Geriatrics, Gerontology & Elderly Care

Biography

Biography: Ryan Saffer

Abstract

Returns to the hospital within 30 days of initial discharge are common among geriatric patients and burden the healthcare system. Older patients commonly have polypharmacy, which is associated with hospital returns, especially with cardiovascular and psychotropic drugs. More than half (51.7%) of dementia patients have at least two comorbid conditions which increases the risk of hospitalization. Polypharmacy increases the likelihood of Drug-Related Problems (DRPs), including drug-drug interactions, adverse drug reactions and noncompliance, as well as increases morbidity and mortality. Impaired cognition (i.e., dementia) also increases the risk for DRPs. Dementia and DRPs are both frequently implicated in hospital admissions (and readmissions) in the geriatric population. The aims of this study were to examine the relationship between polypharmacy and returns to the hospital among patients both with and without dementia, as well as to determine why patients with dementia and polypharmacy return to the hospital within 30 days of initial discharge. We hypothesized those patients 75 years old and older with dementia and polypharmacy are more likely to return to the hospital within 30 days than geriatric patients with neither dementia nor polypharmacy.

This is a retrospective descriptive analysis of an existing Quality Improvement database created for the Safe Transitions for At Risk Patients (STAR) Program, which was designed to reduce returns to the hospital. Patient population includes patient’s ≥ 75 years old who were admitted to a community hospital between July 2015 and June 2017. Patients who were admitted directly to the ICU, hospice patients and those who expired in the hospital were excluded. Patients were divided into those with dementia and those without dementia based on ICD-10 codes (F00.x-F03.x, F05.1, G30.x and G31.1) and physician and nursing notes and medications for dementia. Polypharmacy was defined as the prescription of ≥ 9 routine medications, excluding vitamins except vitamin D. Hospital returns were defined as ED visits, observation stays and inpatient admissions within 30 days of discharge from any hospital admission (either inpatient admission or observation stay). Groups were compared using a chi-square test with a p-value<0.05 for statistical significance.

Patients with both dementia and polypharmacy were most likely to return to the hospital within 30 days of discharge. Those with polypharmacy alone were the second most likely to return, followed by patients with dementia alone. Patients with neither dementia or polypharmacy were least likely to return to the hospital. Hypoalbuminemia, COPD and Congestive Heart Failure and mild anemia were also associated with higher returns to the hospital. These comorbidities could account in part for the association between dementia and polypharmacy and returns to the hospital. Return visits within 30 days of initial discharge were most frequently related to cardiovascular diagnoses, followed by infectious disease, pulmonary diagnoses, gastrointestinal diagnoses and trauma. Further research should explore the specific diagnoses associated with returns to the hospital among patients with both dementia and polypharmacy, in order to develop interventions to reduce unnecessary hospital returns.