Introduction
1.1 Background
Hospital admission and readmission are common phrases used in the healthcare settings. According to Western Australia [WA] Health Services (2012), an admitted patient to hospital is a person who meets the admission criteria and is admitted through the hospital’s admission procedure to receive treatment within a given duration. A readmitted patient, on the other hand, refers to the patient who has been in inpatient and is then re-admitted after being discharged within four weeks from the same establishment (WA Health Services, 2012). The older generation starting from 45 years and above has higher rates of hospital admission and readmission compared to the general population (Courtney, et al. 2012). According to Longman et al., (2012) and Almagro, et al., (2006), the continued increase in hospital admissions of the elderly is one of the crucial and multifaceted issues that are affecting health services. In this case, it is important to define and identify the key factors that constitute this increased health issue to facilitate effective intervention.
According to Courtney, et al., (2012), patients who seek these healthcare services experience a functional decline while at home, which has the capability to reduce the quality of life as well as their independence; thus increasing their readmission rate. The functional decline directly relates to the quality of life of an individual, which is independent in the way older patients perform their daily activities such as dressing and feeding as well as instrumental activities of daily living (Courtney, et al., 2011). Courtney, et al., (2011) and Beswick, et al., (2008) argue that the core factor contributing to this problem is the reduced physical function that calls for continued hospitalisation, long-term nursing home care, as well as premature death.
Readmissions are costly for both the patient and the healthcare system (Chan, et al. 2011). According to Kassin, et al. (2012), the increased hospital readmission of elder patients within 30 days is a clear indication that there is a need for more improved health care research. The 30 days hospital readmission for the elderly patients relates to the specific risk factors that are prevalent in this group (Park, Andrade, Mastey, Sun, & Hicks, 2014). Various studies have suggested that demographic and clinical parameters tend to be risk factors for patient readmissions (Kassin, et al., 2012; Tsai, Joynt, Orav, Gawande, & Jha, 2013). These clinical factors may include polypharmacy where one has more than five medications, using high-risk medications such as anticoagulants, having more than five chronic conditions, and possessing specific clinical conditions such as heart failure and depression (Aljishi & Parekh, 2014). Other risk factors for readmission may either be logistical and/or demographic factors. Such factors include race, reduced social network indicators such as being with no family or friends prior hospitalisation, lower socioeconomic status, older age, male, and low health literacy (Aljishi & Parekh, 2014; Albrecht, et al., 2014; Laurin, Moullec, Bacon, & Lavoie, 2012; Richardson, et al., 2012). It is also important that we investigate possible psychological risk factors in relation to readmission such as Depression.
It is clear that as readmission rates rise then health care costs will continue to increase as these patients continue using the services of the hospitals or healthcare facilities. As such, it is important to address this problem by attempting to reduce it. The most important thing to do in this case should be to introduce and enhance the discharge planning process in an attempt to reduce the risk factors associated with the transitioning from hospital to home (Sellers, et al., 2013; Chan, et al., 2011). The process should aim at improving the efficiency of health care services delivery to patients while reducing the high cost of readmission to hospital (Dorman, et al., 2012; Ramsey & Hobbs, 2006; Volpato, et al., 2011). Park, et al. (2014) and Kansagara, et al., (2011) recommends for continuous research to identify specific risk factors that can then be addressed. These factors can assist in identifying the possible solutions that can be implemented within the healthcare institution to reduce the readmission rates.
1.2 Aim
The purpose of this study is to identify any risk factors for hospital readmission in elderly patients over the age of 65 years.
1.3 Thesis Outline
Overview of the recent literature within the last ten years of risk factors due to emergency readmission to hospital after discharge of patients from hospital is provided in chapter 2. Chapter 3 introduces the research methods for a secondary analysis study of a current database to determine risk factors for readmission of older people to hospital.
Chapter 2: Literature Review
2.1 Introduction
This literature review addresses the risk factors for hospital readmission associated with elderly patients (i.e., greater than 65 years of age). The literature review then provides a critical discussion of the recent literature that relate to the risk factors for hospital readmission in elderly patients through a systematic review. Previous research has shown that the aging population is associated with an increase in hospital admissions (Garcia-Perez, et al., 2011; Kristensen, Bech, & Quentin, 2015). Garcia-Perez, et al., (2011) note that such a population has a tendency of increasing both social and healthcare services. Their research suggests that the increase in admission of this population increases the consumption of healthcare resources (Garcia-Perez, et al., 2011). Factors that contribute to hospital readmissions relate to health-care factors as well as patient-related factors, and disease-related factors or a combination of these factors (Garcia-Perez, et al., 2011; Bahadori & FitzGerald, 2007). Some of these factors are avoiding while the disease-related factors are hard to control. Garcia-Perez, et al., (2011) claim that defining and understanding these factors is an effective approach for identifying patients at risk of readmission to hospital. Besides, such an understanding is suitable for designing preventive interventions for improving the efficiency of the hospital to home transition.
