Risk factors for hospital readmissions in elderly patients: a systematic review.

Population ageing is associated with an increase in hospital admissions. Defining the factors that affect the risk of hospital readmission could identify individuals at high risk and enable targeted interventions to be designed. This aim of this study was to identify the risk factors for hospital readmission in elderly people. A systematic review of the literature published in English or Spanish was performed by electronically searching EMBASE, MEDLINE, CINAHL, SCI and SSCI. Some keywords were aged, elder, readmission, risk, etc. Selection criteria were: prospective cohort studies with suitable statistical analysis such as logistic regression, that explored the relationship between the risk of readmission with clinical, socio-demographic or other factors in elderly patients (aged at least 75 years) admitted to hospital. Studies that fulfilled these criteria were reviewed and data were extracted by two reviewers. We assessed the methodological quality of the studies and prepared a narrative synthesis. We included 12 studies: 11 were selected from 1392 articles identified from the electronic search and one additional reference was selected by manual review. Socio-demographic factors were only explanatory in a few models, while prior admissions and duration of hospital stay were frequently relevant factors in others. Morbidity and functional disability were the most common risk factors. The results demonstrate the need for increased vigilance of elderly patients who are admitted to hospital with specific characteristics that include previous hospital admissions, duration of hospital stay, morbidity and functional disability.

[Morbidity in the caregivers of patients confined to their homes]. / Morbilidad en cuidadores de pacientes confinados en su domicilio.

OBJECTIVE: To study the presence of physical and psychological morbidity in the main carers of patients in home care programmes. DESIGN: A descriptive crossover study with a control group. SETTING: Primary care. PATIENTS: The study group consisted of 79 main carers of patients in the home care programme. The control group was 82 people, paired by age and sex, and chosen at random from the list of individual health cards. MEASUREMENTS AND MAIN RESULTS: 84.8% of carers were women, with mean age 58.7 +/- 11.6, and 45.1% were daughters of the invalid, with an average 7.6 +/- 7.9 years as carer. 78.5% had some chronic illness related to stress versus 59.8% in the control group (p = 0.01). 69.6% had psychological malaise connected with anxiety, and 43% connected with depression, versus 45.1% (p = 0.002) and 25.6% (p = 0.02), respectively, in the control group. There were no significant differences in mean frequency of attendance over the preceding 6 months between carers and controls (3.7 +/- 3.8 versus 3 +/- 4.6 times). CONCLUSIONS: There is a significantly greater amount of psychological malaise related to anxiety and depression among carers than in the control group. Many of them may be untreated. Carers have significantly more chronic illnesses, possibly related to stress, than the control group and receive little help in their work. However, they do not generate greater demand for medical care than the control group.

[User satisfaction in a health district. Differences according to the care model]. / Satisfacción de los usuarios de una zona de salud. Diferencias según modelo asistencial.

OBJECTIVES: To evaluate user satisfaction with their medical care, in relation to some points of care procedures, and to study the association between medical care and the care model. DESIGN: A descriptive cross-sectional study, carried out through a telephone poll. SETTING: Primary Care. PATIENTS AND OTHER PARTICIPANTS: Systematic randomised sample of 538 users, who were listed at a Health Centre as having an individual health card. MEASUREMENTS AND MAIN RESULTS: There was a 73.8% reply rate, with a total of 397 valid polls. Total Cronbach's alpha of the variables concerning satisfaction was 0.91. There were no differences in the sociodemographic variables between the users of the two care models. Waiting time before entering the consulting room was significantly greater among users of the reformed model (RM) than the traditional model (TM) (P < 0.00001). Variables associated with satisfaction with the doctor were: doctor's interest in the patient's problems, assessment of the time spent by the doctor in clinical investigation, agreement with the doctor's prescription, clarification of doubts, use of the clinical history and overall satisfaction with the medical care received. RM doctors were found more satisfactory for all these variables (p < 0.00001). CONCLUSIONS: These findings showed greater satisfaction among RM users.

[Analysis for different age groups of the coverage of the preventive measures and health publicity programme]. / Análisis de la cobertura del programa de actividades preventivas y promoción de la salud según grupos de edad.

OBJECTIVE: To find out whether the preventive measures proposed in the Preventive Measures and Health Promotion Programme (PMHPP) are a priority among youth with a low level of health service demand. DESIGN: Descriptive, retrospective study. SETTING: Primary Care Centre. PATIENTS: 378 patients (179 men and 199 women) making up a representative sample stratified by age and gender. MEASUREMENTS AND MAIN RESULTS: The particular page for recording PMHPP was found in only 13% of the medical records of the 15-24 age group (28.32% of the total sample). Tobacco and alcohol habits were tackled at the recommended intervals significantly less (p < 0.001) in people under 25 than in those over. Only 20% of the patients between 15 and 25 had both their weight and height recorded (39.1% in total). The 7-14 year-old group had an almost 60% correct immunisation against tetanus as against 24.56% for the rest (p < 0.001). In 66% of the records of women under 35 their immunity status against German Measles was not recorded. CONCLUSIONS: The PMHPP reaches least those who would most benefit from a preventive approach to problems such as tobacco, alcohol and overweight. We must focus our efforts on changing this situation: if not, the programme's effectiveness will continue to be limited.