Risk factors for early emergency hospital readmission in elderly medical patients

Background: Early emergency readmissions is a common and important problem in the elderly patient. Identification of the risk factors for early emerge ncy readmissions is needed to prevent this occurring. Objective: The aim of this study was to study the risk factors for early emergency readmission i n the elderly medical patient. Methods: A case-control study (sex- and age- matched) was conducted from March to December 1996. 380 elderly (age 65 yea rs or over) medical patients with emergency hospital readmission (within 28 days) and 380 matched controls were recruited from an acute university gen eral hospital in Hong Kong. Potential risk factors which included demograph ic, socio-economic, principal medical diseases, comorbid diseases, dysphagi a, physical functional status and mental status were studied. results: In b ivariate analyses for the risk factors of early emergency readmission, inst itutional carer, previous visiting nurse service, adverse drug reaction, ch ronic obstructive pulmonary disease, end-stage renal failure, mobility bein g chair- or bed-bound, dysphagia, use of a nasogastric tube feeding, urinar y incontinence and bowel incontinence were significant. Readmission cases h ad higher mean number of comorbid diseases, lower mean Barthel Index, highe r mean number of impairments in Activities of Daily Living (ADL) tasks and lower mean Abbreviated Mental Test score than controls. In multivariate log istic regression model, the number of ADL impairments (OR = 1.13, 95% CI = 1.08-1.19), no income (OR = 2.28, 95% CI = 1.19-4.37), adverse drug reactio n (OR = 4.19, 95% CI = 1.56-11.2), advanced malignancy (OR = 2.45, 95% CI = 1.37-4.37), congestive heart failure (OR = 1.63, 95% CI = 1.05-2.53), chro nic obstructive airways disease (OR = 2.1, 95% CI = 1.47-3.02), end-stage r enal failure (OR = 5.48, 95% CI = 1.69-17.75), dysphagia (OR = 3.9, 95% CI = 1.5-10.11) and the number of comorbid diseases (OR = 1.3, 95% CI = 1.13-1 .49) were significant risk factors for early emergency readmissions. Living in a private old aged home was associated with a lower risk of readmission s (OR = 0.53, 95% CI = 0.36-0.93). Conclusions: Definite medical, functiona l and socio-economic factors were found to be risk factors for early emerge ncy readmissions in the elderly medical patient. A multiple risk factors in tervention approach should be considered in designing future prevention str ategies.