Abstract
BackgroundFor older adults, a good transition from hospital to the primary or long-term care setting can decrease readmissions. This paper presents the 6-month post-discharge healthcare utilization of older adults and describes the numbers of readmissions and deaths for the most frequently occurring aftercare arrangements as a starting point in optimizing the post-discharge healthcare organization.MethodsThis cross-sectional study included older adults insured with the largest Dutch insurance company. We described the utilization of healthcare within 180 days after discharge from their first hospital admission of 2015 and the most frequently occurring combinations of aftercare in the form of geriatric rehabilitation, community nursing, long-term care, and short stay during the first 90 days after discharge. We calculated the proportion of older adults that was readmitted or had died in the 90–180 days after discharge for the six most frequent combinations. We performed all analyses in the total group of older adults and in a sub-group of older adults who had been hospitalized due to a hip fracture.ResultsA total of 31.7% of all older adults and 11.4% of the older adults with a hip fracture did not receive aftercare. Almost half of all older adults received care of a community nurse, whereas less than 5% received long-term home care. Up to 18% received care in a nursing home during the 6 months after discharge. Readmissions were lowest for older adults with a short stay and highest in the group geriatric rehabilitation + community nursing. Mortality was lowest in the total group of older aldults and subgroup with hip fracture without aftercare.ConclusionsThe organization of post-discharge healthcare for older adults may not be organized sufficiently to guarantee appropriate care to restore functional activity. Although receiving aftercare is not a clear predictor of readmissions in our study, the results do seem to indicate that older adults receiving community nursing in the first 90 days less often die compared to older adults with other types of aftercare or no aftercare. Future research is necessary to examine predictors of readmissions and mortality in both older adult patients discharged from hospital.
Highlights
For older adults, a good transition from hospital to the primary or long-term care setting can decrease readmissions
Approximately 18% of people over 75 years old are newly admitted to the hospital annually [1]
A total of 12.5% died during admission or during the 90 days after discharge
Summary
A good transition from hospital to the primary or long-term care setting can decrease readmissions. 18% of people over 75 years old are newly admitted to the hospital annually [1]. Among older adults who are clinically admitted, irreversible loss of function can arise (this number varies between 30 to 60%) [2]. These older adult patients are especially at risk of becoming frail. Frail older adult patients are less capable to live independently at home, leading to a greater dependency in daily life, the loss of the ability to care for oneself, an increased mortality risk [3, 4] and an increased healthcare utilization in different care settings [5]. One study reported that a third of frail older adults die within 100 days after discharge from hospital [6]
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