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Identifying The Risk Factors For Unplanned Readmission

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Question:

Discuss about the Identifying the risk factors for unplanned readmission to hospital within 4 weeks in elderly Patients over the age of 65 years?
 
 

Answer:

Introduction:

This chapter discusses the concept of unplanned readmission rate for elderly care home. This literature review discusses about the concept of unplanned readmission for elderly people. This review has discussed probable risk factors also. For the successful completion of this literature review, secondary journals and articles have been considered as effective sources. According to Au et al., (2012), unplanned readmission is considered as the admission, which has taken place within 1 month of previous discharge, as well as index admission. However, if a person is shifted to another hospital then it is not considered as discharge case. So, unplanned readmission is not applicable for this aspect.

Probable risk factors:

Demographic factors: gender, income, educational levels and personal living conditions

According to the first study Archer et al., (2012), the demographic factors facilitate the readmission of the elderly patient’s within a month from the hospital discharge. This is due to factors such as gender, age, income, educational level and the personal living style of the individuals.

Age: will be written more

Archer et al., (2012) have found that at certain cases, after being discharged from the hospital, the elderly patients become negligent towards their health. The elderly patients do not abide by the health regulations that they need to follow post hospital release. 

Gender:

Six scholarly studies (Woz et al., 2012, Wang et al., 2016, Archer et al., 2012, Au et al., 2012, Gu et al., 2014, Smith et al., 2015) have been done to find out the effect of gender on the aspect of hospital readmission. Most of the studies have found gender as a significant factor for hospital readmission. According to Woz et al., (2012), gender is considered as a risk factor for the aspect of 30 days of post discharge hospital readmission. This study has found that generally in the post discharge phenomenon, re-utilisation of hospital is costly. This study has evaluated the involvement between hospital readmission and gender within 30 days of discharge. Readmission after 30 days of discharge is a complex phenomenon. Hospital readmission if often considered as a poor quality of health service among different hospitals and healthcare sectors. According to Shaula et al., (2012), there are several factors which can affect the aspect of hospital readmission for a patient. Male gender is considered as a severe risk factor for hospital readmission. In different types of context of diseases, it has been seen that male gender is readmitted for several causes than woman. There are few studies which have considered ‘gender’ as a modifiable factor of hospital readmission.

 


On the other hand Au et al., (2012) discussed that there are lower rate of preventive care among men. It has been also studied that men visit hospital and health center at few times than woman. For these reasons, men always put high risk of poor result after the discharge of hospital. For this reason, rate of hospital readmission increases among men. In this study, researcher has used gender, homelessness and marital status as dichotomous variable. Prior hospitalization is the risk factor for men. However, for women, predictive factor is hospital utilisation in 6 months prior to the index hospitalization. There are many additional factors; those are being retired, having positive screen of depression and unmarried men. On the other hand, there are men those who do not report to the hospital within 30 days of hospital discharge.

According to the other two studies, it can be stated that early hospital readmission is very common phenomenon in United States of America. Author 2 has studied that men mostly use emergency department of hospital for the common source of medical care. Men are more likely to be readmitted to any type of hospital within 30 days. The rate of readmission for men is comparatively higher than women. Men always have higher rate of 30 day readmission to hospital than women. It has also been discussed that men are also less likely to complete a follow up appointment with the doctor who cares primarily after discharge of the male patient.

It can also help to reduce the level of risk for the aspect of readmission among men. According to this study, for the group of women, only prognostic factor is hospital utilization in prior 6months to the index hospitalization. On the other hand, () argued that for the group of men, prior hospitalization is also another risk factor for returning to the hospital within 30 days. In the case of men, there are other important risk factors; those are retired men, single men (not married), having positive depression history. Depressed men have higher chance of readmission. Author 5 has also studied that that men have higher rate of hospital readmission than women. Prior hospital utilization is predictive for the future use of hospital. It is also evident that generally men often miss the date of follow up appointments with physicians. It is also appeared to be an individual risk factor for hospital readmission (Shaula et al., 2012).

