Abstract
BackgroundOlder persons are substantial consumers of both hospital- and community care, and there are discussions regarding the potential for preventing hospitalizations through high quality community care. The present study report prevalence and factors associated with admissions to hospital for community-dwelling older persons (> 67 years of age), receiving community care in a Norwegian municipality.MethodsThis was a cohort study of 1531 home-dwelling persons aged ≥67 years, receiving community care. We retrospectively scrutinized admissions to hospital for the study cohort over a one-year period in 2013. The frequency of admissions was evaluated with regard to association with age (age groups 67–79 years, 80–89 years and ≥ 90 year) and gender. The hospital admission incidence was calculated by dividing the number of admissions by the number of individuals included in the study cohort, stratified by age and gender. The association between age and gender as potential predictors and hospitalization (outcome) was first examined in univariate analyses followed by multinomial regression analyses in order to investigate the associations between age and gender with different causes of hospitalization.ResultsWe identified a total of 1457 admissions, represented by 739 unique individuals, of which 64% were women, and an estimated mean age of 83 years. Mean admission rate was 2 admissions per person-year (95% confidence interval (CI): 1.89–2.11). The admission rate varied with age, and hospital incidents rates were higher for men in all age groups. The overall median length of stay was 4 days. The most common reason for hospitalization was the need for further medical assessment (23%). We found associations between increasing age and hospitalizations due to physical general decline, and associations between male gender and hospitalizations due to infections (e.g., airways infections, urinary tract infections).ConclusionsWe found the main reasons for hospitalizations to be related to falls, infections and general decline/pain/unspecified dyspnea. Men were especially at risk for hospitalization as they age. Our study have identified some clinically relevant factors that are vital in understanding what health care personnel in community care need to be especially aware of in order to prevent hospitalizations for this population.
Highlights
Older persons are substantial consumers of both hospital- and community care, and there are discussions regarding the potential for preventing hospitalizations through high quality community care
Demographic and frequencies related to hospitalizations We identified a total of 1457 admissions, represented by 729 unique individuals from the study cohort (n = 1531), out of which 64% were women
303 referrals related to infections (ICD-10 chapter AJKLN) constituted nearly 21% of overall admissions, while falls caused 13% (191 referrals) of the hospitalizations for the study cohort
Summary
Older persons are substantial consumers of both hospital- and community care, and there are discussions regarding the potential for preventing hospitalizations through high quality community care. The present study report prevalence and factors associated with admissions to hospital for community-dwelling older persons (> 67 years of age), receiving community care in a Norwegian municipality. The proportion of increasing age is associated with an increasing demand for specialized health care [7, 8], and this rising demand for acute hospital beds leads to a strong policy interest in identifying interventions which are effective in reducing avoidable hospital admissions [9,10,11,12,13]. Whereas quite a few studies have found that a previous hospital admission were associated with a higher risk to be re-hospitalized [12, 14, 15], Roland and colleagues [16] found that having two or more admissions one year, proved to have a low sensitivity in detecting older patients who will have high admissions in the following year. Several studies underline that the severity of disease and the burden of comorbidity are strong predictors of hospitalizations [11, 12, 15, 17], and that functional disability, cognitive impairment, as well as factors related to living conditions (i.e., low socio-economic level and social deprivation) seem to play a part in frequency of hospitalizations for older persons [15, 18, 19]
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