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Should I stay or should I go – Factors associated with hospitalization risk among older persons in Sweden
Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

An increasingly older population will most likely lead to greater demands on the health care system, as older age is associated with an increased risk of having acute and chronic conditions. The number of diseases or disabilities is not the only marker of the amount of health care utilized, as persons may seek hospitalization without a disease and/or illness that requires hospital healthcare. Hospitalization may pose a severe risk to older persons, as exposure to the hospital environment may lead to increased risks of iatrogenic disorders, confusion, falls and nosocomial infections, i.e., disorders that may involve unnecessary suffering and lead to serious consequences.

Aims: The overall aim of this thesis was to describe and explore individual trajectories of cognitive development in relation to hospitalization and risk factors for hospitalization among older persons living in different accommodations in Sweden and to explore older persons' reasons for being transferred to a hospital.

Methods: The study designs were longitudinal, prospective and descriptive, and both quantitative and qualitative methods were used. Specifically, latent growth curve modelling was used to assess the association of cognitive development with hospitalization. The Cox proportional hazards regression model was used to analyse factors associated with hospitalization risk overtime. In addition, an explorative descriptive design was used to explore how home health care patients experienced and perceived their decision to seek hospital care.

Results: The most common reasons for hospitalization were cardiovascular diseases, which caused more than one-quarter of first hospitalizations among the persons living in ordinary housing and nursing home residents (NHRs). The persons who had been hospitalized had a lower mean level of cognitive performance in general cognition, verbal, spatial/fluid, memory and processing speed abilities compared to those who had not been hospitalized. Significantly steeper declines in general cognition, spatial/fluid and processing speed abilities were observed among the persons who had been hospitalized. Cox proportional hazards regression analysis showed that the number of diseases, number of drugs used, having experienced a fall and being assessed as malnourished according to the Mini Nutritional Assessment scale were related to an increased hospitalization risk among the NHRs. Among the older persons living in ordinary housing, the risk factors for hospitalization were related to marital status, i.e., unmarried persons and widows/widowers had a decreased hospitalization risk. In addition, among social factors, receipt of support from relatives was related to an increased hospitalization risk, while receipt of support from friends was related to a decreased risk. The number of illnesses was not associated with the hospitalization risk for older persons in any age group or for those of either sex, when controlling for other variables. The older persons who received home health care described different reasons for their decisions to seek hospital care. The underlying theme of the home health care patients’ perceptions of their transfer to a hospital involved trust in hospitals. This trust was shared by the home health care patients, their relatives and the home health care staff, according to the patients.

Conclusions: This thesis revealed that middle-aged and older persons who had been hospitalized exhibited a steeper decline in cognition. Specifically, spatial/fluid, processing speed, and general cognitive abilities were affected. The steeper decline in cognition among those who had been hospitalized remained even after controlling for comorbidities. The most common causes of hospitalization among the older persons living in ordinary housing and in nursing homes were cardiovascular diseases, tumours and falls. Not only health-related factors, such as the number of diseases, number of drugs used, and being assessed as malnourished, but also social factors and marital status were related to the hospitalization risk among the older persons living in ordinary housing and in nursing homes. Some risk factors associated with hospitalization differed not only between the men and women but also among the different age groups. The information provided in this thesis could be applied in care settings by professionals who interact with older persons before they decide to seek hospital care. To meet the needs of an older population, health care systems need to offer the proper health care at the most appropriate level, and they need to increase integration and coordination among health care delivered by different care services.

Place, publisher, year, edition, pages
Jönköping: Jönköping University, School of Health and Welfare , 2016. , 117 p.
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 70
Keyword [en]
Older persons, hospitalization, risk factors, cognitive decline, qualitative content analyses, longitudinal, Cox regression, latent growth curve modelling
National Category
Gerontology, specializing in Medical and Health Sciences
Identifiers
URN: urn:nbn:se:hj:diva-29966ISBN: 978-91-85835-69-0 (print)OAI: oai:DiVA.org:hj-29966DiVA: diva2:929760
Public defence
2016-06-17, Forum Humanum, School of Health and Welfare, Jönköping, 13:00
Opponent
Supervisors
Available from: 2016-05-19 Created: 2016-05-19 Last updated: 2016-05-23Bibliographically approved
List of papers
1. Cognitive trajectories in relation to hospitalization among older Swedish adults
Open this publication in new window or tab >>Cognitive trajectories in relation to hospitalization among older Swedish adults
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2018 (English)In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 74, 9-14 p.Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION:

Research indicate that cognitive impairment might be related to hospitalization, but little is known about these effects over time.

