Outcomes of hospital admissions among frail older people: a 2-year cohort study

Background‘Frailty crises’ are a common cause of hospital admission among older people and there is significant focus on admission avoidance. However, identifying frailty before a crisis occurs is challenging, making it difficult to effectively target community services. Better longer-term outcome data are needed if services are to reflect the needs of the growing population of older people with frailty.AimTo determine long-term outcomes of older people discharged from hospital following short (<72 hours) and longer hospital admissions compared by frailty status.Design and settingTwo populations aged ≥70 years discharged from hospital units: those following short ‘ambulatory’ admissions (<72 hours) and those following longer inpatient stays.MethodData for 2-year mortality and hospital use were compared using frailty measures derived from clinical and hospital data.ResultsMortality after 2 years was increased for frail compared with non-frail individuals in both cohorts. Patients in the ambulatory cohort classified as frail had increased mortality (Rockwood hazard ratio 2.3 [95% confidence interval {CI} = 1.5 to 3.4]) and hospital use (Rockwood rate ratio 2.1 [95% CI = 1.7 to 2.6]) compared with those patients classified as non-frail.ConclusionIndividuals with frailty who are discharged from hospital experience increased mortality and resource use, even after short ‘ambulatory’ admissions. This is an easily identifiable group that is at increased risk of poor outcomes. Health and social care systems might wish to examine their current care response for frail older people discharged from hospital. There may be value in a ‘secondary prevention’ approach to frailty crises targeting individuals who are discharged from hospital.

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Maintaining independence in older people

Reviews in Clinical Gerontology ◽

10.1017/s0959259810000079 ◽

2010 ◽

Vol 20 (2) ◽

pp. 128-153 ◽

Cited By ~ 35

Author(s):

AD Beswick ◽

R Gooberman-Hill ◽

A Smith ◽

V Wylde ◽

S Ebrahim

Keyword(s):

Older People ◽

Social Engagement ◽

Hospital Admissions ◽

Meta Analysis ◽

Functional Decline ◽

Complex Interventions ◽

Preventive Strategies ◽

Health And Social Care ◽

Quality Trial ◽

High Quality Trial

SummaryAppropriate social and medical interventions may help maintain independence in older people. Determinants of functional decline, disability and reduced independence are recognized and specific interventions target the treatment of clinical conditions, multiple health problems and geriatric conditions, prevention of falls and fractures, and maintenance of physical and cognitive function and social engagement.Preventive strategies to identify and treat diverse unmet needs of older people have been researched extensively. We reviewed systematically recent randomized controlled trials evaluating these ‘complex’ interventions and incorporated the findings of 21 studies into an established meta-analysis that included 108,838 people in 110 trials. There was an overall benefit of complex interventions in helping older people to live at home, explained by reduced nursing home admissions rather than death rates. Hospital admissions and falls were also reduced in intervention groups. Benefits were largely restricted to earlier studies, perhaps reflecting general improvements in health and social care for older people. The wealth of high-quality trial evidence endorses the value of preventive strategies to help maintain independence in older people.

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Prevalence, repairs and complications of hypospadias: an Australian population-based study

Archives of Disease in Childhood ◽

10.1136/archdischild-2015-308809 ◽

2015 ◽

Vol 100 (11) ◽

pp. 1038-1043 ◽

Cited By ~ 28

Author(s):

Francisco Javier Schneuer ◽

Andrew J A Holland ◽

Gavin Pereira ◽

Carol Bower ◽

Natasha Nassar

Keyword(s):

Surgical Procedures ◽

Hospital Admissions ◽

Primary Repair ◽

Population Based ◽

Late Complications ◽

Hospital Data ◽

Australian Population ◽

Post Surgery ◽

South Wales ◽

Increased Risk

ObjectiveTo investigate hypospadias’ prevalence and trends, rate of surgical repairs and post-repair complications in an Australian population.MethodsHypospadias cases were identified from all live-born infants in New South Wales, Australia, during the period 2001–2010, using routinely collected birth and hospital data. Prevalence, trends, surgical procedures or repairs, hospital admissions and complications following surgery were evaluated. Risk factors for reoperation and complications were assessed using multivariate logistic regression.ResultsThere were 3186 boys with hypospadias in 2001–2010. Overall prevalence was 35.1 per 10 000 live births and remained constant during the study period. Proportions of anterior, middle, proximal and unspecified hypospadias were 41.3%, 26.2%, 5.8% and 26.6%, respectively. Surgical procedures were performed in 1945 boys (61%), with 1718 primary repairs. The overall post-surgery complication rate involving fistulas or strictures was 13%, but higher (33%) for proximal cases. Complications occurred after 1 year post-repair in 52.3% of cases and up to 5 years. Boys with proximal or middle hypospadias were at increased risk of reoperation or complications, but age at primary repair did not affect the outcome.ConclusionOne in 285 infants were affected with hypospadias, 60% required surgical repair or correction and one in eight experienced complications. The frequency of late complications would suggest that clinical review should be maintained for >1 year post-repair.

