scholarly journals Trajectories of Hospital Readmission After A Fall Injury for Older Adults Living in Aged Care or The Community

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Rebecca Mitchell ◽  
Brian Draper ◽  
Jacqueline Close ◽  
Lara Harvey ◽  
Henry Brodaty ◽  
...  
Keyword(s):  
Older Adults ◽  
Hospital Readmission ◽  
Hospital Admissions ◽  
Group Membership ◽  
Hospital Readmissions ◽  
Care Facility ◽  
Aged Care ◽  
Community Living ◽  
Fall Injury ◽  
Trajectory Group

IntroductionFall injuries are one of the leading causes of hospitalisation for adults aged ≥65 years. Distinguishing key characteristics of older adults who are either living in aged care or in the community who have multiple hospital readmissions after a fall injury may inform targeted approaches to the prevention of hospital readmissions. Objectives and ApproachTo examine trajectories of hospital readmission of older adults living in aged care or the community after a fall injury hospitalisation and to identify factors predictive of trajectory group membership. A group-based trajectory analysis of hospital readmissions of adults aged ≥65 years who had a fall injury hospitalisation during 2008-09 in New South Wales, Australia was conducted. Linked hospitalisation and aged care data were examined for a 5 year period to 2013. Group-based trajectory models were derived based on number of subsequent readmissions following the index admission. Multinominal logistic regression examined predictors of trajectory group membership. ResultsThere were 24,729 fall injury hospitalisations; 78.8% of fallers were living in the community and 21.2% in aged care. Five distinct trajectory groups were identified for community-living (i.e. Moderate-declining, Chronic, Low-constant, Low-declining, and High users) and four trajectory groups for aged care residents (i.e. Low, Moderate-declining, Moderate-chronic, and High users). Key predictors of trajectory group membership for both community-living and aged care residents were age group, number of comorbidities, and dementia status. For aged care residents, depression, assistance with activities of daily living, and number of subsequent fall injury admissions were also predictors of group membership, with time to move to an aged care facility a predictor of group membership for community-living. Conclusion / ImplicationsIdentifying trajectories of ongoing hospital use informs targeting of strategies to reduce hospital admissions and design of services to allow community-living individuals to remain as long as possible within their own residence.

scholarly journals Older adults’ understandings and perspectives on frailty in community and residential aged care: an interpretive description

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e035339 ◽  
Author(s):  
Mandy Archibald ◽  
Michael Lawless ◽  
Rachel C Ambagtsheer ◽  
Alison Kitson
Keyword(s):  
Older Adults ◽  
Older Persons ◽  
South Australia ◽  
Care Facility ◽  
Health Behaviours ◽  
Aged Care ◽  
Residential Aged Care ◽  
Care Group ◽  
Static State ◽  
Consumer Perspective

ObjectivesDespite growing interest in frailty as a significant public health challenge, comparatively little is known about how older adults perceive and experience frailty, limiting the effectiveness of strategies to improve frailty management and prevention. The objective of this study was to understand how older people, including frail older persons in residential aged care, perceive and understand frailty through an interpretive–descriptive qualitative study.SettingAged care facility, community-based university for older persons and an aged care auxiliary care group in a large metropolitan centre in South Australia.Participants39 non-frail, prefrail, frail and very frail South Australian older adults.MethodsSeven focus groups were conducted. Participants completed one of two frailty instruments depending on setting and indicated whether they self-identified as frail. Data were analysed inductively and thematically by two independent investigators.ResultsFrailty was described according to three schemas of (1) the old and frail: a static state near the end of life; (2) frailty at any age: a disability model; and (3) frailty as a loss of independence: control, actions and identity. In addition, a theme was identifying linking mindset, cognition and emotion to frailty. The term frailty was viewed negatively and was often implicated with personal choice. There was little correlation between frailty assessments and whether participants self-identified as frail.ConclusionsAside from a disability model, views of frailty as unmodifiable permeated older persons’ diverse perspectives on frailty and are likely to impact health behaviours. To our knowledge, this is among the largest qualitative studies examining consumer perceptions of frailty and contributes a clinically relevant schema linking age, prevention and modifiability from a consumer perspective.