OBJECTIVE:

To assess cognitive change before and after hospitalization among older adults in a population-based longitudinal study with up to 25 years of follow-up.

METHOD:

A longitudinal study on 828 community living men and women aged 50-86 from the Swedish Adoption/Twin Study of Ageing (SATSA) were linked to The Swedish National Inpatient Register. Up to 8 assessments of cognitive performance (general cognitive ability, verbal, spatial/fluid, memory, and processing speed) from 1986 to 2010 were available. Latent growth curve modelling was used to assess the association between cognitive performance and hospitalization including spline models to analyse cognitive trajectories pre- and post-hospitalization.

RESULTS:

A total of 735 persons (89%) had at least one hospital admission during the follow-up. Mean age at first hospitalization was 70.2 (±9.3)years. Persons who were hospitalized exhibited a lower mean level of cognitive performance in general ability, processing speed and spatial/fluid ability compared with those who were not hospitalized. The two-slope models revealed steeper cognitive decline before hospitalization than after among those with at least one hospitalization event, as compared to non-hospitalized persons who showed steeper cognitive decline after the centering age of 70 years.

CONCLUSIONS:

Persons being hospitalized in late life have lower cognitive performance across all assessed domains. The results indicate that the main decline occurs before the hospitalization, and not after. This might indicate that when you get treatment you also benefit cognitively.

Keyword
Cognition; Hospitalization; Latent growth curve modelling; Longitudinal study; Old age
National Category
Gerontology, specializing in Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-29963 (URN)10.1016/j.archger.2017.09.002 (DOI)2-s2.0-85029433562 (Scopus ID)HHJÅldrandeIS (Local ID)HHJÅldrandeIS (Archive number)HHJÅldrandeIS (OAI)
Available from: 2016-05-19 Created: 2016-05-19 Last updated: 2017-10-05Bibliographically approved
2. Factors associated with increased hospitalisation risk among nursing home residents in Sweden: a prospective study with a three-year follow-up
Open this publication in new window or tab >>Factors associated with increased hospitalisation risk among nursing home residents in Sweden: a prospective study with a three-year follow-up
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2016 (English)In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 11, no 2, 130-139 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Hospitalisation of nursing home residents might lead to deteriorating health.

AIM: To evaluate physical and psychological factors associated with hospitalisation risk among nursing home residents.

DESIGN: Prospective study with three years of follow-up.

METHODS: Four hundred and twenty-nine Swedish nursing home residents, ages 65-101 years, from 11 nursing homes in three municipalities were followed during three years. The participants' physical and psychological status was assessed at baseline. A Cox proportional hazards model was used to evaluate factors associated with hospitalisation risk using STATA.

RESULTS: Of the 429 participants, 196 (45.7%) were hospitalised at least once during the three-year follow-up period, and 109 (25.4%) during the first six months of the study. The most common causes of hospitalisation were cardiovascular diseases or complications due to falls. A Cox regression model showed that residents who have had previous falls (P < 0.001), are malnourished (P < 0.001), use a greater number of drugs (P < 0.001) and have more diseases (P < 0.001), are at an increased risk of hospitalisation.

CONCLUSION: Nursing home residents are frequently hospitalised, often due to falls or cardiovascular diseases. Study results underscore the relationships between malnutrition, previous falls, greater numbers of drugs and diseases and higher risk of hospitalisation.

