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Inacio MC, Jorissen RN, Wesselingh S, et al. Predictors of hospitalisations and emergency department presentations shortly after entering a residential aged care facility in Australia: a retrospective cohort study. BMJ Open. 2021;11(11):e057247doi: 10.1136/bmjopen-2021-057247.
Inacio, M. C., Jorissen, R. N., Wesselingh, S., Sluggett, J. K., Whitehead, C., Maddison, J., Forward, J., Bourke, A., Harvey, G., Crotty, M. (2021). Predictors of hospitalisations and emergency department presentations shortly after entering a residential aged care facility in Australia: a retrospective cohort study. BMJ open, 11(11), e057247. https://doi.org/10.1136/bmjopen-2021-057247
Inacio, Maria C, et al. "Predictors of hospitalisations and emergency department presentations shortly after entering a residential aged care facility in Australia: a retrospective cohort study." BMJ open vol. 11,11 (2021): e057247. doi: https://doi.org/10.1136/bmjopen-2021-057247
Inacio MC, Jorissen RN, Wesselingh S, Sluggett JK, Whitehead C, Maddison J, Forward J, Bourke A, Harvey G, Crotty M. Predictors of hospitalisations and emergency department presentations shortly after entering a residential aged care facility in Australia: a retrospective cohort study. BMJ Open. 2021 Nov 17;11(11):e057247. doi: 10.1136/bmjopen-2021-057247. PMID: 34789497; PMCID: PMC8601069.
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BMJ Open. 2021 Nov 17;11(11):e057247. doi: 10.1136/bmjopen-2021-057247.

Predictors of hospitalisations and emergency department presentations shortly after entering a residential aged care facility in Australia: a retrospective cohort study.

BMJ open

Maria C Inacio, Robert N Jorissen, Steve Wesselingh, Janet K Sluggett, Craig Whitehead, John Maddison, John Forward, Alice Bourke, Gillian Harvey, Maria Crotty,

Affiliations

  1. Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia [email protected].
  2. Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
  3. South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
  4. Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia.
  5. Southern Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia.
  6. College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
  7. Northern Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia.
  8. Central Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia.
  9. College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.

PMID: 34789497 PMCID: PMC8601069 DOI: 10.1136/bmjopen-2021-057247

Abstract

OBJECTIVES: To: (1) examine the 90-day incidence of unplanned hospitalisation and emergency department (ED) presentations after residential aged care facility (RACF) entry, (2) examine individual-related, facility-related, medication-related, system-related and healthcare-related predictors of these outcomes and (3) create individual risk profiles.

DESIGN: Retrospective cohort study using the Registry of Senior Australians. Fine-Gray models estimated subdistribution HRs and 95% CIs. Harrell's C-index assessed risk models' predictive ability.

SETTING AND PARTICIPANTS: Individuals aged ≥65 years old entering a RACF as permanent residents in three Australian states between 1 January 2013 and 31 December 2016 (N=116 192 individuals in 1967 RACFs).

PREDICTORS EXAMINED: Individual-related, facility-related, medication-related, system and healthcare-related predictors ascertained at assessments or within 90 days, 6 months or 1 year prior to RACF entry.

OUTCOME MEASURES: 90-day unplanned hospitalisation and ED presentation post-RACF entry.

RESULTS: The cohort median age was 85 years old (IQR 80-89), 62% (N=71 861) were women, and 50.5% (N=58 714) had dementia. The 90-day incidence of unplanned hospitalisations was 18.0% (N=20 919) and 22.6% (N=26 242) had ED presentations. There were 34 predictors of unplanned hospitalisations and 34 predictors of ED presentations identified, 27 common to both outcomes and 7 were unique to each. The hospitalisation and ED presentation models out-of-sample Harrell's C-index was 0.664 (95% CI 0.657 to 0.672) and 0.655 (95% CI 0.648 to 0.662), respectively. Some common predictors of high risk of unplanned hospitalisation and ED presentations included: being a man, age, delirium history, higher activity of daily living, behavioural and complex care needs, as well as history, number and recency of healthcare use (including hospital, general practitioners attendances), experience of a high sedative load and several medications.

CONCLUSIONS: Within 90 days of RACF entry, 18.0% of individuals had unplanned hospitalisations and 22.6% had ED presentations. Several predictors, including modifiable factors, were identified at the time of care entry. This is an actionable period for targeting individuals at risk of hospitalisations.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Keywords: accident & emergency medicine; epidemiology; geriatric medicine; risk management

Conflict of interest statement

Competing interests: CW is a board member of the aged care organisation Helping Hand.

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