2.2 Search Strategy
A search of the literature was performed from relevant resources for the risk factors of readmission of older patients to a hospital by an online search through the databases of EBSCO host including, Medline, Cinahl, Pubmed, PsycINFO, and the Cochrane Library. The search was conducted using the key words “risk factor*” AND “(elderly patients or older people) AND “hospital readmission”. Articles were only searched for within the past ten years (i.e. the search was conducted from 2006-2016), were published worldwide and were accessible as full articles. Case studies and animals studies were excluded from this search. The search of the databases for risk factors for elderly patient hospital readmission, yielded a total of 490 articles. The review process, after exclusion of studies, concluded that 22 articles were suitable for inclusion based on the criteria in regards to health risk factors. The risk health factors studies were in Spain (n = 1), United Kingdom (n = 1), the United States (US) (n = 12), and For the articles addressing more than one risk factor, reviewing was independently done at each section of the study. Figure 1 shows the numbers of excluded articles and the reasons for the excluding for potential article addressing health risk factors.
Figure 1 Health Risk Factors Literature Review
2.3 Literature Review
2.3.1 Readmission among the Elderly
This current format lacks flow to your argument. You seem to list risk factors here and then further down and your argument is not evident. Think more about how you write this up that is logical.
Mitchell, Sadikova, Jack, & Paasche-Orlow, (2012) carried out a study on the ‘health literacy and 30-day post discharge’ where these authors claimed that low health literacy, which is the way a patient obtains and understands the fundamental health materials and information, contributes to the increased mortality rate, poor self-management, and higher rates of hospitalisation for chronic diseases. In United States hospitals, unplanned hospital utilisation is a common incidence according to the study (Mitchell, et al., 2012). The study notes that approximately 20% of the Medicare patients are readmitted within a duration of 30 days after the discharge (Mitchell, et al., 2012). The key contributors to this trend are prior hospitalisation, lower socioeconomic status, and advanced age (Mitchell, et al., 2012; Bjorvatn, 2013; Fiscella, et al., 2014). The study consisted of 703 participants where 138 of the participants (20%) had low health literacy while 207 participants (29%) had best health literacy, and 358 of the participants (51%) had reasonable health literacy (Mitchell, et al., 2012). The study emphasises that there lies a high probability that patients with low health literacy will return to the hospital after discharge (Mitchell, et al., 2012). Mitchell, et al., (2012) argue that this can be as a result of failing to understand the discharge instructions; thus, having a direct impact on the increased rate of 30-day hospital readmission.
Kim, et al. (2015) conducted a study whose aim was to identify the hospital, patient, and market factors linked to admitting a patient to a different hospital. Hospital readmission according to this article is an emerging policy for the developing countries as a way of enhancing the safety and assessing the quality of health care (Kim, et al. 2015; Steiner, 2015). Kim, et al., (2015) claim that one-fifth of the U.S. Medicare beneficiaries are those patients hospitalised after 30-day of discharge where during 2003 and 2004, 35% patients were readmitted in a duration of 90 days. Kim, et al., (2015) conducted a study involving a sample of 509775 patients aged 50 years or more. Out of these patients, 59556 (11.7%) were readmitted within 30 days of discharge from the hospital where 79% were re-hospitalised to the same hospital and 21% to a different hospital (Kim, et al. 2015). The study implies that both clinical such as the quality of healthcare services and non-clinical factors such as adherence to medication after discharge, are the cause of patient readmission to different hospitals as these patients claim that they experienced more fragmented care in these hospitals.
