P-154: Risk factors for readmission and death among older patients following discharge from geriatric rehabilitation hospital

摘要

Introduction: Unplanned hospital readmissions shortly after discharge are frequent among older patients. Identifying patients with risk for readmission or death early during hospitalization may aid efforts improving these outcomes after discharge. Methods: This retrospective cohort study included materials from comprehensive geriatric assessment, based on interRAI Post-Acute Care instrument, combined with hospital discharge records of the patients hospitalized in and discharged to their own homes from two geriatric rehabilitation hospitals in 3 years period. Associations of risk factors with readmission and death within 90 days following discharge were analysed using logistic regression. Results: The cohort included 1167 patients (mean age 84.5 ± 6.2 years). The 90-day readmission rate and mortality were 29.5% and 4.3%, respectively. Factors associated with readmission were cognitive impairment (CPS ≥ 1) (OR [95% CI] 1.56 [1.16-2.12]), functional decline (ALDH ≥ 1) (1.69 [1.28-2.25]), a Frailty Index ≥0.20 (1.58 [1.19-2.10]), moderate to high assigned priority level (MAPLe-AC ≥ 3) (1.84 [1.09-3.13]), body mass index < 25 or >[ 30 kg/m~2 (1.35 [1.02-1.78]), and poor self-reported health (1.55 [1.03-2.36]). The risk of death was increased in patients with moderate to severe cognitive impairment (CPS ≥ 3) (2.63 [1.45^.78]), a frailty index ≥ 0.40 (2.28 [1.26-4.10]), poor self-reported health (3.49 [1.43-8.51]), instable health status (CHESS ≥ 2) (3.74 [2.05-6.79], heart failure (1.86 [1.05-3.30]), cancer (3.81 [2.07-7.03]), urinary incontinence (2.04 [1.06-3.91], and faecal incontinence (2.58 [1.44-4.60]). Key conclusions: Cognitive impairment, frailty index and poor self-reported health status were risk factors both for readmission and death within 90 days after discharge from a geriatric rehabilitation hospital. Functional decline was associated with readmissions.