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Predictors of short-term hospitalization and emergency department presentations in aged care.
- Source :
-
Journal of the American Geriatrics Society [J Am Geriatr Soc] 2021 Nov; Vol. 69 (11), pp. 3142-3156. Date of Electronic Publication: 2021 Jun 21. - Publication Year :
- 2021
-
Abstract
- Objectives: To examine individual, medication, system, and healthcare related predictors of hospitalization and emergency department (ED) presentation within 90 days of entering the aged care sector, and to create risk-profiles associated with these outcomes.<br />Design and Setting: Retrospective population-based cohort study using data from the Registry of Senior Australians.<br />Participants: Older people (aged 65 and older) with an aged care eligibility assessment in South Australia between January 1, 2013 and May 31, 2016 (N = 22,130).<br />Measurements: Primary outcomes were unplanned hospitalization and ED presentation within 90 days of assessment. Individual, medication, system, and healthcare related predictors of the outcomes at the time of assessment, within 90 days or 1-year prior. Fine-Gray models were used to calculate subdistribution hazard ratios (sHR) and 95% confidence intervals (CI). Harrell's C-index assessed predictive ability.<br />Results: Four thousand nine-hundred and six (22.2%) individuals were hospitalized and 5028 (22.7%) had an ED presentation within 90 days. Predictors of hospitalization included: being a man (hospitalization sHR = 1.33, 95% CI 1.26-1.42), ≥3 urgent after-hours attendances (hospitalization sHR = 1.21, 95% CI 1.06-1.39), increasing frailty index score (hospitalization sHR = 1.19, 95% CI 1.11-1.28), individuals using glucocorticoids (hospitalization sHR = 1.11, 95% CI 1.02-1.20), sulfonamides (hospitalization sHR = 1.18, 95% CI 1.10-1.27), trimethoprim antibiotics (hospitalization sHR = 1.15, 95% CI 1.03-1.29), unplanned hospitalizations 30 days prior (hospitalization sHR = 1.13, 95% CI 1.04-1.23), and ED presentations 1 year prior (hospitalization sHR = 1.07, 95% CI 1.04-1.10). Similar predictors and hazard estimates were also observed for ED presentations. The hospitalization models out-of-sample predictive ability (C-index = 0.653, 95% CI 0.635-0.670) and ED presentations (C-index = 0.647, 95% CI 0.630-0.663) were moderate.<br />Conclusions: One in five individuals with aged care eligibility assessments had unplanned hospitalizations and/or ED presentation within 90 days with several predictors identified at the time of aged care eligibility assessment. This is an actionable period for targeting at-risk individuals to reduce hospitalizations.<br /> (© 2021 The American Geriatrics Society.)
- Subjects :
- Aged
Anti-Bacterial Agents
Female
Glucocorticoids
Humans
Male
Registries
Residential Facilities
Retrospective Studies
Risk Factors
Sex Factors
South Australia
Sulfonamides
Time Factors
Emergency Service, Hospital statistics & numerical data
Geriatric Assessment statistics & numerical data
Hospitalization statistics & numerical data
Medication Adherence statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1532-5415
- Volume :
- 69
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- Journal of the American Geriatrics Society
- Publication Type :
- Academic Journal
- Accession number :
- 34155634
- Full Text :
- https://doi.org/10.1111/jgs.17317