Early re-hospitalization of elderly people discharged from a geriatric ward.

BACKGROUND AND AIMS: Hospitalized elderly patients generally have a high level of disability and comorbidity. In many cases, at hospital discharge, the achieved health status balance is poor, and consequently the risk of further disability and hospital readmission is great. Identifying factors leading to hospital readmission could be helpful in reducing such events. The aim of the study was to evaluate the incidence and predictive factors of hospital readmission. METHODS: We conducted an observational cohort study of a group of patients discharged from the Geriatric Ward of the San Giovanni Battista Hospital, Torino (Italy). The study sample contained 839 patients aged 80.6 +/- 6.3 years. The average hospital stay was 17.5 +/- 18.9 days (range 1-274 days). RESULTS: Follow-up lasted three months, at the end of which 107 patients (12.8%) had been readmitted, 83 (9.9%) had only one readmission and 24 (2.9%) one or more readmissions. The first readmission took place within 15 days of discharge for 24 patients (2.9%) and within 30 days of discharge for 27 (3.2%). A new hospital admission within 15 days of discharge increased the risk of mortality (RR=3) and also the probability of a second re-hospitalization. 10.1% patients died; 88.2% of the patients who died had at least one readmission, whereas only 4.2% of live patients had a new hospital admission. CONCLUSIONS: Tumors, dementia, comorbidity, high education level, day hospital course and period of convalescence were all significantly and independently related to readmission.

[Comorbidity in the elderly: a sample of 2373 hospitalized elderly patients]. / La comorbilità nell'anziano: studio in 2373 pazienti ricoverati in una Divisione per acuti.

The aim of this study was to discuss about prevalence and clinical rilevance of comorbidity in the elderly patients. Our sample included 2373 (mean age 77.8 +/- 8.5; 1302 men and 1071 woman) consecutively admitted to the University Department of Geriatric Medicine of Torino. We examined some demographic variables, cognitive and functional status, main pathologies. Severity of illness was assessed using the C.I.R.S. The coexistence of two or more diseases was 83%: cardiovascular and chronic pulmonary diseases were the most frequently recorded (respectively 68% and 27%). The comorbidity and severity indexes of C.I.R.S. were associated respectively with mortality (O.R. 1.78; C.I. 1.36 - 2.33) and length of hospital staying (O.R. 2.35; C.I. 1.19 - 4.65). Comorbidity is an important specific prognostic indicator for reliable risk stratification of older patients.

[Falls in hospitalized elderly patients: incidence and risk factors]. / Le cadute nell'anziano ospedalizzato: incidenza e fattori di rischio.

Aim of the study was to determine the incidence and risk factors for falls in hospitalized elderly patients. In a prospective observational study we investigated the characteristics of 620 elderly patients. We examined demographic variables, cognitive and functional status, main pathologies and drugs. Balance and gait were evaluated by Tinetti's scale. Seventy patients (11.3%) fell during hospitalization. The incidence rate of first falls was 5.2 per 1000 patient-days. Five independent variables were significantly and independently associated to falls: age, balance impairment, acute cognitive impairment, diabetes, and use of tricyclic antidepressants. Falls are common in hospitalized elderly patients and risk factors identification can be useful for a targeted multiple intervention falls prevention programme.

Multidimensional assessment and risk factors for prolonged hospitalization in the elderly.

BACKGROUND AND AIMS: Frailty, multiple pathologies, functional impairment and socioeconomic conditions can prolong the length of hospitalization in the elderly. The aim of our study was to analyze risk factors for prolonged hospitalization. METHODS: Our sample included 1054 patients consecutively admitted to the University Department of Geriatric Medicine of Torino, Italy. We examined some demographic variables (age, sex, socioeconomic conditions), affective, cognitive and functional status, main pathologies, and blood pressure and some hematological parameters (hemoglobin, creatinine, albumin, sodium). RESULTS: The number of functions lost to IADL and ADL, DMI (Dependent Medical Index) dependence, high levels of creatinine and low blood levels of albumin and sodium were associated with longer hospitalization, as also were the following clinical diagnoses: tumor, chronic obstructive pulmonary disease (COPD), hip fractures, peripheral arterial disease (PAD), and pressure sores. Independent predictors of prolonged hospitalization were: the number of functions lost to the ADL index, pressure sores, hip fracture, peripheral arterial disease with critical ischemia, and low levels of sodium. CONCLUSIONS: Multidimensional assessment is essential to identify medical, functional and socioeconomic problems, and can highlight risk factors for prolonged hospitalization.