According to the World Health Organization [WHO] (2006), older people comprise the largest percentage of the patients admitted to acute hospital care. For instance, patients aged 65+ years constitute 36% of hospital admissions (WHO, 2006). The key reason for such admissions is due to the reduced physical functioning which according to WHO (2006) cannot be improved during the discharge time. Adding on, the article states that hospital readmission and multiple admissions contribute to the general use of the hospital beds (WHO, 2006). For instance, in the United Kingdom patients with a history of more than two history of hospital admissions encounter at least 20 fold increases with the risk of unintended hospital admission constituting to 38% of all readmissions (WHO, 2006). The WHO (2006) recommends that proper hospital discharge management is an effective measure for curbing this trend as this helps in facilitating an effective and safe transference of the elder people from in-patient hospital care to home-based care. Such measures according to this journal study are important as they play a substantial role in preventing subsequent readmission (Berenson, Paulus, & Kalman, 2012; WHO, 2006).
Ziebarth (2015) carried out a study of the factors affecting the hospital readmission and possible measures that can be used to reduce them. In this journal, Ziebarth (2015) claims that the implementation of Patient Protection and Affordable Care Act (PPACA) has facilitated a variety of changes in the healthcare institutions that in turn have affected the beneficiaries of the Medicare program, which attempt to control the risk factors for hospital readmission. “Hospital readmissions affect over 80 percent of all Medicare enrolees (Ziebarth, 2015, p. 1).” People who are re-hospitalised have a common tendency of being old and having multiple chronic diseases (Ziebarth, 2015; Kociol, et al., 2012; Locker, Baston, Mason, & Nicholl, 2007). Leppin, et al., (2014) and Howell, Coory, Martin, & Duckett, (2009) affirms these claims by asserting that early hospital readmission is common among the high-risk and elderly patients. The study asserts that the prevalence of the readmission of the patients with chronic diseases can be contributed to by a variety of factors such as inadequate follow-up care, deficient dependence on family caregivers, and poor patient agreement with care instructions among other reasons.
In an attempt to regulate the readmission rates, the Affordable Care The results of theis study reveal that after passing the ACA policy, the readmission rate of the targeted and non-targeted hospitals reduced quickly (Zuckerman, et al., 2016). The rate in the observation units for both conditions increased to 4.7% in 2015 from 2.6% in 2007 for targeted conditions while the non-targeted conditions increased to 4.2% from 2.5% in the same duration. Nelson and Pulley (2015) claim that the attempts of reducing the readmission rates in America are an opportunity for reducing healthcare costs while improving the quality of these services. In this case, the study discusses the various policies used to curb this trend such the use of ACA and Centres for Medicare and Medicaid Services (CMS) who were directed by the Congress to penalise any health institution with a worse readmission rate within the 30 days of discharge (Kapella, Larson, Patel, Covey, & Berry, 2006; Mehta, et al., 2011).
2.3.2 Limitations of Patient Readmission
Davies, Saynina, McDonald, & Baker (2013) carried out a study on the limitations of readmitting a patient to the same hospital. According to these authors, 20% of the hospital discharges Medicare patients follow readmission to serious care facility within a duration of 30 days after discharge, leading to the spending of more than $15 billion by CMS since readmission is a prominence quality metric of these hospitals (Davies, et al., 2013). A readmission is a preferred approach for improving the quality of services in most hospitals (Davies, et al., 2013; Kwaan, et al., 2013; Halfon, et al., 2006). Besides, readmission to the different hospital takes place for 30% of all the readmissions in US (Davies, et al., 2013). To affirm this, a study of US patients was carried out (Davies, et al., 2013). A different study by Leppin, et al. (2014) discloseshat reducing the readmission rate is a key priority aiming at improving the quality of healthcare services. One out of five Medicare beneficiaries according to this study is re-hospitalised within 30 days, which increases the overall cost by $26 billion per annum (Davies, et al., 2013). As a way of curbing this menace and increase the quality of healthcare services, the U.S. government has made the 30 days re-hospitalisation a national priority. In addition, the study claims that interventions are the most effective way of reducing readmission of patients within 30 days (Leppin, et al., 2014; Jencks, Williams, & Coleman, 2009; Vilaro, et al., 2010). Such interventions according to these authors facilitate self-care for these patients when transiting from hospital to home.
