CHARACTERISTICS OF GERIATRIC-PATIENTS RELATED TO EARLY AND LATE READMISSIONS TO HOSPITAL

The aim of the study was to evaluate which characteristics of geriatri c patients account for readmission to hospital, 6 months after dischar ge. All patients (203 females, 176 males) consecutively admitted over a two-month period to four acute geriatric care units, located in the cities of Chieti, Perugia, Pescara and Prato, participated in the stud y. Data that could potentially explain early and late readmissions wer e collected for each patient. Prevalence of diseases and comorbidity w ere assessed with the Cumulative Illness Rating Scale (CIRS); physical function by self-report (ADL, IADL) and objective (Stand and Walking Speed) measures; cognitive level by MMSE; and depressive symptoms by t he Geriatric Depression Scale (GDS). information on family and social support were also obtained. After discharge, data on hospital readmiss ions were collected for six months. For each readmitted patient (cases ), medical records were reviewed, and supplementary information was ob tained from families and general practitioners. Readmissions were clas sified as ''early'' (within the first three months), ''late'' (within the third and sixth month), and ''multiple'' (2 or more readmissions i rrespective of the period). Patients not readmitted (alive at home) we re considered as controls. Systematic differences between centers and between periods of readmissions were evaluated using one-way analyses of variance, and Pearson's chi(2) test. Factors related to early, late , and multiple readmission were identified in multivariate logistic re gression models. On univariate analysis, patients readmitted over the first three-month period were sicker than controls (CIRS classes 3-4: 52.1% vs 34.1%), had more social problems or behavioral symptoms, and were more functionally impaired (ADL dependencies 3.3+/-0.4 vs 2.1+/-0 .2). Patients who were readmitted between the third and the sixth mont h after discharge had a significantly higher CIRS total score (p=0.006 ). Patients with multiple readmissions had more severe diseases, and m ore social problems. On multivariate analysis, early readmission was a ssociated with unsatisfactory social conditions, living alone, severit y of diseases and cognitive impairment, while late readmission was ass ociated with comorbidity only. Multiple readmissions were related only to social factors, and to hospital admission before the baseline eval uation. The findings of this study suggest that interventions aimed at improving unfavorable social conditions may reduce the rate of rehosp italization in geriatric patients. (Aging Clin. Exp. Res. 10: 339-346, 1998) (C) 1998, Editrice Kurtis.