OBJECTIVES: To identify risk factors for early hospital readmission in low-income community-dwelling older adults. DESIGN: Prospective cohort study. SETTING: University-affiliated urban safety-net healthcare system in Indianapolis, Indiana. PARTICIPANTS: Community-dwelling adults aged 65 and older with annual income less than 200% of the federal poverty level and enrolled in the Geriatric Resources for Assessment and Care of Elders (GRACE) randomized controlled trial (N = 951). MEASUREMENTS: Participant health and functional status at baseline and 6, 12, 18, and 24 months. Early readmission was defined as a repeat hospitalization occurring within 30 days of a prior hospital discharge. Candidate risk factors included sociodemographic characteristics, health and functional status, prior care, lifestyle, and satisfaction with care. RESULTS:Of 457 index admissions in 328 participants, 85 (19%) were followed by an early readmission. The independent risk factors for early readmission identified according to regression analysis were living alone (odds ratio (OR) = 1.71, 95% confidence interval (CI) = 1.02-2.87), fair or poor satisfaction with primary care physician (OR = 2.12, 95% CI = 1.01-4.46), not having Medicaid (OR = 1.80, 95% CI = 1.05-3.11), receiving a new assistive device in the past 6 months (OR = 2.26, 95% CI = 1.26-4.05), and staying in a nursing home in the past 6 months (OR = 5.08, 95% CI = 1.56-16.53). Age, race, sex, education, and chronic diseases were not associated with early readmission. CONCLUSION: A broad range of nonmedical risk factors played a greater role than previously recognized in early hospital readmission of low-income seniors.
RCT Entities:
OBJECTIVES: To identify risk factors for early hospital readmission in low-income community-dwelling older adults. DESIGN: Prospective cohort study. SETTING: University-affiliated urban safety-net healthcare system in Indianapolis, Indiana. PARTICIPANTS: Community-dwelling adults aged 65 and older with annual income less than 200% of the federal poverty level and enrolled in the Geriatric Resources for Assessment and Care of Elders (GRACE) randomized controlled trial (N = 951). MEASUREMENTS: Participant health and functional status at baseline and 6, 12, 18, and 24 months. Early readmission was defined as a repeat hospitalization occurring within 30 days of a prior hospital discharge. Candidate risk factors included sociodemographic characteristics, health and functional status, prior care, lifestyle, and satisfaction with care. RESULTS: Of 457 index admissions in 328 participants, 85 (19%) were followed by an early readmission. The independent risk factors for early readmission identified according to regression analysis were living alone (odds ratio (OR) = 1.71, 95% confidence interval (CI) = 1.02-2.87), fair or poor satisfaction with primary care physician (OR = 2.12, 95% CI = 1.01-4.46), not having Medicaid (OR = 1.80, 95% CI = 1.05-3.11), receiving a new assistive device in the past 6 months (OR = 2.26, 95% CI = 1.26-4.05), and staying in a nursing home in the past 6 months (OR = 5.08, 95% CI = 1.56-16.53). Age, race, sex, education, and chronic diseases were not associated with early readmission. CONCLUSION: A broad range of nonmedical risk factors played a greater role than previously recognized in early hospital readmission of low-income seniors.
Authors: Barbara Riegel; Liming Huang; Mark E Mikkelsen; Ann Kutney-Lee; Alexandra L Hanlon; Christopher M Murtaugh; Kathryn H Bowles Journal: J Am Geriatr Soc Date: 2018-11-30 Impact factor: 5.562
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