Readmission risk factors after hospital discharge among the elderly.

Hospital readmission rates among the elderly are attracting increasing attention. Readmission is costly, especially as proposed new guidelines could deny reimbursement for readmissions. Identifying key factors at discharge that can serve as prognostic indicators for readmission is an important step toward developing and targeting interventions to reduce hospital readmissions rates. Published literature has listed predominantly demographic, clinical, and health care utilization characteristics to describe the factors that put the elderly at risk. However, additional factors are proposed that include social, clinical, individual-level, environmental, and system-level factors. Multimodal interventions have been tested and some reduction in readmissions has been shown. Whether these additional factors might lead to a further reduction remains unclear. In addition to possible factors at discharge, factors identified after the patient has been discharged also must be identified and addressed. The patient safety literature characterizes factors that put the elderly at risk for adverse drug events, which function as antecedent factors for readmission and likely include the environmental and system-level factors. Synthesizing these factors from the readmission and patient safety literature provides the basis to develop a more comprehensive conceptual framework to identify research gaps aimed at reducing hospital readmissions among the elderly.