Predictors of short‐term hospitalization and emergency department presentations in aged care
Objectives To examine individual, medication, system, and healthcare related predictors of hospitalization and emergency department (ED) presentation within 90 days of entering the aged care sector, and to create risk‐profiles associated with these outcomes. Design and setting Retrospective populati...
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Veröffentlicht in: | Journal of the American Geriatrics Society (JAGS) 2021-11, Vol.69 (11), p.3142-3156 |
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creator | Inacio, Maria C. Jorissen, Robert N. Khadka, Jyoti Whitehead, Craig Maddison, John Bourke, Alice Pham, Clarabelle T. Karnon, Jonathon Wesselingh, Steve L. Lynch, Elizabeth Harvey, Gillian Caughey, Gillian E. Crotty, Maria |
description | Objectives
To examine individual, medication, system, and healthcare related predictors of hospitalization and emergency department (ED) presentation within 90 days of entering the aged care sector, and to create risk‐profiles associated with these outcomes.
Design and setting
Retrospective population‐based cohort study using data from the Registry of Senior Australians.
Participants
Older people (aged 65 and older) with an aged care eligibility assessment in South Australia between January 1, 2013 and May 31, 2016 (N = 22,130).
Measurements
Primary outcomes were unplanned hospitalization and ED presentation within 90 days of assessment. Individual, medication, system, and healthcare related predictors of the outcomes at the time of assessment, within 90 days or 1‐year prior. Fine–Gray models were used to calculate subdistribution hazard ratios (sHR) and 95% confidence intervals (CI). Harrell's C‐index assessed predictive ability.
Results
Four thousand nine‐hundred and six (22.2%) individuals were hospitalized and 5028 (22.7%) had an ED presentation within 90 days. Predictors of hospitalization included: being a man (hospitalization sHR = 1.33, 95% CI 1.26–1.42), ≥3 urgent after‐hours attendances (hospitalization sHR = 1.21, 95% CI 1.06–1.39), increasing frailty index score (hospitalization sHR = 1.19, 95% CI 1.11–1.28), individuals using glucocorticoids (hospitalization sHR = 1.11, 95% CI 1.02–1.20), sulfonamides (hospitalization sHR = 1.18, 95% CI 1.10–1.27), trimethoprim antibiotics (hospitalization sHR = 1.15, 95% CI 1.03–1.29), unplanned hospitalizations 30 days prior (hospitalization sHR = 1.13, 95% CI 1.04–1.23), and ED presentations 1 year prior (hospitalization sHR = 1.07, 95% CI 1.04–1.10). Similar predictors and hazard estimates were also observed for ED presentations. The hospitalization models out‐of‐sample predictive ability (C‐index = 0.653, 95% CI 0.635–0.670) and ED presentations (C‐index = 0.647, 95% CI 0.630–0.663) were moderate.
Conclusions
One in five individuals with aged care eligibility assessments had unplanned hospitalizations and/or ED presentation within 90 days with several predictors identified at the time of aged care eligibility assessment. This is an actionable period for targeting at‐risk individuals to reduce hospitalizations. |
doi_str_mv | 10.1111/jgs.17317 |
format | Article |
fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2544159822</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2544159822</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3887-c3105e420be1fbdfc0ade1b54a85b270b6b0451f8614391f5fb4cfbdb1fe3c8d3</originalsourceid><addsrcrecordid>eNp10LtOwzAUBmALgWgpDLwAssQCQ1tf4jQZUQUFhAQSsBLZznGbKomDnQqViUfgGXkS3AsMSHjwGfzpl8-P0DElAxrOcD71AzridLSDulRw1hcRFbuoSwhh_SSmUQcdeD8nhDKSJPuow8O7iHnURS8PDvJCt9Z5bA32M-var4_PFlyFZ9Y3RSvL4l22ha2xrHMMFbgp1HqJc2ikayuoW9w48GGulcdFkFPIsZYODtGekaWHo-3soeery6fxdf_ufnIzvrjra54ko3BTIiBiRAE1KjeayByoEpFMhGIjomJFIkHNaheeUiOMinSAihrgOsl5D51tchtnXxfg26wqvIaylDXYhc-YiMLKacJYoKd_6NwuXB1-F1Qap5TxNA7qfKO0s947MFnjikq6ZUZJtio9C6Vn69KDPdkmLlQF-a_8aTmA4Qa8FSUs_0_KbiePm8hvL4mN2w</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2596912396</pqid></control><display><type>article</type><title>Predictors of short‐term hospitalization and emergency department presentations in aged care</title><source>MEDLINE</source><source>Wiley Online Library</source><creator>Inacio, Maria C. ; Jorissen, Robert N. ; Khadka, Jyoti ; Whitehead, Craig ; Maddison, John ; Bourke, Alice ; Pham, Clarabelle T. ; Karnon, Jonathon ; Wesselingh, Steve L. ; Lynch, Elizabeth ; Harvey, Gillian ; Caughey, Gillian E. ; Crotty, Maria</creator><creatorcontrib>Inacio, Maria C. ; Jorissen, Robert N. ; Khadka, Jyoti ; Whitehead, Craig ; Maddison, John ; Bourke, Alice ; Pham, Clarabelle T. ; Karnon, Jonathon ; Wesselingh, Steve L. ; Lynch, Elizabeth ; Harvey, Gillian ; Caughey, Gillian E. ; Crotty, Maria</creatorcontrib><description>Objectives
To examine individual, medication, system, and healthcare related predictors of hospitalization and emergency department (ED) presentation within 90 days of entering the aged care sector, and to create risk‐profiles associated with these outcomes.
Design and setting
Retrospective population‐based cohort study using data from the Registry of Senior Australians.
Participants
Older people (aged 65 and older) with an aged care eligibility assessment in South Australia between January 1, 2013 and May 31, 2016 (N = 22,130).
Measurements
Primary outcomes were unplanned hospitalization and ED presentation within 90 days of assessment. Individual, medication, system, and healthcare related predictors of the outcomes at the time of assessment, within 90 days or 1‐year prior. Fine–Gray models were used to calculate subdistribution hazard ratios (sHR) and 95% confidence intervals (CI). Harrell's C‐index assessed predictive ability.
Results
Four thousand nine‐hundred and six (22.2%) individuals were hospitalized and 5028 (22.7%) had an ED presentation within 90 days. Predictors of hospitalization included: being a man (hospitalization sHR = 1.33, 95% CI 1.26–1.42), ≥3 urgent after‐hours attendances (hospitalization sHR = 1.21, 95% CI 1.06–1.39), increasing frailty index score (hospitalization sHR = 1.19, 95% CI 1.11–1.28), individuals using glucocorticoids (hospitalization sHR = 1.11, 95% CI 1.02–1.20), sulfonamides (hospitalization sHR = 1.18, 95% CI 1.10–1.27), trimethoprim antibiotics (hospitalization sHR = 1.15, 95% CI 1.03–1.29), unplanned hospitalizations 30 days prior (hospitalization sHR = 1.13, 95% CI 1.04–1.23), and ED presentations 1 year prior (hospitalization sHR = 1.07, 95% CI 1.04–1.10). Similar predictors and hazard estimates were also observed for ED presentations. The hospitalization models out‐of‐sample predictive ability (C‐index = 0.653, 95% CI 0.635–0.670) and ED presentations (C‐index = 0.647, 95% CI 0.630–0.663) were moderate.
