SCREENING ELDERS FOR RISK OF HOSPITAL ADMISSION

Objective: To define a set of screening criteria that identifies elder s who are, at high risk for repeated hospital admission in the future. Design: Longitudinal cohort study. Logistic regression analysis of da ta from half of the subjects was used to identify risk factors for rep eated hospital admission. The ability of these risk factors to identif y elders who are at high risk for repeated hospitalization in the futu re was then tested using data from the other half of the subjects. Set ting: United States. Participants: A subsample (n = 5876) of a multist age probability sample of all non-institutionalized U.S. civilians who were 70 years or older in 1984. Measurements: At baseline (1984), eld erly subjects were asked about their demographic, socioeconomic, medic al, and functional characteristics and about their recent use of healt h. services. Their subsequent hospital admissions and mortality were t hen monitored through the records of the Medicare program and the Nati onal Death Index (1985-88). Results: Among the subjects in the first h alf of the sample, eight factors emerged as risk factors for repeated admission: older age, male, sex, poor self-rated general health, avail ability of an informal caregiver, having ever had coronary artery dise ase, and having had, during the previous year, a hospital admission, m ore than six doctor visits, or diabetes. Based on the presence or abse nce of these factors in 1984, 7.2% of the subjects in the second half of the sample were estimated to have a high probability of repeated ad mission (P(ra) greater-than-or-equal-to 0.5) during 1985-1988. In comp arison with subjects estimated to have a low risk (P(ra) < 0.5), this high-risk group's actual experiences during 1985-1988 included a highe r cumulative incidence of repeated admission (41.8% vs 26.2%, P < 0.00 01), a higher cumulative rate of mortality (44.2% vs 19.0%, P < 0.0001 ), more hospital days per person-year survived (5.2 vs 2.6), and highe r hospital charges per person-year survived ($3731 vs $1841). Conclusi on: Eight easily ascertained risk factors affect elders' probability o f being hospitalized repeatedly within four years. In the future, brie f surveys about the presence of these factors could be used to estimat e elders' risk of future hospitalization and, thereby, to identify som e of those who may derive the greatest benefit from interventions desi gned to avert the need for hospitalization.