scholarly journals The Impact of Peer Support on the Risk of Future Hospital Readmissions among Older Adults with a Medical Illness and Co-Occurring Depression

2018 ◽  
Vol 7 (9) ◽  
pp. 156
Author(s):  
Kyaien Conner ◽  
Tamara Cadet ◽  
Monique Brown ◽  
Joshua Barnett
Keyword(s):  
Older Adults ◽  
Peer Support ◽  
Hospital Readmission ◽  
Protective Factor ◽  
Medical Condition ◽  
Hospital Readmissions ◽  
Medical Illness ◽  
Future Hospital ◽  
Discharge From Hospital ◽  
The Impact

Older adults account for 60% of all preventable hospital readmissions. Although not all readmissions are preventable, evidence indicates that up to 75% of hospital readmissions can be prevented with enhanced patient education, pre-discharge assessment, and effective care upon discharge. Social support, specifically peer support, after discharge from hospital may be a crucial factor in minimizing the risk of preventable hospital readmission. The pilot study reported here evaluated the relationship between peer support and hospital readmissions in a sample of depressed older adults (N = 41) who were recently discharged from hospital due to a medical condition and who simultaneously had an untreated mental health diagnosis of depression. As hypothesized, participants who received the 3-month long peer support intervention were significantly less likely to be readmitted compared to those who did not receive the intervention. Findings from this preliminary information suggest that peer support is a protective factor that can positively affect patient outcomes, reduce the risk of hospital readmission, and reduce depressive symptoms among older adults with health and behavioral health comorbidities.

Prevalence of Cognitive Impairment Among Elderly Patients Upon Hospital Admission Using Mini-Cog™ Assessments Performed by Advanced Pharmacy Practice Experience Students

2018 ◽  
Vol 33 (1) ◽  
pp. 21-29 ◽  
Author(s):  
Nghi (Andy) Bui ◽  
Mobolaji Adeola ◽  
Rejena Azad ◽  
Joshua T. Swan ◽  
Kathryn S. Agarwal ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Hospital Admission ◽  
Patient Outcomes ◽  
Hospital Readmission ◽  
Hospital Readmissions ◽  
Pharmacy Practice ◽  
Pharmacy Students ◽  
Day Hospital ◽  
Practice Experience

Background: Older adults with cognitive impairment may have difficulty understanding and complying with medical or medication instructions provided during hospitalization which may adversely impact patient outcomes. Objective: To evaluate the prevalence of cognitive impairment among patients aged 65 years and older within 24 hours of hospital admission using Mini-Cog™ assessments performed by advanced pharmacy practice experience (APPE) students. Methods: Students on APPE rotations were trained to perform Mini-Cog™ assessments during routine medication education sessions from February 2017 to April 2017. The primary end point was the prevalence of cognitive impairment indicated by a Mini-Cog™ score of ≤3. Secondary end points were the average number of observed Mini-Cog™ practice assessments required for APPE students to meet competency requirements, caregiver identification, and 30-day hospital readmissions. Results: Twelve APPE students completed the training program after an average of 4.4 (standard deviation [SD] = 1.0) graded Mini-Cog™ assessments. Of the 1159 admissions screened, 273 were included in the analysis. The prevalence of cognitive impairment was 55% (n = 149, 95% confidence interval [CI]: 48%-61%). A caregiver was identified for 41% (n = 113, 95% CI: 35%-47%) of patients, and 79 patients had a caregiver present at bedside during the visit. Hospital readmission within 30 days of discharge was 15% (n = 41, 95% CI: 11%-20%). Conclusion: Cognitive impairment could substantially impair a patient’s ability to comprehend education provided during hospitalization. Pharmacy students can feasibly perform Mini-Cog™ assessments to evaluate cognitive function, thereby allowing them to tailor education content and involve caregivers when necessary.

scholarly journals Sex inequality for hospital readmissions due to pulmonary diseases: a sex perspective in management is warrant