Conclusions
One in five individuals with aged care eligibility assessments had unplanned hospitalizations and/or ED presentation within 90 days with several predictors identified at the time of aged care eligibility assessment. This is an actionable period for targeting at‐risk individuals to reduce hospitalizations.</description><identifier>ISSN: 0002-8614</identifier><identifier>EISSN: 1532-5415</identifier><identifier>DOI: 10.1111/jgs.17317</identifier><identifier>PMID: 34155634</identifier><language>eng</language><publisher>Hoboken, USA: John Wiley & Sons, Inc</publisher><subject>Aged ; aged care ; Anti-Bacterial Agents ; Antibiotics ; Elder care ; emergency department presentation ; Emergency medical care ; Emergency Service, Hospital - statistics & numerical data ; Female ; Geriatric Assessment - statistics & numerical data ; Glucocorticoids ; Health care ; Hospitalization ; Hospitalization - statistics & numerical data ; Humans ; Male ; Medication Adherence - statistics & numerical data ; Population studies ; predictors ; Registries ; Residential Facilities ; Retrospective Studies ; Risk Factors ; Sex Factors ; South Australia ; Sulfonamides ; Time Factors ; Trimethoprim</subject><ispartof>Journal of the American Geriatrics Society (JAGS), 2021-11, Vol.69 (11), p.3142-3156</ispartof><rights>2021 The American Geriatrics Society.</rights><rights>2021 American Geriatrics Society and Wiley Periodicals LLC</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3887-c3105e420be1fbdfc0ade1b54a85b270b6b0451f8614391f5fb4cfbdb1fe3c8d3</citedby><cites>FETCH-LOGICAL-c3887-c3105e420be1fbdfc0ade1b54a85b270b6b0451f8614391f5fb4cfbdb1fe3c8d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjgs.17317$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjgs.17317$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34155634$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Inacio, Maria C.</creatorcontrib><creatorcontrib>Jorissen, Robert N.</creatorcontrib><creatorcontrib>Khadka, Jyoti</creatorcontrib><creatorcontrib>Whitehead, Craig</creatorcontrib><creatorcontrib>Maddison, John</creatorcontrib><creatorcontrib>Bourke, Alice</creatorcontrib><creatorcontrib>Pham, Clarabelle T.</creatorcontrib><creatorcontrib>Karnon, Jonathon</creatorcontrib><creatorcontrib>Wesselingh, Steve L.</creatorcontrib><creatorcontrib>Lynch, Elizabeth</creatorcontrib><creatorcontrib>Harvey, Gillian</creatorcontrib><creatorcontrib>Caughey, Gillian E.</creatorcontrib><creatorcontrib>Crotty, Maria</creatorcontrib><title>Predictors of short‐term hospitalization and emergency department presentations in aged care</title><title>Journal of the American Geriatrics Society (JAGS)</title><addtitle>J Am Geriatr Soc</addtitle><description>Objectives
To examine individual, medication, system, and healthcare related predictors of hospitalization and emergency department (ED) presentation within 90 days of entering the aged care sector, and to create risk‐profiles associated with these outcomes.
Design and setting
Retrospective population‐based cohort study using data from the Registry of Senior Australians.
Participants
Older people (aged 65 and older) with an aged care eligibility assessment in South Australia between January 1, 2013 and May 31, 2016 (N = 22,130).
Measurements
Primary outcomes were unplanned hospitalization and ED presentation within 90 days of assessment. Individual, medication, system, and healthcare related predictors of the outcomes at the time of assessment, within 90 days or 1‐year prior. Fine–Gray models were used to calculate subdistribution hazard ratios (sHR) and 95% confidence intervals (CI). Harrell's C‐index assessed predictive ability.
Results
Four thousand nine‐hundred and six (22.2%) individuals were hospitalized and 5028 (22.7%) had an ED presentation within 90 days. Predictors of hospitalization included: being a man (hospitalization sHR = 1.33, 95% CI 1.26–1.42), ≥3 urgent after‐hours attendances (hospitalization sHR = 1.21, 95% CI 1.06–1.39), increasing frailty index score (hospitalization sHR = 1.19, 95% CI 1.11–1.28), individuals using glucocorticoids (hospitalization sHR = 1.11, 95% CI 1.02–1.20), sulfonamides (hospitalization sHR = 1.18, 95% CI 1.10–1.27), trimethoprim antibiotics (hospitalization sHR = 1.15, 95% CI 1.03–1.29), unplanned hospitalizations 30 days prior (hospitalization sHR = 1.13, 95% CI 1.04–1.23), and ED presentations 1 year prior (hospitalization sHR = 1.07, 95% CI 1.04–1.10). Similar predictors and hazard estimates were also observed for ED presentations. The hospitalization models out‐of‐sample predictive ability (C‐index = 0.653, 95% CI 0.635–0.670) and ED presentations (C‐index = 0.647, 95% CI 0.630–0.663) were moderate.
