Original Article
Comorbidity and social factors predicted hospitalization in frail elderly patients1☆

https://doi.org/10.1016/j.jclinepi.2004.01.013Get rights and content

Abstract

Objective

Studies on factors predicting the hospital admission of geriatric patients have reported different findings. The present study was undertaken to examine the rate of hospitalization among a large sample of frail elderly people living in the community and to identify the most important clinical and patient-centered factors associated with the hospital admission.

Study design and setting

This is an observational cohort study. All patients (n = 1,291) in six Italian home health care agencies were assessed by a trained staff who collected data on the Minimum Data Set for Home Care (MDS-HC) form. We constructed a longitudinal database including MDS-HC data and information on hospital utilization by each patient.

Results

During the follow-up of 12 months, the rate of hospitalization was about 26% of the studied sample. Persons living alone were more likely to have a hospital admission than those living with an informal caregiver (odds ratio OR = 2.59, 95% confidence interval CI = 1.82–3.69). Similarly, persons with economic hardship were more frequently hospitalized than those without these problems (OR = 3.01, 95% CI = 1.75–5.18). Comorbidity and previous hospital admission were associated with a higher risk to be hospitalized, too.

Conclusion

Our results support the hypothesis that a mix of social and health problems are independent predictors of hospitalization. Identification of those factors that best predict hospital admissions and readmissions gives direction for potential interventions and further research toward reducing unnecessary hospitalizations.

Introduction

Studies on factors predicting the hospital admission of geriatric patients have reported different findings. Some studies [1], [2], [3], [4], [5] underline that the severity of disease together with the burden of comorbidity are the strongest predictors of hospitalization. On the other hand, some authors [6], [7], [8] have reported that functional disability, cognitive impairment, and social factors may affect the rate of hospitalization, beyond the specific medical conditions. These discrepant results are not surprising and may be explained by the fact that, in addition to factors directly related to the patient, many other variables may influence hospital admission.

The present study was undertaken to examine the rate of hospitalization among a large sample of frail elderly people living in the community and to identify the most important clinical and patient-centered factors associated with the hospital admission. Such information may be very helpful for providing direction for developing interventions to decrease these events.

Section snippets

Data

Data were collected as part of the national home care program Silver Network Home Care Project, under the sponsorship of the Italian Gerontology and Geriatrics Society, the Italian General Practitioners Society, and Pfizer Italy [9]. The purpose of this project was to reorganize the care of the frail older people living in the community, adopting an integrated social and medical care program along with a case management approach [10] and using the Minimum Data Set for Home Care (MDS-HC)

Results

Differences in baseline characteristics of the study sample population according to the hospital admission are shown in Table 1. Patients were Caucasian and predominately female (57%), with a mean age of 74.7 years (SD = 14.3 years). More than 62% of the individuals were aged 75 years or older. Overall, patients had a moderate-to-severe impairment in basic and instrumental activities of daily living; similarly, cognitive function was compromised in a large number of patients (more than 50% showed

Discussion

The high incidence of hospital admission among elderly people, with associated comorbidity and costs, highlights the need for identifying high-risk patients and potential strategies focused on risk factors that might be modified. Using a unique database, we were able to recognize four patient-centered characteristics that were significantly and independently related to the risk of hospitalization: those living alone without informal caregiver, those with economic hardship, those with a previous

References (30)

  • E.I. Williams et al.

    Factors affecting early unplanned readmission of elderly patients to hospital

    BMJ

    (1988)
  • F. Landi et al.

    A model for integrated home care of frail older patients: the Silver Network Project

    Aging Clin Exp Res

    (1999)
  • F. Landi et al.

    A simple program to train case managers in community elderly care

    Aging Clin Exp Res

    (1996)
  • J.N. Morris et al.

    Comprehensive clinical assessment in community setting: applicability of the MDS-HC

    J Am Geriatr Soc

    (1997)

    • Cited by (0)

    ☆

    This study was supported by a grant from the “Progetto Finalizzato Invecchiamento” of the National Research Council and from Pfizer Italiana SpA.

    1

    The Silvernet-HC Study Group is composed of the following. Steering Committee: R. Bernabei, P.U. Carbonin, M.P. Ruffilli; Coordination: F. Landi, F. Lattanzio; Writing Panel: G. Gambassi, A. Russo, M. Cesari, L. Manigrasso, F. Pagano, M.E. De Caris, A. Valiani, A. Federici, G. Onder, A. Sgadari. The full list of participants has been published elsewhere: Aging Clin Exp Res 1999;11:262–72 and Anziani Oggi 2000;3–4:152.

    View full text
    Copyright © 2004 Elsevier Inc. All rights reserved.