2019 ◽  
Author(s):  
Alessandra Buja ◽  
Anna De Polo ◽  
Milena Sperotto ◽  
Tatjana Baldovin ◽  
Silvia Cocchio ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Pulmonary Edema ◽  
Resource Use ◽  
Hospital Readmission ◽  
Hospital Admissions ◽  
Hospital Readmissions ◽  
Pulmonary Diseases ◽  
Male Patients ◽  
Logistic Regressions ◽  
Male Sex

Abstract Background Pulmonary diseases are a common and costly cause of 30-day readmissions. In this study we analysed the association between sex and the risk of readmission in a cohort of patients admitted to the hospital for COPD exacerbation and other major pulmonary diseases. The goal is to tailor disease management programs to improve clinical outcomes and prevent waste in resource use. Methods This was a retrospective cohort study based on administrative data collected in the Veneto Region in 2016. We included 15,069 hospital admissions among residents aged ≥ 65 years for DRGs of the most common disorders of the respiratory system: bronchitis and asthma, pneumonia, pulmonary edema, respiratory failure, and COPD. Multilevel logistic regressions were performed to test the association between 30-day hospital readmission and sex, adjusting for confounding factors. Results For bronchitis and asthma, male patients had a twofold significantly higher odd of 30-day readmission than male patients (aOR, 2.07; 95% CI, 1.11-3.87). The odd of readmission for men was also significantly higher for pneumonia (aOR, 1.40; 95% CI, 1.13-1.72), for pulmonary edema and respiratory failure (aOR, 1.28; 95% CI, 1.05-1.55), and for COPD (aOR, 1.34; 95% CI, 1.00-1.81). Conclusions This study found that male sex is a major risk factors for readmission in patients aged more than 65 years with a primary pulmonary diagnosis. More studies are needed to understand the underlying determinants of this phenomena and to provide targets for future interventions

scholarly journals The effectiveness and cost effectiveness of a hospital avoidance program in a residential aged care facility: a prospective cohort study and modelled decision analysis

2020 ◽  
Author(s):  
Hannah Carter ◽  
Xing J. Lee ◽  
Trudy Dwyer ◽  
Barbara O’Neill ◽  
Dee Jeffrey ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cost Effectiveness ◽  
Length Of Stay ◽  
Hospital Admissions ◽  
Care Facility ◽  
Aged Care ◽  
Residential Aged Care ◽  
Aged Care Facility ◽  
Residential Aged Care Facility ◽  
The Cost

Abstract Background: Residential aged care facility residents experience high rates of hospital admissions which are stressful, costly and often preventable. The EDDIE program is a hospital avoidance initiative designed to enable nursing and care staff to detect, refer and quickly respond to early signals of a deteriorating resident. The program was implemented in a 96-bed residential aged care facility in regional Australia. Methods: A prospective pre-post cohort study design was used to collect data on costs of program delivery, hospital admission rates and length of stay for the 12 months prior to, and following, the intervention. A Markov decision model was developed to synthesize study data with published literature in order to estimate the cost-effectiveness of the program. Quality adjusted life years (QALYs) were adopted as the measure of effectiveness. Results: The EDDIE program was associated with a 19% reduction in annual hospital admissions and a 31% reduction in the average length of stay. The cost-effectiveness analysis found the program to be both more effective and less costly than usual care, with 0.06 QALYs gained and $249,000 health system costs saved in a modelled cohort of 96 residents. A probabilistic sensitivity analysis estimated that there was an 86% probability that the program was cost-effective after taking the uncertainty of the model inputs into account. Conclusions: This study provides promising evidence for the effectiveness and cost-effectiveness of a nurse led, early intervention program in preventing unnecessary hospital admissions within a residential aged care facility. Further research in multi-site randomised studies is needed to confirm the generalisability of these results.

scholarly journals Medication-Related Factors and Hospital Readmission in Older Adults with Chronic Kidney Disease