Conclusions
One in five individuals with aged care eligibility assessments had unplanned hospitalizations and/or ED presentation within 90 days with several predictors identified at the time of aged care eligibility assessment. This is an actionable period for targeting at‐risk individuals to reduce hospitalizations.</description><subject>Aged</subject><subject>aged care</subject><subject>Anti-Bacterial Agents</subject><subject>Antibiotics</subject><subject>Elder care</subject><subject>emergency department presentation</subject><subject>Emergency medical care</subject><subject>Emergency Service, Hospital - statistics & numerical data</subject><subject>Female</subject><subject>Geriatric Assessment - statistics & numerical data</subject><subject>Glucocorticoids</subject><subject>Health care</subject><subject>Hospitalization</subject><subject>Hospitalization - statistics & numerical data</subject><subject>Humans</subject><subject>Male</subject><subject>Medication Adherence - statistics & numerical data</subject><subject>Population studies</subject><subject>predictors</subject><subject>Registries</subject><subject>Residential Facilities</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Sex Factors</subject><subject>South Australia</subject><subject>Sulfonamides</subject><subject>Time Factors</subject><subject>Trimethoprim</subject><issn>0002-8614</issn><issn>1532-5415</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp10LtOwzAUBmALgWgpDLwAssQCQ1tf4jQZUQUFhAQSsBLZznGbKomDnQqViUfgGXkS3AsMSHjwGfzpl8-P0DElAxrOcD71AzridLSDulRw1hcRFbuoSwhh_SSmUQcdeD8nhDKSJPuow8O7iHnURS8PDvJCt9Z5bA32M-var4_PFlyFZ9Y3RSvL4l22ha2xrHMMFbgp1HqJc2ikayuoW9w48GGulcdFkFPIsZYODtGekaWHo-3soeery6fxdf_ufnIzvrjra54ko3BTIiBiRAE1KjeayByoEpFMhGIjomJFIkHNaheeUiOMinSAihrgOsl5D51tchtnXxfg26wqvIaylDXYhc-YiMLKacJYoKd_6NwuXB1-F1Qap5TxNA7qfKO0s947MFnjikq6ZUZJtio9C6Vn69KDPdkmLlQF-a_8aTmA4Qa8FSUs_0_KbiePm8hvL4mN2w</recordid><startdate>202111</startdate><enddate>202111</enddate><creator>Inacio, Maria C.</creator><creator>Jorissen, Robert N.</creator><creator>Khadka, Jyoti</creator><creator>Whitehead, Craig</creator><creator>Maddison, John</creator><creator>Bourke, Alice</creator><creator>Pham, Clarabelle T.</creator><creator>Karnon, Jonathon</creator><creator>Wesselingh, Steve L.</creator><creator>Lynch, Elizabeth</creator><creator>Harvey, Gillian</creator><creator>Caughey, Gillian E.</creator><creator>Crotty, Maria</creator><general>John Wiley & Sons, Inc</general><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7TK</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>202111</creationdate><title>Predictors of short‐term hospitalization and emergency department presentations in aged care</title><author>Inacio, Maria C. ; Jorissen, Robert N. ; Khadka, Jyoti ; Whitehead, Craig ; Maddison, John ; Bourke, Alice ; Pham, Clarabelle T. ; Karnon, Jonathon ; Wesselingh, Steve L. ; Lynch, Elizabeth ; Harvey, Gillian ; Caughey, Gillian E. ; Crotty, Maria</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3887-c3105e420be1fbdfc0ade1b54a85b270b6b0451f8614391f5fb4cfbdb1fe3c8d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Aged</topic><topic>aged care</topic><topic>Anti-Bacterial Agents</topic><topic>Antibiotics</topic><topic>Elder care</topic><topic>emergency department presentation</topic><topic>Emergency medical care</topic><topic>Emergency Service, Hospital - statistics & numerical data</topic><topic>Female</topic><topic>Geriatric Assessment - statistics & numerical data</topic><topic>Glucocorticoids</topic><topic>Health care</topic><topic>Hospitalization</topic><topic>Hospitalization - statistics & numerical data</topic><topic>Humans</topic><topic>Male</topic><topic>Medication Adherence - statistics & numerical data</topic><topic>Population studies</topic><topic>predictors</topic><topic>Registries</topic><topic>Residential Facilities</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Sex Factors</topic><topic>South Australia</topic><topic>Sulfonamides</topic><topic>Time Factors</topic><topic>Trimethoprim</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Inacio, Maria C.</creatorcontrib><creatorcontrib>Jorissen, Robert N.</creatorcontrib><creatorcontrib>Khadka, Jyoti</creatorcontrib><creatorcontrib>Whitehead, Craig</creatorcontrib><creatorcontrib>Maddison, John</creatorcontrib><creatorcontrib>Bourke, Alice</creatorcontrib><creatorcontrib>Pham, Clarabelle T.