[Unplanned readmissions of frail elderly patients: a retrospective analysis of admissions in a teaching hospital]

Abstract

OBJECTIVE: To assess the prevalence and predictors of readmission in patients of 65 years or older. DESIGN: Retrospective data analysis. METHOD: We used a dossier analysis to identify the number of readmissions and patient characteristics of all patients aged 65 years or older admitted to the Radboud University Medical Centre between 29 September 2013 and 4 October 2014. We also used data from the Dutch hospital safety tool (VMS) screening bundle for frail elderly patients. Predictors for readmission were investigated using logistic regression analysis. RESULTS: The readmission rate within 30 days of discharge was 10.9% (95% CI 10.2 - 11.7) of all admissions of elderly patients. The most common symptom associated with readmission was dyspnea (24.9%). Diseases with an increased risk for readmission were: heart failure (OR=2.6; 95% CI 1.9 - 3.7), chronic obstructive pulmonary disease (OR=2.2; 95% CI 1.5 - 3.2), renal insufficiency (OR=1.8; 95% CI 1.3 - 2.6) and cancer (OR=1.5; 95% CI 1.1 - 2.1). Total burden of disease and functional limitations accounted jointly for 49% of the variance in readmissions. Repeated readmissions could be less well predicted (explained variance: 14%); the use of more than 3 drugs (OR=1.07; 95% CI 1.02 - 1.13) and a low body mass index (OR=0.94; 95% CI 0.88 - 0.99) were predictors for multiple readmissions. CONCLUSION: Elderly patients suffering from dyspnea have the highest risk for readmission. Patients with heart failure, COPD, renal failure, cancer, functional loss or malnutrition require extra attention on transition from hospital to home in order to lower the number of unnecessary readmissions.