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299 A Retrospective Review of Unscheduled Hospital Admissions of Nursing Home Residents Over a Two Year Period

Age and Ageing ◽

10.1093/ageing/afz103.191 ◽

2019 ◽

Vol 48 (Supplement_3) ◽

pp. iii17-iii65

Author(s):

Aoife McFeely ◽

Cliona Small ◽

Susie Hyland ◽

Jonathan O'Keeffe ◽

Graham Hughes ◽

...

Keyword(s):

Nursing Home ◽

Older People ◽

Hospital Admissions ◽

Nursing Home Residents ◽

Integrated Approach ◽

Care Team ◽

Similar Data ◽

Readmission Rates ◽

Increased Risk ◽

One Year

Abstract Background Older people living in Nursing Homes (NHs) represent a frail and vulnerable group. With multiple co-morbidities they are at increased risk of acute health deterioration prompting urgent hospital transfer. Our aim was to examine the outcomes for nursing home residents following unscheduled hospital attendances. Methods A prospective database was collected between 1 January 2016 and 31 December 2017. This recorded all emergency admissions of older people from NHs. The data was retrospectively analysed. Outcomes assessed included: length of stay (LOS), 30-day readmission rates, number of readmissions within one year and mortality. We compared these results to similar data collected in 2012-13. Results Over a two-year period, there were 1435 hospital admissions; a 7% increase from 1015 in 2012. 60% were female and 40% male with a mean age of 84.7 years. The average LOS was 9.58 days (vs 11.2 days in 2012-13). The 30-day readmission rate was 9.8% (vs 14% in 2012-13). 30.45% of all patients went on to have 2 or more readmissions within one year, an increase from 21.1% in 2012-13. The total in-hospital mortality was 14%. Conclusion An increase in the number of NH residents presenting to an acute hospital over the past 5 years was observed. Despite this, we have seen reductions in average LOS and 30 day readmission rates. There is, however, an increasing number of recurrent admissions (≥ 2) to the hospital within one year. These results highlight the importance of an integrated approach to patient care; from the primary care team, hospital team, palliative and community care services. We believe the continued development of Nursing Home Outreach Programmes and community liaison services, combined with the evolving role of the in-hospital Geriatric ANP and liaison palliative care team, will help reduce inappropriate ED referrals and encourage advanced care planning.

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THE EVALUATION OF INTERPROFESSIONAL EDUCATION IN PRIMARY CARE: A SOCIAL NETWORK ANALYSIS

Innovation in Aging ◽

10.1093/geroni/igz038.181 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S47-S47

Author(s):

Linda C Smit ◽

Jeroen Dikken ◽

Nienke M Moolenaar ◽

Marieke J Schuurmans ◽

Niek J De Wit ◽

...

Keyword(s):

Social Network ◽

Social Network Analysis ◽

Network Analysis ◽

Older People ◽

Health Care Professionals ◽

Interprofessional Education ◽

Social Care ◽

Care Providers ◽

Frail Older People ◽

Health And Social Care

Abstract Effective, safe, person-centred care relies on skilled interprofessional collaboration (IPC) and practice. Little is known about interprofessional education (IPE) to increase IPC in the context of care for frail older people in the community. This study evaluates the effectiveness of IPE on IPC of primary health and social care providers providing care to frail older people in three districts in the Netherlands. A before-after study among 55 health care professionals using social network analysis was performed. The number of contacts increased on average with two contacts. The reciprocity in the districts increased with 15%, 2% and 13%. The diversity of contacts increased between 6% and 10% (p <.001; p .055; p .371). The IPE effectuated a larger, more collaborative, and diverse interprofessional network of health and social care professionals providing care to frail older people suggesting a ripple-effect of networked interventions.

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Cardiovascular Disease-related Hospital Admissions of Patients with Inflammatory Arthritis

The Journal of Rheumatology ◽

10.3899/jrheum.140476 ◽

2014 ◽

Vol 42 (2) ◽

pp. 188-192

Author(s):

Jennie Ursum ◽

Mark M.J. Nielen ◽

Jos W.R. Twisk ◽

Mike J.L. Peters ◽

François G. Schellevis ◽

...