IMPLICATIONS FOR PRACTICE: Preventive interventions aimed at malnutrition and falls at the nursing home could potentially reduce the number of hospitalisations. With improved education and support to nurses concerning risk assessment at the nursing homes, it may be possible to reduce the numbers of avoidable hospitalisation among nursing home residents and in the long run improve quality of life and reduce suffering.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2016
Keyword
hospitalization; nursing home residents; preventive care; prospective design
National Category
Gerontology, specializing in Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-29964 (URN)10.1111/opn.12107 (DOI)000382486700006 ()26663380 (PubMedID)2-s2.0-84949845065 (Scopus ID)
Available from: 2016-05-19 Created: 2016-05-19 Last updated: 2017-11-30Bibliographically approved
3. Factors associated with hospitalization risk among community living middle aged and older persons: results from the Swedish Adoption/TwinStudy of Aging (SATSA)
Open this publication in new window or tab >>Factors associated with hospitalization risk among community living middle aged and older persons: results from the Swedish Adoption/TwinStudy of Aging (SATSA)
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2016 (English)In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 66, 102-108 p.Article in journal (Refereed) Published
Abstract [en]

The aims of the present study were to: (1) describe and compare individual characteristics of hospitalized and not hospitalized community living persons, and (2) to determine factors that are associated with hospitalization risk over time. We conducted a prospective study with a multifactorial approach based on the population-based longitudinal Swedish Adoption/Twin Study of Aging (SATSA). A total of 772 Swedes (mean age at baseline 69.7 years, range 46–103, 59.8% females) answered a postal questionnaire about physical and psychological health, personality and socioeconomic factors. During nine years of follow-up, information on hospitalizations and associated diagnoses were obtained from national registers. Results show that 484 persons (63%) had at least one hospital admission during the follow-up period. The most common causes of admission were cardiovascular diseases (25%) and tumors (22%). Cox proportional hazard regression models controlling for age, sex and dependency within twin pairs, showed that higher age (HR = 1.02, p < 0.001) and more support from relatives (HR = 1.09, p = 0.028) were associated with increased risk of hospitalization, while marital status (unmarried (HR = 0.75, p = 0.033) and widow/widower (HR = 0.69, p < 0.001)) and support from friends (HR = 0.93, p = 0.029) were associated with lower risk of hospitalization. Social factors were important for hospitalization risk even when medical factors were controlled for in the analyses. Number of diseases was not a risk in the final regression model. Hospitalization risk was also different for women and men and within different age groups. We believe that these results might be used in future interventions targeting health care utilization.

Keyword
Hospitalization; Prospective design; Older persons; Marital status; Social factors; Friends support
National Category
Gerontology, specializing in Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-29965 (URN)10.1016/j.archger.2016.05.005 (DOI)000381646000015 ()27281475 (PubMedID)2-s2.0-84973131261 (Scopus ID)HHJÅldrandeIS (Local ID)HHJÅldrandeIS (Archive number)HHJÅldrandeIS (OAI)
Available from: 2016-05-19 Created: 2016-05-19 Last updated: 2017-11-30Bibliographically approved
4. In hospital we trust: Experiences of older peoples' decision to seek hospital care
Open this publication in new window or tab >>In hospital we trust: Experiences of older peoples' decision to seek hospital care
2015 (English)In: Geriatric Nursing, ISSN 0197-4572, E-ISSN 1528-3984, Vol. 36, no 4, 306-311 p.Article in journal (Refereed) Published
Abstract [en]

The purpose of this study was to explore how older people experience and perceive decisions to seek hospital care while receiving home health care. Twenty-two Swedish older persons were interviewed about their experiences of decision to seek hospital while receiving home health care. The interviews were analyzed using qualitative content analysis. The findings consist of one interpretative theme describing an overall confidence in hospital staff to deliver both medical and psychosocial health care, In Hospital We Trust, with three underlying categories: Superior Health Care, People’s Worries, and Biomedical Needs. Findings indicate a need for establishing confidence and ensuring sufficient qualifications, both medical and psychological, in home health care staff to meet the needs of older people. Understanding older peoples’ arguments for seeking hospital care may have implications for how home care staff address individuals’ perceived needs. Fulfillment of perceived health needs may reduce avoidable hospitalizations and consequently improve quality of life.

Keyword
Hospitalization, Home Health Care, Decision making, Older persons, Qualitative Research Methods
National Category
Gerontology, specializing in Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-28661 (URN)10.1016/j.gerinurse.2015.04.012 (DOI)000360187900009 ()25971421 (PubMedID)2-s2.0-84938746848 (Scopus ID)
Available from: 2015-12-16 Created: 2015-12-16 Last updated: 2017-12-01Bibliographically approved

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