Along the same argument, Zuckerman (2016) addshat continuous hospital readmission within 30 days constitutes to more Medicare expenditures to approximately $17 billion per year. To avoid this instance, Zuckerman (2016) states that most of these readmissions can be avoided through effective changes in hospital care such as improving the discharge planning and facilitating the follow-up process of discharged patients (Zuckerman, 2016; Jha, Orav, & Epstein, 2009; Tuso & Beattie, 2015). Moreover, policies such as ACA have constituted to a massive reduction of the readmitted patients per year (Zuckerman, 2016). According to this study, the number of patients readmitted in 2010 to 2015 reduced by 565,000 compared to the previous number (Zuckerman, 2016) The ACA policy introduced the Hospital Readmissions Reduction Program that targeted the reduction of readmission for patients with pneumonia, heart failure, and heart attack (Zuckerman, 2016). These patients according to the author of the article experienced numerous benefits as hospitals responded to this new incentive (Zuckerman, 2016). The policy aimed at countering both clinical factors such as quality of the healthcare services and non-clinical factors such as adhering to the medical instructions after discharge.
2.3.3 Factor Leading to Increased Admission Rates of the Elderly
Fauci, et al., (2011) with the aim of evaluating factors causing the increased admission rate for the epithelial ovarian cancer (EOC) among the elderly patients argue that complications incurred after the operation increase the probability of readmitting these patients again. Thromboembolic events and wound complications are the key causes of readmission of the EOC patients according to the study (Fauci, et al., 2011). In the attempt of reducing thromboembolic events, which increase readmission rate, the study recommends that surgeons should adhere to the American College of Chest Physicians (ACCP) guidelines (Coleman, Parry, Chalmers, & Min, 2006). Besides, effective outpatient management according to this study is also a key factor that can assist in handling the complicated wound seromas; thus reducing readmission rates.
Cawthon, et al., (2012) also conducted research on the perspective of the patients on the need for improving the care transition from hospital to home. Care to transition, in this case, is a key cause of confusion and miscommunication among families, patients, and healthcare providers; thus making the transition a vulnerable time in treatment. Interventions according to these authors are one of the effective strategies for reducing readmission rates (Cawthon, et al., 2012; Herrin, et al., 2015). However, the study advocates for the need of understanding the perspective of patients to such measures (Cawthon, et al., 2012). Upon the completion of the field study, the authors found that 72.8% of the patients were consulting the pharmacists while others (69.6%) illustrated that they were adhering to the medication schedule as a way of responding to the appropriate medications, and 68.0% were receiving follow-up phone call at home (Cawthon, et al., 2012). Such interventions according to Cawthon, et al., (2012) was sensitive on the health literacy used; thus should be tailored to individual patients for ease of understanding. As such, the participants of the study advocates for improved medication understanding through intervention as it makes them feel comfortable (Cawthon, et al., 2012).
The rate of readmission is an effective approach to measuring the quality of healthcare services (Robinson & Kerse, 2012; Hasan, et al., 2010). As a result, instant readmissions after discharge is a clear show of care deficiencies. Most of the causes of the readmission can be controlled and prevented bearing the fact that the key cause of this trend is the lower quality of healthcare services in hospitals. Nevertheless, the study claims that the proportion of the readmitted patients capable of being prevented range from 5-71% (Robinson & Kerse, 2012). Through some systematic reviews, researchers have found that intervention can assist in reducing the rate of readmission. The results of the study revealed that out of the 95,318 patients admitted to the hospital, 66,983 are aged 65 years and older (Robinson & Kerse, 2012). This, therefore, calls for the need of taking into account the well-being of older people when planning the appropriate interventions to use. Chances for readmission of the older population increases have reached 10.8% in New Zealand (Robinson & Kerse, 2012). More important, it is worth noting that the readmitted patients have severe issues and worse outcomes constituting to a higher morbidity and mortality rate.
2.4 Risk Factors for Hospital Readmission of Older Patients
An ageing population has a tendency to increase hospital readmission (Campione, Smith, & Mardon, 2015). This necessitates the need for identifying the factors affecting the risk of rehospitalisation; thus simplifying the identification of the individuals at risk and appropriate course of actions in the intervention of this challenge. Campione, et al., (2015) disclose that there is need for identifying the risk factors that exacerbate the readmission rate as it increases unnecessary health costs. As such, this section of the study will assess the risk factors causing and increasing the readmission of elderly patients. To facilitate this process, risk factors will be categorised under three groups: psychosocial risk factors, socio-demographic risk factors, and physical health risk factors.
2.4.1 Psychosocial Health
Psychosocial health refers to the mental, social, and spiritual welfare of a patient (Gudmundsson, et al., 2006). The literature reviewed, in this section relates to the risk factors affecting these aspects of the psychosocial health of elderly patients. To be more specific, the studies have assessed the articles which have discussed both anxiety and depression of patients, and how they contribute to the increased readmission rate.