</creatorcontrib><creatorcontrib>Karnon, Jonathon</creatorcontrib><creatorcontrib>Wesselingh, Steve L.</creatorcontrib><creatorcontrib>Lynch, Elizabeth</creatorcontrib><creatorcontrib>Harvey, Gillian</creatorcontrib><creatorcontrib>Caughey, Gillian E.</creatorcontrib><creatorcontrib>Crotty, Maria</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Inacio, Maria C.</au><au>Jorissen, Robert N.</au><au>Khadka, Jyoti</au><au>Whitehead, Craig</au><au>Maddison, John</au><au>Bourke, Alice</au><au>Pham, Clarabelle T.</au><au>Karnon, Jonathon</au><au>Wesselingh, Steve L.</au><au>Lynch, Elizabeth</au><au>Harvey, Gillian</au><au>Caughey, Gillian E.</au><au>Crotty, Maria</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predictors of short‐term hospitalization and emergency department presentations in aged care</atitle><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle><addtitle>J Am Geriatr Soc</addtitle><date>2021-11</date><risdate>2021</risdate><volume>69</volume><issue>11</issue><spage>3142</spage><epage>3156</epage><pages>3142-3156</pages><issn>0002-8614</issn><eissn>1532-5415</eissn><abstract>Objectives
To examine individual, medication, system, and healthcare related predictors of hospitalization and emergency department (ED) presentation within 90 days of entering the aged care sector, and to create risk‐profiles associated with these outcomes.
Design and setting
Retrospective population‐based cohort study using data from the Registry of Senior Australians.
Participants
Older people (aged 65 and older) with an aged care eligibility assessment in South Australia between January 1, 2013 and May 31, 2016 (N = 22,130).
Measurements
Primary outcomes were unplanned hospitalization and ED presentation within 90 days of assessment. Individual, medication, system, and healthcare related predictors of the outcomes at the time of assessment, within 90 days or 1‐year prior. Fine–Gray models were used to calculate subdistribution hazard ratios (sHR) and 95% confidence intervals (CI). Harrell's C‐index assessed predictive ability.
Results
Four thousand nine‐hundred and six (22.2%) individuals were hospitalized and 5028 (22.7%) had an ED presentation within 90 days. Predictors of hospitalization included: being a man (hospitalization sHR = 1.33, 95% CI 1.26–1.42), ≥3 urgent after‐hours attendances (hospitalization sHR = 1.21, 95% CI 1.06–1.39), increasing frailty index score (hospitalization sHR = 1.19, 95% CI 1.11–1.28), individuals using glucocorticoids (hospitalization sHR = 1.11, 95% CI 1.02–1.20), sulfonamides (hospitalization sHR = 1.18, 95% CI 1.10–1.27), trimethoprim antibiotics (hospitalization sHR = 1.15, 95% CI 1.03–1.29), unplanned hospitalizations 30 days prior (hospitalization sHR = 1.13, 95% CI 1.04–1.23), and ED presentations 1 year prior (hospitalization sHR = 1.07, 95% CI 1.04–1.10). Similar predictors and hazard estimates were also observed for ED presentations. The hospitalization models out‐of‐sample predictive ability (C‐index = 0.653, 95% CI 0.635–0.670) and ED presentations (C‐index = 0.647, 95% CI 0.630–0.663) were moderate.
Conclusions
One in five individuals with aged care eligibility assessments had unplanned hospitalizations and/or ED presentation within 90 days with several predictors identified at the time of aged care eligibility assessment. This is an actionable period for targeting at‐risk individuals to reduce hospitalizations.</abstract><cop>Hoboken, USA</cop><pub>John Wiley & Sons, Inc</pub><pmid>34155634</pmid><doi>10.1111/jgs.17317</doi><tpages>15</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Aged aged care Anti-Bacterial Agents Antibiotics Elder care emergency department presentation Emergency medical care Emergency Service, Hospital - statistics & numerical data Female Geriatric Assessment - statistics & numerical data Glucocorticoids Health care Hospitalization Hospitalization - statistics & numerical data Humans Male Medication Adherence - statistics & numerical data Population studies predictors Registries Residential Facilities Retrospective Studies Risk Factors Sex Factors South Australia Sulfonamides Time Factors Trimethoprim |
title | Predictors of short‐term hospitalization and emergency department presentations in aged care |
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