Predictors for Unplanned Hospitalization of New Home Care Clients

TitlePredictors for Unplanned Hospitalization of New Home Care Clients
Publication TypeJournal Article
Year of Publication2017
AuthorsRonneikko J.K, Makela M., Jamsen E.R, Huhtala H., Finne-Soveri H., Noro A., Valvanne J.N
JournalJournal of the American Geriatrics Society
Keywords*Home care, *Hospitalization, *Resident Assessment Instrument for Home Care, *scoring system, Adult, Aged, article, body mass, chronic obstructive lung disease, cognitive defect, congestive heart failure, coronary artery disease, feces incontinence, Female, Finland, follow up, functional status, Health Status, hospital discharge, Human, kidney failure, major clinical study, Male, malignant neoplasm, Middle Aged, outpatient care, pain, parkinson disease, risk factor, skin ulcer, urine incontinence, very elderly

Objectives: To identify factors predicting unplanned hospitalization of new home care clients using the Resident Assessment Instrument for Home Care (RAI-HC). Design(s): A register-based study based on RAI-HC assessments and nationwide hospital discharge records. Setting(s): Municipal home care services in Finland. Participant(s): New Finnish home care clients aged 63 and older (N = 15,700). Measurements: Information from home care clients' first RAI-HC assessment was connected to information regarding their first hospitalization over 1 year of follow-up. Multivariate regression analyses were used to evaluate the independent risk factors for hospitalization. Result(s): Forty-three percent (n = 6,812) of participants were hospitalized at least once. The strongest independent risk factors were hospitalization during the year preceding the RAI-HC assessment (odds ratio (OR) = 2.01, 95% confidence interval (CI) = 1.87-2.16), aged 90 and older (OR = 1.69, 95% CI = 1.48-1.92), renal insufficiency (OR = 1.44, 95% CI = 1.22-1.69) and using 10 or more drugs (OR = 1.41, 95% CI = 1.26-1.58). Other independent risk factors were male sex, previous emergency department visits or other acute outpatient care use, daily urinary incontinence, fecal incontinence, history of falls, cognitive impairment, chronic skin ulcer, pain, unstable health status, housing-related problems, and poor self-rated health. Parkinson's disease, coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, and cancer were independent prognostic indicators. A body mass index of 24 kg/m2 or greater and the client's own belief that functional capacity could improve had a protective role. Conclusion(s): Assessing new home care clients using the RAI-HC reveals modifiable risk factors for unplanned hospitalization. Systematic assessment by a multidisciplinary team at the beginning of the service and targeting modifiable risk factors could reduce the risk of unplanned hospitalization.© 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society

Short TitleJournal of the American Geriatrics Society