Educational background:  

Two studies (Bastable, 2016 and study conducted by Krames Patient Education) have been completed for analyzing the effect and connection of educational background of a person on the aspect of hospital readmission. Study conducted by Krames Patient Education has emphasized on the necessity of education for every patient coming in hospital.

 


According to the study being conducted by Krames Patient Education, [1st author] the social factors those results in hospital readmission of the elderly patients includes inability of taking medicines post discharge, living alone thereby, unable to take proper care of themselves and the age of the patient. After been released from the hospital due to old age and staying alone, the patients are unable to take care of themselves and fail in taking proper medication that adversely affect their health. As a result, health deterioration occurs thereby, been readmitted to the hospital. It is also applicable for the patients with poor educational background and insufficient background.

On the other hand author of 2nd study Bastable (2016) argued that few patients have proper education and knowledge on the aspect of post discharge care. Few persons have clear understanding of the instruction of after hospital care. Lack of proper knowledge on taking of medicine also causes readmission of the patient. Patients should have the knowledge that he/she needs to follow the appointments date of doctor properly. 30% patients who have  less knowledge on post care of hospital discharge, likely to have the higher chance of getting readmitted in hospital.

According to the study Reducing Hospital Readmissions With Enhanced Patient Education, patient education program is required for all the patients. It should be equally distributed towards all the patients. There are many studies who have emphasized on teaching efforts for the patients and health workers also. An educative organizational culture can reduce the level of hospital readmission for the patients. With high technology and educative materials, patients can be able to understand all aspects of post hospital care.

Personal living condition:

According to Kassin et al., (2012), moreover, patients with inadequate educational background are also unable to understand the medications and health regulation thereby, causing negligence that eventually leads to hospital readmission of the elderly patients.

Income:  

Four studies have been conducted to investigate social factors those affect the aspect of hospital readmission for a person. Income level is an important factor which can affect the personal living hood of a person. According to Henry Ford’s Center for Health Policy and Health Services Research, patients with high poverty are 24% more likely to be readmitted in hospital. The relationship between patient and the risk of readmission varies for different patients. Each and every study has pointed out that readmission is a product of complex set of factors. It is often complex to separate variable of poverty while investigating the relationship between income and hospital readmission.

 


Another study Woz et al., (2012) found that income level is most significant factor for the matter of hospital readmission. According to the study done by (), there are different socio economic factors those can affect the rate of hospital readmission. Patients with less income are unable to bear the expenses post hospital discharge resulting in hospital readmission. In developing countries, patients cannot bear the expenses of hospital readmission. There are factors like poverty, living alone can become the chance of being readmitted to hospital. According to a study, it has been found that patients living in high poverty are 24% more likely to be readmitted in hospital. It has also been stated that married patients get enough social support than unmarried patients.

Psychological factors: depression, anxiety and stress level 400 more will be written

As discussed in the study of Au et al., (2012), in case of elderly patients, due to psychological factors such as anxiety, depression and stress level, hospital readmission is generally noticed. 

Depression:

Post hospital discharge the elderly patients succumbs to depression due to inability to live independently. As commented by Archer et al., (2012), depression results in major health deterioration as the elderly patient is always depressed. As a result, the medications and other health facilities do not work efficiently on them leading to hospital readmission. At certain instances, the elderly patients feels stressed out after been released from the hospital that eventually leads to anxiety.

Anxiety:

Increased level of stress and anxiety results in high blood pressure, cardiac arrest, kidney failure. The elderly patients have weak health conditions post hospital release. Therefore, depression, anxiety and stress level adversely affects their health resulting in hospital readmission (Albrecht et al., 2014).

Stress level:

As per the study Bisharat, Handler & Schwartz (2012) coronary artery bypass graft (CABG) surgery patients are mainly affected by the major, minor depression, anxiety. It has been found by studies that patients are often become so anxious to get home after spending several times in hospitals. However, hospital readmission often happens. Readmission is problematic in terms of mental health of the patients.

