Unplanned Hospital Care Use in Older Adults: The Role of Psychological and Social Well‐Being

Abstract

OBJECTIVES: To explore the association of psychological and social well-being with unplanned hospital utilization in an older Swedish population. DESIGN: Data for this study were gathered from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K). Information on hospital care use was extracted from the Stockholm County Council Inpatient Register for up to 4 years after the baseline SNAC-K assessment (2001)(2002)(2003)(2004)(2005)(2006)(2007). Participants with dementia or living in institutions were excluded from the study sample. SETTING: Community-based study of randomly selected adults, aged 60 years or older, living in the Kungsholmen district of Stockholm. PARTICIPANTS: A complete case analysis was performed on 2139 individuals. MEASUREMENTS: We created standardized indexes of psychological well-being (integrating life satisfaction and positive and negative affect) and social well-being (integrating social connections, support, and participation). Negative binomial models were used to estimate the association of psychosocial well-being with unplanned admissions, hospital days, and 30-day readmissions, considering potential sociodemographic, lifestyle, personality, and clinical confounders. RESULTS: Individuals with psychological well-being scores above the median had lower rates of unplanned hospital admissions (incidence rate ratio [IRR] = 0.67; 95% confidence interval [CI] = 0.55-0.82) and hospital days (IRR = 0.67; 95% CI = 0.49-0.92) compared to those with scores below the median. High levels of social well-being were also protective for unplanned admissions and hospital days, but the statistical significance was lost in the fully adjusted models. Relative to individuals with low well-being on both indexes, the rate of unplanned admissions and hospital days was lowest in those with both high psychological and social well-being (IRR = 0.72; 95% CI = 0.55-0.93; and IRR = 0.57; 95% CI = 0.39-0.85, respectively). For 30-day readmissions, a statistically significant negative association was found with psychological well-being, but only when operationalized as a continuous variable. CONCLUSION: Given their association with unplanned admissions and hospital days, targeting aspects of psychosocial well-being could be a viable strategy for reducing healthcare use and, eventually, costs. J Am Geriatr Soc 68:272-280, 2020.

Correlations of Subjective and Social Well-Being With Sedentary Behavior and Physical Activity in Older Adults—A Population-Based Study

“…A detailed description is presented in Supplementary Table 2 . For social connections, individuals were asked about marital status; cohabitation status; parenthood; friendships; social network size; and frequency of direct or remote contacts with parents, children, relatives, neighbors, and friends ( 30 ). For social support, individuals were asked about the reported satisfaction with aforementioned contacts; perceived material and psychological support; sense of affinity with association members, relatives, and residence area; and being part of a group of friends ( 30 ).…”

“…For social connections, individuals were asked about marital status; cohabitation status; parenthood; friendships; social network size; and frequency of direct or remote contacts with parents, children, relatives, neighbors, and friends ( 30 ). For social support, individuals were asked about the reported satisfaction with aforementioned contacts; perceived material and psychological support; sense of affinity with association members, relatives, and residence area; and being part of a group of friends ( 30 ). For social participation, individuals were asked about the frequency of attending the theatre, concerts, or art exhibitions; travelling; playing cards/games; or participating in social groups or a pension organization ( 30 ).…”

The Impact of Psychological Status, Social Well‐Being, and Physical Function on Healthcare Utilization

“…Two articles in this issue explore the impact of psychological, social, and functional factors on unplanned hospitalizations and other types of healthcare utilization. The article by Straatmann et al is based on data from the Swedish National Study on Aging and Care in Kungsholmen and evaluates 2139 older adults over 4 years.…”

“…Two articles in this issue explore the impact of psychological, social, and functional factors on unplanned hospitalizations and other types of healthcare utilization. The article by Straatmann et al is based on data from the Swedish National Study on Aging and Care in Kungsholmen and evaluates 2139 older adults over 4 years. The authors developed standardized indexes of psychological well‐being (integrating life satisfaction and positive and negative affect) and social well‐being (including social connections, social support, and participation) and hypothesized that older adults with high psychological and social well‐being would have a lower risk of unplanned hospital use, and individuals with both high psychological and high social well‐being would have the greatest protective effect against unplanned hospital use.…”

“…Accelerometry data would allow for testing of the impact of sedentary behavior vs light, moderate, or vigorous activity on healthcare utilization. Further, while the study by Cheng et al 2 included several covariates (eg, demographic data, socioeconomic information, and comorbidities), the factors in the study by Straatmann et al (ie, psychosocial variables, such as resilience and social supports), along with cognitive status, medications, disease severity, pain, fear of falling, and care preferences, among others, should also be considered.…”