How many articles examined psychosocial health
Coventry, Gemmell, and Todd (2011) argue that despite the important role that physiological and clinical parameters of chronic obstructive pulmonary disease COPD plays in readmission rate, it is important to consider the psychosocial status of the patients. They argue that anxiety and depression are more prevalent for COPD patients as well the discharged AECOPD patients. Along the same argument, Balcells, et al., (2010) demonstrated that anxiety and depression are a key cause of treatment failure in the first exacerbation. Balcells, et al., (2010) added that patients with high rates of depression or anxiety or both are at a higher risk of being readmitted as they have poor Health-Related Quality of Life (HRQoL). Gudmundsson, et al., (2006) also found COPD patients often report cases of poor health status, depression, and anxiety to be the cause of re-hospitalisation.
So the above paragraph should have gone something like this
Edmondson, Green, Ye, Halazun, & Davidson (2014) state that the key risk factor for elderly patients is due to the increased stress rate after one is diagnosed with ACS. According to Edmondson, et al., (2014), stress levels during hospitalisation tends to increase the risk of readmission for these patients within 30-days after they are discharged. Ideally, admission of the ACS is a stressful occurrence following the strange surroundings, fear, and loss of control (Edmondson, et al., 2014). As a result, the study recommends for the intervention that addresses stress issues to reduce the mortality issues associated with this disease. With similar intent, Sharif, Parekh, Pierson, Kuo, & Sharma (2014) argue that the key causes of readmission of patients are the provider, patient, and system factors. Among the key causes of early readmission anxiety, depression, alcohol abuse, and smoking are the key contributing factors (Sharif, et al., 2014).
2.4.2 Socio-demographic Factor
Socio-demographic factor comprises of age, race, gender, language, and ethnicity as well as socioeconomic status such as education and income level (Cornette, et al., 2005). The study in this section reviews studies that have focused on the socio-demographic factors that increase the risk of readmission of the elderly patients. The factors of interest for this study are age, sex, income, and education as they directly influence the readmission rate.
How many studies, what type of studies, sample size.
Cornette, et al. (2005) evaluated the risk factors for readmission of older patients.
Age
The study found that age is a key factor determining the frequency that one gets readmitted according to this study. According to the study, 24% of the patients older than 65 years were readmitted to hospitals within six months while 27% of the patients over 75 years are admitted to surgical settings (Cornette, et al. 2005). In addition, 6% of the patients over 65 years are readmitted within 30 days of discharge (Cornette, et al. 2005). The study found that the core factors contributing to the early readmission include the male sex _ you need to separate these out. Summarise all studies here in relation to gender
higher number of comorbid diseases _as above
Another key determinant of the readmission rates is the quality of care from the patient’s income level (McFarland, Ornstein, & Holcombe, 2015). Through the Affordable Care Act
In a cohort study by Silverstein, Qin, Mercer, Fong, & Haydar (2008), they confirm that among the many readmissions in the U.S., elder patients constitute to 18% of readmitted patients to hospital. Silverstein, et al., (2008) suggests that the risk factors for readmission of the elderly patients ranges from the patient characteristics such as gender and low-earning patients (Silverstein, et al., 2008). Upon the completion of the study, it was evident that patients with over 75 years, African American race, and gender (male) stand a higher chance of being readmitted (Silverstein, et al., 2008). In conjunction with these factors, the authors of the study add that lack of supplemental health insurance, discharge to long-term care, and medical service admission tend to increase the readmission rate (Silverstein, et al., 2008).
In a different study, Kirby, Dennis, Jayasinghe, & Harris (2010) note that emergency departments in Australia handle prevention, diagnosis, and management of urgent and acute facets of illness of all the age groups. Nevertheless, Kirby, et al., (2010) argue that some factors limit the access to these departments as most patients experience multifaceted social needs. Among the overcrowding population facing these challenges are males from low socioeconomic backgrounds facing severe psychosocial challenges. The study claims that the income of a person determines how one is served and the quality of services that one receives in these rooms (Kirby, et al., 2010). The economically disadvantaged patients have a tendency of being readmitted back to hospitals following the quality of services provided to them at the initial admission period (Kirby, et al., 2010). The study emphasises the need for quality health services during the primary care as it determines whether the individual will be readmitted patients to hospital or not (Kirby, et al., 2010). Garrison, Mansukhani, & Bohn (2013) also agrees that there exists a link between the ease of access to the emergency department with the education level of the patient.
