Early hospital readmission of nursing home residents and community-dwelling elderly adults discharged from the geriatrics service of an urban teaching hospital: patterns and risk factors

Abstract

OBJECTIVES: To compare rates and risk factors for early hospital readmission for nursing home residents and community-dwelling older adults. DESIGN: Retrospective cohort study. SETTING: Geriatric inpatient service at a large urban hospital. PARTICIPANTS: Nursing home residents (n=625) and community-dwelling individuals (n=413) aged 65 and older admitted over a 1-year period. MEASUREMENTS: Thirty-day readmissions. RESULTS: There were 1,706 hospital admissions within the 1-year study period involving 1,038 individuals. The 30-day readmission rate was higher for subjects discharged to a nursing home than those discharged to the community (34.4% vs 22.6%, P < .001). Chronic kidney disease and pressure ulcers were associated with greater risk of readmission in both groups. Chronic obstructive pulmonary disease was a risk factor for readmission only in community-dwelling individuals. Congestive heart failure and dementia were associated with greater risk of readmission only in nursing home residents. Readmission rates varied between individual nursing homes by more than a factor of 2. Risk of readmission was 30% lower in nursing home residents cared for by hospitalist than nonhospitalist geriatricians. CONCLUSION: Higher rates of hospital readmission for individuals discharged to nursing homes than to the community and differing patterns of risk factors for readmission indicate the importance of customized interventions to reduce readmission rates for two distinct elderly populations.