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Predictors of Rehospitalization Among Elderly Patients Admitted to a Rehabilitation Hospital: The Role of Polypharmacy,Functional Status,and Length of Stay
Authors:Alessandro Morandi  Giuseppe Bellelli  Eduard E. Vasilevskis  Renato Turco  Fabio Guerini  Tiziana Torpilliesi  Salvatore Speciale  Valeria Emiliani  Simona Gentile  John Schnelle  Marco Trabucchi
Affiliation:1. Department of Rehabilitation and Aged Care Hospital Ancelle, Cremona, Italy;2. Geriatric Research Group, Brescia, Italy;3. Center for Quality Aging, Department of Medicine, Vanderbilt University, Nashville, TN;4. Department of Health Science, University of Milano-Bicocca and Geriatric Clinic, S. Gerardo Hospital, Monza, Italy;5. Department of Medicine, Vanderbilt University, Nashville, TN;6. Center for Health Services Research, Department of Medicine, Vanderbilt University, Nashville, TN;g Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, Nashville, TN;h Tennessee Valley Geriatric Research Education Clinical Center, Nashville, TN;i University of Tor Vergata, Rome, Italy
Abstract:

Objectives

Rehospitalizations for elderly patients are an increasing health care burden. Nonetheless, we have limited information on unplanned rehospitalizations and the related risk factors in elderly patients admitted to in-hospital rehabilitation facilities after an acute hospitalization.

Setting

In-hospital rehabilitation and aged care unit.

Design

Retrospective cohort study.

Participants

Elderly patients 65 years or older admitted to an in-hospital rehabilitation hospital after an acute hospitalization between January 2004 and June 2011.

Measurements

The rate of 30-day unplanned rehospitalization to hospitals was recorded. Risk factors for unplanned rehospitalization were evaluated at rehabilitation admission: age, comorbidity, serum albumin, number of drugs, decline in functional status, delirium, Mini Mental State Examination score, and length of stay in the acute hospital. A multivariable Cox proportional regression model was used to identify the effect of these risk factors for time to event within the 30-day follow-up.

Results

Among 2735 patients, with a median age of 80 years (interquartile range 74–85), 98 (4%) were rehospitalized within 30 days. Independent predictors of 30-day unplanned rehospitalization were the use of 7 or more drugs (hazard ratio [HR], 3.94; 95% confidence interval, 1.62–9.54; P = .002) and a significant decline in functional status (56 points or more at the Barthel Index) compared with the month before hospital admission (HR 2.67, 95% CI: 1.35–5.27; P = .005). Additionally, a length of stay in the acute hospital of 13 days or more carried a twofold higher risk of rehospitalization (HR 2.67, 95% CI: 1.39–5.10); P = .003).

Conclusions

The rate of unplanned rehospitalization was low in this study. Polypharmacy, a significant worsening of functional status compared with the month before acute hospital admission, and hospital length of stay are important risk factors.
Keywords:Rehospitalization   elderly   in-hospital rehabilitation risk factors
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