Garrison, et al., (2013) add that social support is a significant factor determining the readmission rate among elderly patients. Hospital to home transition is a core factor determining the readmission rate among the elderly patients (Garrison, et al., 2013). This process requires someone who is in a position of interpreting the discharge medications in a proper way. Garrison, et al., (2013) claim that patients should have a sound education level for them to effectively interpret these instructions relates this transitioning to the clinical factors that increase this rate. Social support and education level should support the way a discharged individual takes medications and adheres to the directions given by the physician (Garrison, et al., 2013). This is important if a discharged patient lacks an appropriate person to facilitate the transitioning stage, the authors argue that they will be re-hospitalised to the hospital within 30 days of exoneration (Garrison, et al., 2013). Interestingly, married couples according to the study have an added advantage as they get the necessary care from their family members (Garrison, et al., 2013).
2.4.3 Physical Health
Physical health entails the health state of an individual by considering whether an individual is physically healthy or not (Allaudeen, Vidyarthi, Maselli, & Auerbach, 2011). Physical health is important in evaluating the health status of a patient by assessing factors such as physical activity, alcohol and drug use, dieting and nutrition, and medical self-care (Van Gestel, et al., 2012). To gain a deeper insight of how these factors increase the readmission risk, this section evaluates the following risk factors: alcohol consumption, daily activity, diet, and comorbidities.
How many studies, how many were found significant etc.
Allaudeen, et al., (2011) found that patients with disease (stages of cancer) for example, are at a higher risk of being readmitted in conjunction with those suffering from cognitive heart failure and weight loss. The study concludes that the key causes of readmission are identifiable clinical and non-clinical factors. Zai, et al., (2013) conducted a study on the effects of the heart failure and weight loss on the readmission rate. Furthermore, 38% of the study participants were readmitted to the hospital within 30 days of discharge. Among the admitted, patients revealed that different heart failure symptoms such as fatigue, lack of exercise, irregular heartbeat, and shortness of breath were the key cause of hospital readmission.
Emons, et al., (2016) also carried a research aiming at identifying the risk factors associated with hypoglycaemia readmissions. The study found that 24.5% of ER patients were readmitted in 30 days where 14.4% of this number were suffering from hypoglycaemia. Concluding the study, the authors claim that factors leading to the hypoglycaemia readmissions for the patients suffering from diabetes include: adults older than 45 years, exposure to NH/SNF/hospital, and respiratory and cardiovascular-related comorbid conditions (Emons, et al. 2016). Franchi, et al., (2013) evaluated the risk factors associated with readmission for older adults in geriatric wards and internal medicine. According to this study, 19% of the patients are re-hospitalised within 90 days after release. Through a multivariate analysis in the study, it was made clear that comorbidity and severity index as well as drug use, liver and vascular diseases, and previous hospital admissions were the key risk factors for the increased readmission for the older patients.
Physical inactivity is a noticeable aspect for elderly patients (Van Gestel et al., 2012). A reduction in the physical fitness according to Van Gestel (2012) as it leads to a shift in lifestyle due to low daily physical activities (PA); thus inducing a circle of reduced exercise constituting to the reduced activity levels and increasing social isolation. A study conducted by Chawla, Bulathsinghala, Tejada, Wakefield, & ZuWallack (2014) revealed that patients with lower physical activity levels a week after discharge stood a chance of 6.7 times of being readmitted within 30 days. Physical inactivity limits the functionality of an individual. Patients who do not leave the house after being discharged are at risk of being readmitted (Chawla, et al., 2014; Van Gestel, et al., 2012). Besides, exacerbations have a negative impact on the physical activity especially in increasing fatigue and dyspnoea, an outcome that takes a minimum of one week to recover.
Acute care hospitals are of equal importance in healthcare more especially in the recovery of the older patients once they have been discharged from the hospital (Fisher, et al., 2013). The penalties advocated by the ACA policies have to force massive studies on ways of reducing the readmission rates. In the attempt of controlling this menace, research has shown the mobility levels of older patients is an effective strategy for evaluating the response of patients to the treatment. Moreover, Fisher, et al., (2013) noted that mobility level of elderly patients is an indicator of the biomarker risk of 30-day readmission. The study results suggest that mobility levels during and after acute illness have a relationship with the risk of the re-hospitalisation of older adults (Fisher, et al., 2013). Having control of the acute illness is an effective way of enhancing mobility, which according to Fisher, et al., (2013) has a dramatic impact on the older adults with chronic conditions.
Malnutrition is a common phenomenon in acute hospitalisation constituting to the increased readmission rates and prolonged hospital stay (Kollipara, et al., 2006). With the increasing risks of obesity, most of the admitted patients tend to be overfeeding and have unhealthy eating practices; thus increasing obesity (Kollipara, et al., 2006). As a way of improving the quality of service delivered to the patients with higher risk of readmission, the diet should be assessed (Kollipara, et al., 2006). Kollipara, et al., (2006) low health literacy is a factor affecting the patient’s diet in urban public hospitals. In this case, the inadequacy of sodium knowledge increases the risk of readmission for the discharged patients with heart failure. As a way of rectifying this trend in public hospitals, Kollipara, et al., (2006) recommend that effective education towards nutrition deficiencies should be emphasised to improve the outcome of the population under risk. Consequentially, Zhuang, et al., (2015) disclose that patients with nutritional risk preoperatively stand a higher chance of being readmitted within 30 days of discharge.
Additionally, there exists a relationship between alcohol abuse and smoking, and increased rate of readmission after hospital admission for patients with heart failure (Franchi, et al., 2013). The article suggests that patients who excessively use alcohol and smoke stand a chance of being readmitted five and two times more respectively (Franchi, et al., 2013). Whitlock (2010) evaluates a relationship between early readmission for the patients taking alcohol and those suffering from acute pancreatitis (AP). The study found that 19% of the patients with 0 were readmitted and treated in the emergency departments within the duration of 30 days after discharge (Whitlock, 2010). Along with these results, the study suggests that alcohol has a direct influence on readmission rate (Whitlock, 2010). As a result, the study claims that AP is just like any other chronic disease following the readmission rates encountered from the patients suffering from this disease.
More important, Zhuang, et al., (2015) note that it is a common practice of readmitting patients after a surgery. One out of seven patients admitted for a surgical procedure is readmitted patients to hospital in a duration of 30 days after discharge (Zhuang, et al., 2015). In an attempt of evaluating the key factors that increase these risks, the study evaluated the risk factors that contribute to the increased readmission for the patients suffering from gastric cancer. Factors evaluated in the study were age, sex, race, and body mass index (BMI). Along the same argument, Clendenne, Bowden, Griggs, Morgan, & Umstattd Meyer (2015) evaluated the factors that tend to increase the risk of readmission. They evaluated factors in the study include BMI, pulse rate, body temperature, and systolic blood pressure. The study concludes that factors causing readmission within 30 days are similar to those causing readmission in 60 and 90 days (Clendenne, et al., 2015). BMI was found to play a significant role in increasing the readmission rate (Clendenne, et al., 2015).
2.5 Research Gap
As the reviewed works of literature have shown, readmission is a common occurrence across the globe (Garcia-Perez, et al., 2011). From the articles already reviewed, the risk factors that have been investigated for readmission are age, gender, surgical operation, lack of support, anxiety, and depression, income and education level, as well as dietary among other comorbidities. Each study lays emphasis on specific factors and carries a study to assess their effect on readmission rate. Moreover, the age of the study participants in the presented studies varies from 45 to 80 years as a way of increasing the number of existing studies. However, this study aims at evaluating the readmission rate for patients with over 65 years who can speak and understand English. The study aims at evaluating all the mentioned risk factors as presented in articles evaluated in this study.
2.6 Conclusion
Thirty-day readmission is a common practice, especially for the older adults. This occurrence has stirred various perceptions from different parties across the world. ACA has expressed its concerns on this issue by introducing numerous programs and policies aiming at reducing this trend. As a result, hospitals have invested in profitable researchers that reveal a big picture of the study and avoid penalties for failing to meet the requirements of these policies. There exists a variety of risk factors that tend to increase the readmission rates. The predominant factors according to the reviewed studies are age, gender, surgical, operation, lack of support, anxiety, and depression, income, and education level, as well as dietary among other comorbidities. Assessing the readmitted patients to hospital rate is an effective way of evaluating the effectiveness of treatment. As a way of controlling this trend, transition management and discharge planning process should be improved.
After this sentence, you need to list in here very clearly what your inclusion and exclusion criteria were the search of the databases