Physical health factors: Co morbidity diseases, physical activity, alcohol consumption and smoking

Co morbidity diseases:

Three studies have been done to find out the effect of co morbid disease on the aspect of hospital readmission. Co morbid disease is considered as the state where an additional disease or disorder can harm the patient. Co morbid disease is the additional disease or disorder exists with the primary disease. As per the data gathered from Australian health statistics, existence of co morbidity exists in Arthritis, asthma, cancer, back problem, COPD, Diabetes, CVD and different mental health conditions. As discussed by Clement et al., (2013), psychosocial factors highlight the relation between the behavior and thought of the individuals with the social factors. As mentioned by Bisharat, Handler & Schwartz (2012), the social and psychological factors greatly influences the health and lifestyle of the individuals. Unplanned admissions results due to complications of the existing health issue, co-morbid health issue or other health complications due to the existing health complications.   The elderly patient develops co morbid diseases after been released from the hospital. Post hospital release, the elderly patients develops co morbid diseases due to weak resistance power that adversely affects their health. At certain cases, elderly patients resume back to their old habits of smoking and alcohol consumption that is strictly prohibited. This also results in developing co morbid diseases eventually been re-hospitalized.

Physical activity

As mentioned by Montecino-Rodriguez, Berent-Maoz & Dorshkind (2013), old age results in weak immune system that decreases the resistance power of the individuals to fight diseases. This is one of the significant reasons for the elderly patients for being hospitalized again. Due to less physical activity, the old patients become weak.

 

Alcohol consumption: An observational study of alcohol-related readmission dynamics in young people

Two studies have discussed about the effect of alcohol consumption on the rate of hospital readmission. Two studies have found significant impact of alcohol consumption on hospital readmission. According to Hoy (2013), alcohol consumption often causes harm to the young people in London. This study has completed analysis on young people of England aged 10-25 years. These young people have an index of alcohol related emergency admission between the years of 2003-2004. These people were also tracked by the researcher for subsequent readmission related to alcohol consumption. For this aspect of alcohol consumption, the reasons related to hospital readmission are mental health issue, injury, self harm, assault and other substance. It has been found by other study (author 2), most of the young people are the victim of the alcohol consumption.

On other hand, one more study Chavez et al., (2016) has defined that for heart diseases and other diseases, alcohol consumption should be strictly managed. Unhealthy alcohol consumption can impair the level of recovery of older patients after surgical or medical hospitalization.  

Smoking 200 more will be incorporated

With alcohol consumption, smoking is also injurious to health. Excessive alcohol consumption and smoking can cause readmission to the patients.

However, study by Clement et al., (2013) have found that there are few simple steps those can reduce the rate of hospital readmission. One needs to manage the medicine, coordinate with the contact information and be detailed at discharge.

 

References:

Admission, Readmission, Discharge and Transfer Policy of WA Health Services. (2017). www.health.wa.gov.au. Retrieved 15 April 2017, from https://www.health.wa.gov.au/circularsnew/attachments/718.pdf

Albrecht, J. S., Gruber?Baldini, A. L., Hirshon, J. M., Brown, C. H., Goldberg, R., Rosenberg, J. H., ... & Furuno, J. P. (2014). Depressive symptoms and hospital readmission in older adults. Journal of the American Geriatrics Society, 62(3), 495-499.

Archer, J., Bower, P., Gilbody, S., Lovell, K., Richards, D., Gask, L., ... & Coventry, P. (2012). Collaborative care for depression and anxiety problems. The Cochrane Library.

Au, A. G., McAlister, F. A., Bakal, J. A., Ezekowitz, J., Kaul, P., & van Walraven, C. (2012). Predicting the risk of unplanned readmission or death within 30 days of discharge after a heart failure hospitalization. American heart journal, 164(3), 365-372.

Bisharat, N., Handler, C., & Schwartz, N. (2012). Readmissions to medical wards: analysis of demographic and socio-medical factors. European journal of internal medicine, 23(5), 457-460.

