuity in geriatric trauma patients

Castillo-Ángeles

Zogg

Jarman

et al. 2023

J Trauma Acute Care Surg

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BACKGROUND:Readmission to a non-index hospital, or care discontinuity, has been shown to have worse outcomes among surgical patients. Little is known about its effect on geriatric trauma patients. Our goal was to determine predictors of care discontinuity and to evaluate its effect on mortality in this geriatric population. METHODS:This was a retrospective analysis of Medicare inpatient claims (2014)(2015) of geriatric trauma patients. Care discontinuity was defined as readmission within 30 days to a non-index hospital. Demographic and clinical characteristics (including readmission diagnosis category) were collected. Multivariate logistic regression analysis was performed to identify predictors of care discontinuity and to assess its association with mortality. RESULTS:We included 754,313 geriatric trauma patients. Mean age was 82.13 years (SD, 0.50 years), 68% were male and 91% were White. There were 21,615 (2.87%) readmitted within 30 days of discharge. Of these, 34% were readmitted to a non-index hospital. Overall 30-day mortality after readmission was 25%. In unadjusted analysis, readmission to index hospitals was more likely to be due to surgical infection, GI complaints, or cardiac/vascular complaints. After adjusted analysis, predictors of care discontinuity included readmission diagnoses, patient-and hospital-level factors. Care discontinuity was not associated with mortality (OR, 0.93; 95% confidence interval, 0.86-1.01). CONCLUSION:More than a third of geriatric trauma patients are readmitted to a non-index hospital, which is driven by readmission diagnosis, travel time and hospital characteristics. However, unlike other surgical settings, this care discontinuity is not associated with increased mortality. Further work is needed to understand the reasons for this and to determine which standardized processes of care can benefit this population.

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Section: Discussionsupporting

confidence: 54%

Predictors of care discontinuity in geriatric trauma patients

Castillo-Ángeles

Zogg

Jarman

et al. 2023

J Trauma Acute Care Surg

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“…Ishaemic events: acute myocardial infarction, acute stroke, acute kidney injury stage III, acute mesenteric ischaemia and acute peripheral vascular ischaemia 25. Other complications: acute exacerbation of COPD,26 acute heart failure27 and falls 28…”

Section: Methods and Analysismentioning

confidence: 99%

“…25 Other complications: acute exacerbation of COPD, 26 acute heart failure 27 and falls. 28 Before each follow-up period, the participants or their relatives will be contacted via email, letter or phone to check if the primary endpoint was reached. If one of the outcome components is reached, the trial will be closed for that patient.…”

Section: Primary Outcomementioning

confidence: 99%

Intravenousferric carboxymaltoseversus oral ferrous sulfate replacement in elderly patients after acute non-variceal gastrointestinal bleeding (FIERCE): protocol of a multicentre, open-label, randomised controlled trial

et al. 2023

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IntroductionAcute gastrointestinal bleeding (GIB) is a life-threatening emergency with a critical economic burden. As a result of bleeding, anaemia often requires intravenous or oral iron supplementation. Elderly patients are even more prone to untoward outcomes after hospital discharge if iron supplementation is inefficient. There is a gap in current guidelines on which supplementation route clinicians should choose. We aim to investigate the effect of one dose of intravenous iron therapy versus 3-month oral iron administration on anaemia in an elderly population.Methods and analysisThe FIERCE study is an open-label, randomised controlled, two-armed trial. At least 48 hours after the acute non-variceal GIB treatment, patients will be recruited in participating centres. A random sequence generator will allocate the participants to group A (intravenous ferric carboxymaltose, 1000 mg) or group B (oral ferrous sulfate (FS), ca. 200 mg every day) with an allocation ratio of 1:1 on the day of the planned discharge from the hospital. Randomisation will be stratified for participating centres and the need for transfusion within the same hospitalisation before recruitment to the trial. Quality of life assessment, functional measurement and laboratory tests will be performed at baseline, 1 and 3 months±7 days after enrolment to the trial. The primary endpoint is a composite endpoint, including all-cause mortality, anaemia-associated unplanned emergency visit and anaemia-associated unplanned hospital admission within 3 months of enrolment in the trial.Ethics and disseminationThe study has been approved by the relevant organisation, the Scientific and Research Ethics Committee of the Hungarian Medical Research Council (46395-5/2021/EÜIG). We will disseminate our results to the medical community and will publish our results in peer-reviewed journals.Trial registrationThe trial has been registered at ClinicalTrials.gov (NCT05060731).

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“…Loss of resources including friends and family due to death may lead to isolation 13 . Loss of the resources of health and agility leads to a loss of physical independence 14-16 . The inability to drive may lead to further loss causing isolation and the loss of hobbies 16-18 .…”

Section: Theoretical Frameworkmentioning

confidence: 99%

Sense of Coherence at End of Life in Older People

Gagne-Henderson

Holland

Walshe

2023

J Hosp Palliat Nurs

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As people age, losses accumulate (ie, the death of family and friends, the loss of agility, and the loss of independence). Such losses have an impact on one's Sense of Coherence, that is, one's ability to see the world as comprehensible, manageable, and meaningful. Antonovsky deemed Sense of Coherence as a mostly stable state by the age of 30 years. Until now, there has not been an investigation into how serial loss of resources affects older people as they near the end of life. Sense of Coherence was used as the theoretical framework for this study to answer the question of how older people maintain or regain a Sense of Coherence in the presence of serious illness as they near death. Data were gathered using semistructured interviews and guided by interpretive description. This investigation found new concepts that contribute to Antonovsky's midlevel theory of salutogenesis and the construct of Sense of Coherence. Those are Incomprehensibility and Serial Loss of General Resistance Resources. The results indicate that the crux of a strong Sense of Coherence for this population is excellent communication and a coherent "big-picture" conversation.

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Safety of Elderly Fallers: Identifying Associated Risk Factors for 30-Day Unplanned Readmissions Using a Clinical Data Warehouse

Abstract: Identifying associated risk factors for 30-day unplanned readmissions using a clinical data warehouse

Cited by 4 publications

References 41 publications

Predictors of care discontinuity in geriatric trauma patients

Predictors of care discontinuity in geriatric trauma patients

Intravenousferric carboxymaltoseversus oral ferrous sulfate replacement in elderly patients after acute non-variceal gastrointestinal bleeding (FIERCE): protocol of a multicentre, open-label, randomised controlled trial

Sense of Coherence at End of Life in Older People

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