A study from Australia identifies potentially overlooked risk factors for hospital readmissions: depression, underweight, and obesity. The paper, Recurrent Readmissions in Medical Patients: a Prospective Study, published Wednesday in the Journal of Hospital Medicine, is one of two that examines the risk factors for hospital readmissions.
In the prospective cohort study, Dr. Alison Mudge, FRACP, and colleagues at the Royal Brisbane and Women’s Hospital, Australia, undertook detailed assessment of 142 patients over the age of 50 admitted between February 2006 and February 2007 who had two or more hospitalizations in the preceding six months.
Investigators looked at such factors as depression, nutritional status, and functional status, in addition to demographic and disease variables.
After six months, 55 participants (38.7 percent) had 102 unplanned admissions to the hospital. Unsurprisingly, the strongest predictor of readmission was the presence of a chronic disease diagnosis. But investigators also found a higher risk in those underweight (72 percent) and obese (50 percent), compared to 27 percent of those classified as normal weight and 37 percent of those overweight. Depressive symptoms were also associated with a higher risk of readmission (47 percent readmitted).
Age, sex, number of previous admissions, and discharge support were not significant factors. Measures of cognition and literacy were not associated with readmission, but missing data
may have reduced our ability to detect an association,” the authors note.
Poor nutrition and depression may be surrogate markers for factors such as socioeconomic need or overall burden of disease. “However, our more direct measures of reported social and financial adequacy did not show an association, and the association with poor nutrition and depression persisted in the model adjusted for conventional measures of chronic disease burden,” Mudge tells HealthLeaders.
“There is some evidence that poor nutrition and depression may themselves have an impact on both disease progression and physiological adaptation to disease, through diverse mechanisms including effects on the immune system and muscle structure and function,” she says.
The situation creates a challenge for providers: Both recognizing and treating malnutrition and depression in this chronically ill subgroup are notoriously difficult, despite the fact that both are common, she says.
Previous studies looked at risk factors for hospital admission and readmission, but few have reported predictors of recurrent readmission; those that did largely focused on demographic and disease characteristics, “which are not amenable to intervention at individual level,” according to the paper. In contrast, Mudge and her colleagues placed “particular emphasis on risk factors which might be amenable to intervention.”
Mudge says she hopes the research will increase awareness of poor nutrition and depression as importance concurrent factors in medical illness and encourage research into improving nutritional and depression management in medically ill patients.
More research is needed, she tells HealthLeaders, but this study “suggests that we should make an effort to identify malnutrition and depression in inpatients, and consider them like other conventional risk factors—such as chronic disease and functional impairment—in planning discharge and follow-up.”
See also:
Follow-up Appointments May Not Reduce Readmissions