Clement, R. C., Derman, P. B., Graham, D. S., Speck, R. M., Flynn, D. N., Levin, L. S., & Fleisher, L. A. (2013). Risk factors, causes, and the economic implications of unplanned readmissions following total hip arthroplasty. The Journal of arthroplasty, 28(8), 7-10.

Herrin, J., St Andre, J., Kenward, K., Joshi, M. S., Audet, A. M. J., & Hines, S. C. (2015). Community factors and hospital readmission rates. Health Services Research, 50(1), 20-39.

Hospital Discharge Planning: A Guide for Families and Caregivers | Family Caregiver Alliance. (2017). Caregiver.org. Retrieved 15 April 2017, from https://www.caregiver.org/hospital-discharge-planning-guide-families-and-caregivers

Kaboli, P. J., Go, J. T., Hockenberry, J., Glasgow, J. M., Johnson, S. R., Rosenthal, G. E., ... & Vaughan-Sarrazin, M. (2012). Associations between reduced hospital length of stay and 30-day readmission rate and mortality: 14-year experience in 129 Veterans Affairs hospitals. Annals of internal medicine, 157(12), 837-845.

Kassin, M. T., Owen, R. M., Perez, S. D., Leeds, I., Cox, J. C., Schnier, K., ... & Sweeney, J. F. (2012). Risk factors for 30-day hospital readmission among general surgery patients. Journal of the American College of Surgeons, 215(3), 322-330.

LoGiudice, D., Tropea, J., Brand, C. A., Gorelik, A., & Liew, D. (2016). HOSPITALISED OLDER PEOPLE WITH DEMENTIA AND DELIRIUM: MORE READMISSIONS AND IN-HOSPITAL COMPLICATIONS, GREATER LENGTH OF STAY AND ASSOCIATED HEALTHCARE COSTS. Alzheimer's & Dementia: The Journal of the Alzheimer's Association, 12(7), P579.

Luo, Y., Hawkley, L. C., Waite, L. J., & Cacioppo, J. T. (2012). Loneliness, health, and mortality in old age: A national longitudinal study. Social science & medicine, 74(6), 907-914.

McCormack, R., Michels, R., Ramos, N., Hutzler, L., Slover, J. D., & Bosco, J. A. (2013). Thirty?Day Readmission Rates as a Measure of Quality: Causes of Readmission After Orthopedic Surgeries and Accuracy of Administrative Data. Journal of Healthcare Management, 58(1), 64-77.

McManus, D. D., Saczynski, J. S., Lessard, D., Waring, M. E., Allison, J., Parish, D. C., ... & TRACE-CORE Investigators. (2016). Reliability of Predicting Early Hospital Readmission After Discharge for an Acute Coronary Syndrome Using Claims-Based Data. The American journal of cardiology, 117(4), 501-507.

Montecino-Rodriguez, E., Berent-Maoz, B., & Dorshkind, K. (2013). Causes, consequences, and reversal of immune system aging. The Journal of clinical investigation, 123(3), 958-965.

Popa-Wagner, A., Buga, A. M., Tica, A. A., & Albu, C. V. (2014). Perfusion deficits, inflammation and aging precipitate depressive behaviour. Biogerontology, 15(5), 439-448.

Purtilo, R. B., Haddad, A. M., & Doherty, R. F. (2014). Health professional and patient interaction. Elsevier Health Sciences.

Scott, I. A., Shohag, H., & Ahmed, M. (2014). Quality of care factors associated with unplanned readmissions of older medical patients: a case–control study. Internal medicine journal, 44(2), 161-170.

Silow-Carroll, S., Edwards, J. N., & Lashbrook, A. (2011). Reducing hospital readmissions: lessons from top-performing hospitals. CareManagement, 17(5), 14.

Wang, H., Johnson, C., Robinson, R. D., Nejtek, V. A., Schrader, C. D., Leuck, J., ... & Zenarosa, N. R. (2016). Roles of disease severity and post-discharge outpatient visits as predictors of hospital readmissions. BMC health services research, 16(1), 564.

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