2019 ◽  
Vol 8 (3) ◽  
pp. 395 ◽  
Author(s):  
Wubshet H. Tesfaye ◽  
Gregory M. Peterson ◽  
Ronald L. Castelino ◽  
Charlotte McKercher ◽  
Matthew Jose ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Hospital Readmission ◽  
Hospital Readmissions ◽  
Medication Regimen ◽  
Related Factors ◽  
Medication Regimen Complexity ◽  
Regimen Complexity ◽  
Medication Appropriateness

This study aimed to examine the association between medication-related factors and risk of hospital readmission in older patients with chronic kidney disease (CKD). A retrospective analysis was conducted targeting older CKD (n = 204) patients admitted to an Australian hospital. Medication appropriateness (Medication Appropriateness Index; MAI), medication regimen complexity (number of medications and Medication Regimen Complexity Index; MRCI) and use of selected medication classes were exposure variables. Outcomes were occurrence of readmission within 30 and 90 days, and time to readmission within 90 days. Logistic and Cox hazards regression were used to identify factors associated with readmission. Overall, 50 patients (24%) were readmitted within 30 days, while 81 (40%) were readmitted within 90 days. Mean time to readmission within 90 days was 66 (SD 34) days. Medication appropriateness and regimen complexity were not independently associated with 30- or 90-day hospital readmissions in older adults with CKD, whereas use of renin‒angiotensin blockers was associated with reduced occurrence of 30-day (adjusted OR 0.39; 95% CI 0.19–0.79) and 90-day readmissions (adjusted OR 0.45; 95% CI 0.24–0.84) and longer time to readmission within 90 days (adjusted HR 0.52; 95% CI 0.33–0.83). This finding highlights the importance of considering the potential benefits of individual medications during medication review in older CKD patients.

Examining trajectories of hospital readmission in older adults hospitalised with hip fracture from residential aged care and the community

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Vu Quang Do ◽  
Brian Draper ◽  
Lara Harvey ◽  
Tim Driscoll ◽  
Jeffrey Braithwaite ◽  
...  
Keyword(s):  
Older Adults ◽  
Hip Fracture ◽  
Hospital Readmission ◽  
Aged Care ◽  
Residential Aged Care

Palliative medicine and hospital readmissions in end-stage liver disease

2019 ◽  
pp. bmjspcare-2018-001635 ◽  
Author(s):  
Barret Rush ◽  
Clark Fruhstofer ◽  
Keith R Walley ◽  
Leo Anthony Celi ◽  
Mayur Brahmania
Keyword(s):  
Liver Disease ◽  
Hospital Readmission ◽  
Hospital Admissions ◽  
Hospital Readmissions ◽  
Symptom Burden ◽  
Nursing Facilities ◽  
Index Hospitalisation ◽  
Beneficial Effects ◽  
End Stage Liver Disease ◽  
End Stage

BackgroundPatients with end-stage liver disease (ESLD) have a reduced life expectancy and a significant symptom burden. Our aim is to determine if inpatient palliative care (PC) referral for patients with ESLD is associated with decreased hospital readmission rates.MethodsThe 2013 US Nationwide Readmission Database (NRD) was used for the current analysis. The NRD allows for longitudinal analysis of all patient hospital admissions across 22 states. Patients ≥18 years of age with a diagnosis of ESLD with at least two decompensating events were included in the analysis. PC referral at the index hospitalisation divided the cohort into two groups, which were tracked for 9 months.ResultsA total of 14 325 172 hospital admissions from the 2013 NRD were examined. In the first 3 months of 2013, a total of 3647 patients with ESLD were admitted with 206 (5.6%) receiving PC referral during the index admission. After the index hospitalisation, patients referred to PC were more likely to be discharged to skilled nursing facilities (45.5% vs 14.7%; p<0.01) or hospice/home care (32.9% vs 15.3%; p<0.01). After propensity score matching, those patients referred to PC demonstrated a significantly lower rate of 1-year hospital readmission (11.0% vs 32.1%; p<0.01).ConclusionInpatient PC referral for patients with ESLD was associated with lower rates of hospital readmission. Early concurrent PC referral likely has added beneficial effects beyond quality of life issues and symptom management.

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