Keyword(s):

Primary Care ◽

Hospital Admission ◽

Inflammatory Arthritis ◽

Hospital Admissions ◽

High Rate ◽

Hospital Data ◽

Cvd Risk ◽

Dutch Hospital ◽

Services Research ◽

Increased Risk

Objective.Patients with inflammatory arthritis (IA) have an increased risk of cardiovascular diseases (CVD), suggesting a high rate of CVD-related hospitalizations, but data on this topic are limited. Our study addressed hospital admissions for CVD in a primary care–based population of patients with IA and controls.Methods.All newly diagnosed patients with IA between 2001 and 2010 were selected from electronic medical records of the Netherlands Institute for Health Services Research Primary Care database, representing a national network of general practices. Two control patients matched for age, sex, and practice were selected for each patient with IA. Hospital admission data for all patients was retrieved from the Dutch Hospital Data.Results.There were 2615 patients with IA and 5555 controls included in our study. CVD-related hospital admissions were observed more frequently among patients with IA as compared with control patients: 48% versus 36% (p < 0.001) in a followup period of 4 years. Patients with IA were more often hospitalized because of ischemic heart disease (OR 1.7, 95% CI 1.2–2.2) and for day-care admission because of cerebrovascular disease (OR 2.2, 95% CI 1.0–4.9).Conclusion.Increased hospital admission rates confirm the higher CVD burden among patients with IA compared with controls, and underscore the need for proper CVD risk management in patients with IA.

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Recurrent delirium over 12 months predicts dementia: results of the Delirium and Cognitive Impact in Dementia (DECIDE) study

Age and Ageing ◽

10.1093/ageing/afaa244 ◽

2020 ◽

Author(s):

Sarah J Richardson ◽

Daniel H J Davis ◽

Blossom C M Stephan ◽

Louise Robinson ◽

Carol Brayne ◽

...

Keyword(s):

Cognitive Function ◽

Cognitive Decline ◽

Hospital Admissions ◽

Outcome Data ◽

Illness Severity ◽

Cognitive Outcomes ◽

Dementia Diagnosis ◽

Increased Risk ◽

The Impact ◽

Over Time

Abstract Background Delirium is common, distressing and associated with poor outcomes. Previous studies investigating the impact of delirium on cognitive outcomes have been limited by incomplete ascertainment of baseline cognition or lack of prospective delirium assessments. This study quantified the association between delirium and cognitive function over time by prospectively ascertaining delirium in a cohort aged ≥ 65 years in whom baseline cognition had previously been established. Methods For 12 months, we assessed participants from the Cognitive Function and Ageing Study II-Newcastle for delirium daily during hospital admissions. At 1-year, we assessed cognitive decline and dementia in those with and without delirium. We evaluated the effect of delirium (including its duration and number of episodes) on cognitive function over time, independently of baseline cognition and illness severity. Results Eighty two of 205 participants recruited developed delirium in hospital (40%). One-year outcome data were available for 173 participants: 18 had a new dementia diagnosis, 38 had died. Delirium was associated with cognitive decline (−1.8 Mini-Mental State Examination points [95% CI –3.5 to –0.2]) and an increased risk of new dementia diagnosis at follow up (OR 8.8 [95% CI 1.9–41.4]). More than one episode and more days with delirium (>5 days) were associated with worse cognitive outcomes. Conclusions Delirium increases risk of future cognitive decline and dementia, independent of illness severity and baseline cognition, with more episodes associated with worse cognitive outcomes. Given that delirium has been shown to be preventable in some cases, we propose that delirium is a potentially modifiable risk factor for dementia.

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SOCIAL AND BIOLOGICAL PREDICTORS OF HOSPITAL ADMISSIONS FOR A FALL IN THE ENGLISH LONGITUDINAL STUDY OF AGEING (ELSA)

Innovation in Aging ◽

10.1093/geroni/igz038.233 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S60-S60

Author(s):

Jessica G Abell ◽

Camille Lassale ◽

Andrew Steptoe ◽

G David Batty ◽

Paola Zaninotto

Keyword(s):

Longitudinal Study ◽

Older People ◽

Hospital Admissions ◽

Cox Regression ◽

Premature Mortality ◽

Care Services ◽

Health And Social Care ◽

Icd 10 ◽

First Occurrence ◽

English Longitudinal Study

Abstract Falls are the most frequent type of accidents among older people, with one in three people aged over 65 falling each year. Falls serious enough to result in hospital admission are especially problematic, since they can lead to an increased likelihood of future disability, loss of independence, and premature mortality. Understanding the factors that may determine the risk of experiencing a fall, which requires admission to hospital, is therefore an important priority. This paper seeks to examine this issue using Hospital Episode Statistics (HES) data – administrative data from English hospitals in the National Health Service (NHS). These data have recently been linked with the English Longitudinal Study of Ageing (ELSA). We examine the association between a range of predictors (demographic, social environment, physical and mental functioning) drawn from wave 4 of ELSA with the first occurrence of hospitalisation due to an accidental fall, identified using ICD-10 codes. Analysis using Cox regression suggest a range of factors are negatively associated with admission to hospital with diagnosis of a fall, such as living alone (HR=1.42; 95% CI: 1.19, 1.68), urinary incontinence (HR=1.33; 95% CI: 1.09, 1.61) and depressive symptoms (HR=1.50; 95% CI: 1.23, 1.82). High walking speed (HR=0.30; 95% CI: 0.23, 0.39) and good hand-grip strength (HR=0.97; 95% CI: 0.96, 0.98) were found to be protective. The prevention of serious falls amongst older people will require determinants to be identified and managed effectively by health and social care services.

