Skip to main content Accessibility help
×
Home
Hostname: page-component-79b67bcb76-wlt4x Total loading time: 0.325 Render date: 2021-05-13T19:58:34.304Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": false, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true }

Hospital readmissions in frail older people

Published online by Cambridge University Press:  29 April 2015

Emily Craven
Affiliation:
Department of Geriatric Medicine, Leicester Royal Infirmary, Leicester, UK
Simon Conroy
Affiliation:
Department of Geriatric Medicine, Leicester Royal Infirmary, Leicester, UK
Corresponding
E-mail address:

Summary

The majority of hospital in-patients are older people, and many of these are at increased risk of readmission, which can be an adverse outcome for the patient. Currently there is poor understanding as to how best to reduce the risk of readmission. We searched MEDLINE, EMBASE and the Cochrane library for high quality review articles about readmissions. Each review was quality assessed by two reviewers. Grouped data and evidence from original papers is cited with 95% confidence intervals when possible. Nine review studies of sufficient quality were included. Two addressed risk factors for readmission, which included: age, poor functional status prior to admission, length of stay during the index admission, depression, cognitive impairment, malnutrition, social support and social networks/support. The seven other reviews addressed interventions to reduce readmission, which included: discharge planning, post-discharge support, post-discharge case management, and nutritional supplementation. It is possible to identify older people at risk of readmission using well-established risk factors; discharge planning, post-discharge support and nutritional interventions appear to be effective in reducing readmission. Combined interventions appear to be more effective than isolated interventions.

Type
Review Article
Copyright
Copyright © Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below.

References

1 Zerdevas, P, Dobson, C. Emergency readmission rates: further analysis; 2008.Google Scholar
2 Nuffield Trust. Predicting risk of hospital readmission with PARR-30; 2012: Available at: http://www.nuffieldtrust.org.uk/our-work/projects/predicting-risk-hospital-readmission-parr-30.Google Scholar
3 Hansen, L, Young, R, Hinami, K, Leung, A, Williams, M. Interventions to reduce 30-day rehospitalization: a systematic review. Ann Intern Med 2011; 155: 520–28.CrossRefGoogle ScholarPubMed
4 Billings, J, Blunt, I, Steventon, A, Georghiou, T, Lewis, G, Bardsley, M. Development of a predictive model to identify inpatients at risk of re-admission within 30 days of discharge (PARR-30). BMJ Open 2012; 2 (4).CrossRefGoogle Scholar
5 García-Pérez, L, Linertová, R, Lorenzo-Riera, A, Vázquez-Díaz, J, Duque-González, B, Sarría-Santamera, A. Risk factors for hospital readmissions in elderly patients: a systematic review. QJM 2011; 104: 639–51.CrossRefGoogle ScholarPubMed
6 Preyde, M, Brassard, K. Evidence-based risk factors for adverse health outcomes in older patients after discharge home and assessment tools: a systematic review. J Evid Based Soc Work 2011; 8: 445–68.CrossRefGoogle ScholarPubMed
7 Shepperd, S, Lannin, N, Clemson, L, McCluskey, A, Cameron, I, Barras, S. Discharge planning from hospital to home. Cochrane Database Syst Rev 2013; 1.CrossRefGoogle Scholar
8 Conroy, SP, Stevens, T, Parker, SG, Gladman, JRF. A systematic review of comprehensive geriatric assessment to improve outcomes for frail older people being rapidly discharged from acute hospital: ‘interface geriatrics’. Age Ageing 2011; 40: 436–43.Google ScholarPubMed
9 Linertová, R, García-Pérez, L, Vázquez-Díaz, J, Lorenzo-Riera, A, Sarría-Santamera, A. Interventions to reduce hospital readmissions in the elderly: in-hospital or home care. A systematic review. J Eval Clin Pract 2011; 17: 1167–75.CrossRefGoogle ScholarPubMed
10 Ellis, G, Whitehead, M, O’Neill, D, Robinson, D, Langhorne, P. Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Library 2011.Google Scholar
11 Stratton, R, Hébuterne, X, Elia, M. A systematic review and meta-analysis of the impact of oral nutritional supplements on hospital readmissions. Ageing Res Rev 2013; 4: 884–97.CrossRefGoogle Scholar
12 Cawood, A, Elia, M, Stratton, R. Systematic review and meta-analysis of the effects of high protein oral nutritional supplements. Ageing Res Rev 2012; 2: 278–96.CrossRefGoogle Scholar
13 Braes, T, Moons, P, Lipkens, P, Sterckx, W, Sabbe, M, Flamaing, J et al. Screening for risk of unplanned readmission in older patients admitted to hospital: predictive accuracy of three instruments. Aging Clin Exp Res 2010; 22: 345–51.CrossRefGoogle ScholarPubMed
14 Kansagara, D, Englander, H, Salanitro, A. Risk prediction models for hospital readmission: a systematic review. JAMA 2011; 306: 1688–98.CrossRefGoogle ScholarPubMed
15 Conroy, SP, Ansari, K, Williams, M, Laithwaite, E, Teasdale, B, Dawson, J et al. A controlled evaluation of comprehensive geriatric assessment in the emergency department: the ‘Emergency Frailty Unit’. Age Ageing 2014; 43: 109–14.CrossRefGoogle ScholarPubMed
16 Rockwood, K, Andrew, M, Mitnitski, A. A comparison of two approaches to measuring frailty in elderly people. J Gerontol A Biol Sci Med Sci 2007; 62: 738–43.Google ScholarPubMed
17 Rockwood, K, Mitnitski, A. Frailty in relation to the accumulation of deficits. J Gerontol A Biol Sci Med Sci 2007; 62: 722–27.CrossRefGoogle ScholarPubMed
18 Rubenstein, LZ, Rubenstein, LV. Multidimensional assessment of elderly patients. Adv Intern Med 1991; 36: 81108.Google ScholarPubMed
19 Wright, PN, Tan, G, Iliffe, S, Lee, D. The impact of a new emergency admission avoidance system for older people on length of stay and same-day discharges. Age Ageing 2014; 43: 116–21.CrossRefGoogle ScholarPubMed
20 Foo, CL, Siu, VW, Tan, TL, Ding, YY, Seow, E. Geriatric assessment and intervention in an emergency department observation unit reduced re-attendance and hospitalisation rates. Australas J Ageing 2012; 31: 4046.CrossRefGoogle Scholar
21 Gravelle, H, Dusheiko, M, Sheaff, R, Sargent, P, Boaden, R, Pickard, S et al. Impact of case management (Evercare) on frail elderly patients: controlled before and after analysis of quantitative outcome data. BMJ 2006; 334: 31.CrossRefGoogle ScholarPubMed
22 Lewis, G, Georghiou, T, Steventon, A, Vaithianathan, R, Chitnis, X, Billings, J et al. Analysis of virtual wards: a multidisciplinary form of case management that integrates social and health care. Final report. NIHR Service Delivery and Organisation programme. London: NIHR SDO; 2013.Google Scholar

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Hospital readmissions in frail older people
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Hospital readmissions in frail older people
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Hospital readmissions in frail older people
Available formats
×
×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *