Massamba BA^1,2*, Assane Sall¹, Rokhaya Djajhete¹, Dalahata BA¹ and Mamadou Coume^1,2

¹Geriatrics Department, Fann/Dakar University Hospital, Senegal
²Department of Geriatrics, Faculty of Medicine, Pharmacy and Odontostomatology, Cheikh Anta Diop University, Dakar, Senegal

*Corresponding Author: Massamba BA, Geriatrics Department, Fann/Dakar University Hospital, Senegal.

Received: November 20, 2023; Published: December 14, 2023

Abstract

Background: The elderly, with their multiple co-morbidities and unfavourable geriatric conditions, are particularly at risk of re-hospitalisation. In sub-Saharan Africa, data are virtually non-existent.

Objectives: To determine the prevalence and factors associated with rehospitalisation in our context.

Methodology: This was a retrospective, descriptive and analytical study (1 August 2019-31 July 2020) including people aged 65 and over who were rehospitalised on an unscheduled basis in the geriatrics department of the CHU de Fann. In the analytical study, in order to identify risk factors, we compared patients who had been rehospitalised with those who had not.

Results: Of 242 patients hospitalised during this period, 40 had an unscheduled rehospitalisation, giving a 6-month prevalence rate of 17.3%. The average age was 78 years, with a predominance of men (52.5%). Most of our patients came from the hospital emergency department (57.5%). Arterial hypertension was the most common comorbidity (72.5%), followed by arthritis (34.15%) and heart disease (27.5%). Reasons for re-hospitalisation were dominated by deterioration in general condition (90% of patients), acute mental confusion (37.5%), acute respiratory distress (20%) and refusal to eat (20%). Geriatric syndromes were dominated by loss of autonomy (77.5%), malnutrition (40%), mental confusion (37.5%) and cognitive disorders (37.5%).

Cardiovascular diseases (32.5%), infectious diseases (21.6%) and tumours (21.6%) were the most common.

Re-hospitalisation was found to be significantly associated (p˂0.05) with cardiac decompensation (OR: 3.16), the existence of an active Cancer (OR: 4.45), iatrogenicity (OR: 3.15), mental confusion (OR: 2.38) and major neurocognitive disorders (OR: 2.17).

Conclusion: This study enabled us to determine the prevalence and factors associated with re-hospitalisation in our context. Prevention should focus on early management of these factors.

 Keywords: Dakar; Elderly; Re-hospitalisation

References

1. Abbas MM., et al. “Epidemiology of Parkinson’s Disease-East Versus West”. Movement Disorders Clinical Practice1 (2018): 14‑28.
2. pdf (2021).
3. Aboderin IAG and Beard JR. “Older people’s health in sub-Saharan Africa”. The Lancet9968 (2015): e9‑11.
4. Belmin J. “Vieillissement, stéréotypes et implications”. Soins Gérontologie144 (2020): 34‑37.
5. Magdelijns FJH., et al. “Unplanned readmissions in younger and older adult patients: the role of healthcare-related adverse events”. European Journal of Medical Research1 (2016): 35.
6. Moran J., et al. “Residents Examine Factors Associated With 30-Day, Same-Cause Hospital Readmissions on an Internal Medicine Service”. American Journal of Medical Quality6 (2013): 492‑501.
7. Alassaad A., et al. “A tool for prediction of risk of rehospitalisation and mortality in the hospitalised elderly: secondary analysis of clinical trial data”. BMJ Open2 (2011): e007259‑e007259.
8. Jencks SF., et al. “Rehospitalizations among Patients in the Medicare Fee-for-Service Program”. The New England Journal of Medicine14 (2009): 1418‑1428.
9. M Ba., et al. “Progress report on the short stay geriatric unit in the NUH of Fann (Dakar, Senegal) after more than one year of operation”. NPG134 (2023): 74-84.
10. Rich MW., et al. “Prevention of readmission in elderly patients with congestive heart failure”. Journal of General Internal Medicine 11 (1993): 585‑590.
11. Williams EI and Fitton F. “Factors affecting early unplanned readmission of elderly patients to hospital”. BMJ 6651 (1988): 784‑787.
12. Whitney P., et al. “Relationship between insurance and 30-day readmission rates in patients 65 years and older discharged from an acute care hospital with hospice services”. Journal of Hospital Medicine10 (2016): 688‑693.
13. Cornette P., et al. “Differential risk factors for early and later hospital readmission of older patients”. Aging Clinical and Experimental Research 4 (2005): 322‑328.
14. Lanièce I., et al. “Incidence and main factors associated with early unplanned hospital readmission among French medical inpatients aged 75 and over admitted through emergency units”. Age Ageing 4 (2008): 416‑422.
15. Zanocchi M., et al. “Early re-hospitalization of elderly people discharged from a geriatric ward”. Aging Clinical and Experimental Research 1 (2006): 63‑69.
16. Gérard Lorie. Etude rétrospective des facteurs prédictifs de réhospitalisation des patients admis dans les unités de gériatrie aux CUSL : comment le plan de soin individuel rédigé à la sortie d’hospitalisation prend-il en compte le risque de réhospitalisation? Faculté de santé publique, Université catholique de Louvain; (2019).
17. Franchi C., et al. “Risk factors for hospital readmission of elderly patients”. European Journal of Internal Medicine1 (2013): 45‑51.
18. Maurer PP and Ballmer PE. “Hospital readmissions—are they predictable and avoid_able?” Swiss 606 (2004): 11.
19. Kwok T., et al. Journal of the Royal College of Physicians Lond2 (1999): 153‑156.
20. Dickes-Sotty H., et al. “Devenir à 6 mois après une hospitalisation en court séjour gériatrique à la suite d’une chute”. Gériatrie et Psychologie Neuropsychiatrie du Vieillissement 4 (320): 391‑401.
21. Gooding J and Jette AM. “Hospital Readmissions Among the Elderly”. Journal of the American Geriatrics Society9 (1985): 595‑601.
22. Marcantonio ER., et al. “Factors associated with unplanned hospital readmission among patients 65 years of age and older in a medicare managed care plan”. American Journal of Medicine1 (1999): 13‑17.
23. Gruneir A., et al. “Unplanned readmissions after hospital discharge among patients identified as being at high risk for readmission using a validated predictive algorithm”. Open Medicine2 (2011): e104‑111.
24. Lanièce I., et al. “Incidence and main factors associated with early unplanned hospital readmission among French medical inpatients aged 75 and over admitted through emergency units”. Age and Ageing4 (2008): 416‑422.
25. Lotus Shyu YI., et al. “Caregiver’s needs as predictors of hospital readmission for the elderly in Taiwan”. Social Science and Medicine7 (2004): 1395‑1403.
26. Pacolet J., et al. “VIEILLISSEMENT, AIDE ET SOINS DE SANTE EN BELGIQUE”. 62.
27. Silverstein MD., et al. “Risk Factors for 30-Day Hospital Readmission in Patients ≥65 Years of Age”. Baylor University Medical Center Proceedings4 (2008): 363‑372.
28. Gauthier J., et al. “Réhospitalisation précoce des personnes âgées d’au moins 75 ans admises dans un service de médecine polyvalente post-urgence : taux et facteurs prédictifs”. La Revue de Médecine Interne 8 (2016): 521‑528.
29. Roux-these.pdf (2022).
30. Holloway JJ., et al. “Clinical and sociodemographic risk factors for readmission of Medicare beneficiaries”. Health Care Financing Review1 (1988): 27‑36.
31. Mudge AM., et al. “Recurrent readmissions in medical patients: A prospective study”. Journal of Hospital Medicine2 (2011): 61‑67.
32. Willers C., et al. “Readmission within three months after inpatient geriatric care—Incidence, diagnosis and associated factors in a Swedish cohort”. PLOS ONE3 (2021): e0248972.
33. Dramé M., et al. “Facteurs prédictifs de mortalité à long terme chez des patients âgés de 75 ans ou plus hospitalisés en urgence : la cohorte SAFES”. Presse Médicale7‑8 (2009): 1068‑1075.
34. Factors Associated With Accelerated Hospitalization and Re hospitalization Among Medicare Home Health Patients | The Journals of Gerontology: Series A | Oxford Academic (2022).
35. Garcia-Perez L., et al. “Risk factors for hospital readmissions in elderly patients: a systematic review”. QJM 8 (2011): 639‑651.
36. Mazière S., et al. “Facteurs prédictifs du déclin fonctionnel de la personne âgée après une hospitalisation en court séjour gériatrique : importance de l’évolution fonctionnelle récente”. Presse Médicale2 (2011): e101‑110.
37. Diagnostics et calendrier des réadmissions de 30 jours après une hospitalisation pour insuffisance cardiaque, infarctus aigu du myocarde ou pneumonie | Syndromes coronariens aigus. JAMA (2022).
38. Krumholz HM., et al. “A Taxonomy for Disease Management”. Circulation 13 (2006): 1432‑1445.
39. Rich MW and Freedland KE. “Effect of DRGs on three-month readmission rate of geriatric patients with congestive heart failure”. American Journal of Public Health6 (1988): 680‑682.
40. Narain P., et al. “Predictors of Immediate and 6-Month Outcomes in Hospitalized Elderly Patients: The Importance of Functional Status”. Journal of the American Geriatrics Society9 (1988): 775‑783.
41. Whitney RL., et al. “Hospitalization Rates and Predictors of Rehospitalization Among Individuals With Advanced Cancer in the Year After Diagnosis”. Journal of Clinical Oncology31 (2017): 3610‑3617.
42. Burhenn P., et al. “Predictors of hospital readmission among older adults with cancer”. Journal of Geriatric Oncology7 (2020): 1108‑1114.
43. Cecile M., et al. “Accidents iatrogènes médicamenteux chez le sujet âgé hospitalisé en court séjour gériatrique : étude de prévalence et des facteurs de risques”. La Revue de Médecine Interne 5 (2009): 393‑400.
44. Ankri J. “Iatrogenic drug risk in elderly patients”. Gerontological Society 4 (2002): 93‑106.
45. Di Iorio A., et al. “Characteristics of geriatric patients related to early and late readmissions to hospital”. Aging Clinical and Experimental Research4 (1998): 339‑346.
46. Fethke CC., et al. “Risk Factors Affecting Readmission of the Elderly into the Health Care System”. Medical Care5 (1986): 429‑437.
47. Lanièce I., et al. “Incidence and main factors associated with early unplanned hospital readmission among French medical inpatients aged 75 and over admitted through emergency units”. Age Ageing4 (2008): 416‑422.

Citation

Citation: Massamba BA., et al. “Re-Hospitalization of Elderly Patients in the Geriatrics Department of Hospital National Center of Fann”.Acta Scientific Medical Sciences 8.1 (2024): 17-25.

Copyright

Copyright: © 2024 Massamba BA., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.