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Reducing unplanned hospital admissions in Older people with high needs: a review of local practice in a small sample of primary care patients in an inner London borough.

The International Journal of Person Centered Medicine ◽

10.5750/ijpcm.v6i2.561 ◽

2016 ◽

Vol 6 (2) ◽

pp. 108-118

Author(s):

Harriet Selina Anne Sinclair ◽

Alison Furey

Keyword(s):

Primary Care ◽

High Risk ◽

Older People ◽

Social Care ◽

Hospital Admissions ◽

Health Check ◽

Care Needs ◽

Health And Social Care ◽

Risk Patients ◽

Unplanned Hospital Admissions

Background: Older people with complex health and social care needs are a growing group of people with high use of NHS and social services. In particular, this group account for a large number of unplanned hospital admissions a year.Aims: To evaluate the evidence base for preventing unplanned hospital admissions in this group, to identify their characteristics and to undertake a focussed local review of their primary care management.Methods: A literature review, a review of the Southwark CCG data risk stratification tool and a review of high risk patients and their management at a Southwark GP practice.Results: High risk patients have multiple comorbidities and are frequent users of healthcare services. Although there was in general good involvement with social care services, there were certain areas that could be improved upon. For instance, the referral of frequent fallers to falls services and provision of an older person’s annual health check both offer opportunities for primary prevention.Conclusions: An older person’s annual health check would ensure holistic assessment of their health and social care needs and could then be acted upon to ensure that there is the required level of support in place, including a personalised anticipatory care plan and attention to key preventative measures such as falls prevention, exercise, smoking cessation, medicines optimisation and sensory impairment.

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Low-trauma fractures indicate increased risk of hip fracture in frail older people

Journal of Bone and Mineral Research ◽

10.1002/jbmr.216 ◽

2011 ◽

Vol 26 (2) ◽

pp. 428-433 ◽

Cited By ~ 10

Author(s):

Jian Sheng Chen ◽

Ian D Cameron ◽

Judy M Simpson ◽

Markus J Seibel ◽

Lyn M March ◽

...

Keyword(s):

Hip Fracture ◽

Older People ◽

Frail Older People ◽

Increased Risk

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Partners at Care Transitions: exploring healthcare professionals’ perspectives of excellence at care transitions for older people

BMJ Open ◽

10.1136/bmjopen-2018-022468 ◽

2018 ◽

Vol 8 (9) ◽

pp. e022468 ◽

Cited By ~ 5

Author(s):

Ruth Baxter ◽

Jane O’Hara ◽

Jenni Murray ◽

Laura Sheard ◽

Alison Cracknell ◽

...

Keyword(s):

Older People ◽

Hospital Admissions ◽

Transitional Care ◽

Transition Period ◽

Care Transitions ◽

Transitions Of Care ◽

Care Needs ◽

High Performing ◽

Health And Social Care ◽

Hospital To Home

IntroductionHospital admissions are shorter than they were 10 years ago. Notwithstanding the benefits of this, patients often leave hospital requiring ongoing care. The transition period can therefore be risky, particularly for older people with complex health and social care needs. Previous research has predominantly focused on the errors and harms that occur during transitions of care. In contrast, this study adopts an asset-based approach to learn from factors that facilitate safe outcomes. It seeks to explore how staff within high-performing (‘positively deviant’) teams successfully support transitions from hospital to home for older people.Methods and analysisSix high-performing general practices and six hospital specialties that demonstrate exceptionally low or reducing 30-day emergency hospital readmission rates will be invited to participate in the study. Healthcare staff from these clinical teams will be recruited to take part in focus groups, individual interviews and/or observations of staff meetings. Data collection will explore the ways in which teams successfully deliver exceptionally safe transitional care and how they overcome the challenges faced in their everyday clinical work. Data will be thematically analysed using a pen portrait approach to identify the manifest (explicit) and latent (abstract) factors that facilitate success.Ethics and disseminationEthical approval was obtained from the University of Leeds. The study will help develop our understanding of how multidisciplinary staff within different healthcare settings successfully support care transitions for older people. Findings will be disseminated to academic and clinical audiences through peer-reviewed articles, conferences and workshops. Findings will also inform the development of an intervention to improve the safety and experience of older people during transitions from hospital to home.

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