Hostname: page-component-669899f699-ggqkh Total loading time: 0 Render date: 2025-04-27T06:23:58.765Z Has data issue: false hasContentIssue false
  • English
  • Français

Predictors of mortality among older adults discharged to or readmitted from a skilled nursing facility

Published online by Cambridge University Press:  14 November 2024

Mary Acelle Garcia Open the ORCID record for Mary Acelle Garcia [Opens in a new window] ,
Natalie Mondragon ,
George Taffet  and
Kathryn Agarwal
Mary Acelle Garcia*
Affiliation:
Baylor College of Medicine, Section of Geriatrics and Palliative Medicine, Department of Medicine, Houston, TX, USA Michael E. deBakey Veterans Affairs Medical Center, Houston, TX
Natalie Mondragon
Affiliation:
Baylor College of Medicine, Section of Geriatrics and Palliative Medicine, Department of Medicine, Houston, TX, USA
George Taffet
Affiliation:
Baylor College of Medicine, Section of Geriatrics and Palliative Medicine, Department of Medicine, Houston, TX, USA Houston Methodist Hospital, Houston, TX, USA
Kathryn Agarwal
Affiliation:
Baylor College of Medicine, Section of Geriatrics and Palliative Medicine, Department of Medicine, Houston, TX, USA Houston Methodist Hospital, Houston, TX, USA
*
Corresponding author: Mary Acelle Garcia: Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

Previous studies have shown that patients who are readmitted to the hospital from a skilled nursing facility (SNF) have a higher mortality rate. The objective of this study is to determine factors associated with high mortality rate for older adults who require hospital readmission while on presumed short stay in SNF to trigger a goals-of-care discussion.

Methods

Retrospective study of 847 patients aged 65 and above who were discharged from 1 large urban academic medical center to multiple SNF in 2019.

Results

Charts of 847 patients admitted to SNF after an acute hospital stay were reviewed; their overall 1-year mortality rate was 28.3%. The 1-year mortality rate among individuals readmitted to the hospital within 30 days of discharge to SNF was 50%, whereas for those who did not require readmission, the rate was 22%. For the most common diagnostic categories of nervous system, and musculoskeletal, patients with readmission to hospital within 30 days of discharge to SNF had a roughly threefold higher 1-year mortality rate. Worse frailty score on hospital readmission, poor nutrition, and weight loss were the most impactful individual factors carrying a higher degree of mortality of up to 83%.

Significance of results

Hospital discharge to SNF and readmission from SNF within 30 days, further decline in functional status, and malnutrition characterize high-risk groups that should trigger care preference and prognostic discussions with patients as these events may be markers of vulnerability and are associated with high 1-year mortality rates.

Keywords

Hospital readmissionGoals of careMortalitySkilled nursing facilityOlder adultsFrailtyMalnutrition
Type
Original Article
Information
Palliative & Supportive Care , Volume 22 , Issue 6 , December 2024 , pp. 1978 - 1983
Check for updates
Copyright
© The Author(s), 2024. Published by Cambridge University Press.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Agarwal, K, Kazim, R, Xu, J, et al. (2016) Unrecognized cognitive impairment and its effect on heart failure readmissions of elderly adults. Journal of American Geriatrics Society 64(11), 2296–2301. doi: 10.1111/jgs.14471.CrossRefGoogle ScholarPubMed
Allen, L, Hernandez, A, Peterson, E, et al. (2011) Discharge to a skilled nursing facility and subsequent clinical outcomes among older patients hospitalized for heart failure. Circulation: Heart Failure 4, 293–300. doi: 10.1161/CIRCHEARTFAILURE.110.959171.Google ScholarPubMed
Burke, R, Burke, M, Canamucio, A, et al. (2020) External validation of the skilled nursing facility prognosis score for predicting mortality, hospital readmission, and community discharge in veterans. Journal of American Geriatrics Society, 2090–2094. doi: 10.1111/jgs.16650.CrossRefGoogle ScholarPubMed
Chen, L, Huang, Z, Lu, J, et al. (2021) Impact of the malnutrition on mortality in elderly patients undergoing percutaneous coronary intervention. Clinical Interventions in Aging 16, 1347–1356. doi: 10.2147/CIA.S308569.CrossRefGoogle ScholarPubMed
Chukmaitov, A, Harless, D, Bazzoli, G, et al. (2019) Preventable hospital admissions and 30-day all-cause readmissions: Does hospital participation in accountable care organizations improve quality of care? American Journal of Medical Quality 34(1), 14–22. doi: 10.1177/1062860618778786.CrossRefGoogle ScholarPubMed
CMS Center for Medicare & Medicaid Services. ACO #8 – Risk Standardized All Condition Readmission. Measure-ACO-8-Readmission.pdf (cms.gov).Google Scholar
Hakkarainen, T, Arbabi, S, Willis, M, et al. (2016) Outcomes of patients discharged to skilled nursing facilities after acute care hospitalizations. Annals of Surgery 263(2), 280–285. doi: 10.1097/SLA.0000000000001367.CrossRefGoogle ScholarPubMed
Hester A, and Davis, D (2013) Validation of the Hester Davis Scale for fall risk assessment in a neurosciences population. Journal of Neuroscience Nursing 45(5), 298–305. doi: 10.1097/JNN.0b013e31829d8b44.CrossRefGoogle Scholar
Jencks, S, Williams, M and Coleman, E (2009) Rehospitalizations among patients in the Medicare fee-for-service program. New England Journal of Medicine 360(14), 1418–1428. doi: 10.1056/NEJMsa0803563.CrossRefGoogle ScholarPubMed
Kawashima, and Evans, C (2023) Needs-based triggers for timely referral to palliative care for older adults severely affected by noncancer conditions: A systematic review and narrative synthesis. BioMed Central Palliative Care 22, . doi: 10.1186/s12904-023-01131-6.Google ScholarPubMed
Liu, L, Bopp, M, Roberson, P, et al. (2002) Undernutrition and risk of mortality in elderly patients within 1 year of hospital discharge. Journal of Gerontolology: Biological Sciences 57(11). doi: 10.1093/gerona/57.11.m741.Google ScholarPubMed
Luo, J, Tang, W, Sun, Y, et al. (2020) Impact of frailty on 30-day and 1-year mortality in hospitalised elderly patients with community-acquired pneumonia: A prospective observational study. British Medical Journal 10(10). doi: 10.1136/bmjopen-2020-038370.Google ScholarPubMed
Orr, N, Forman, D, De Matteis, G, et al. (2015) Heart now realize. Current Geriatrics Reports 4(4), 318–326. doi: 10.1007/s13670-015-0150-9.CrossRefGoogle ScholarPubMed
Shi S, , Olivieri-Mui, B, McCarthy, E, et al. (2021) Changes in a frailty index and association with mortality. Journal of American Geriatrics Society 69(4), 1057–1062. doi: 10.1111/jgs.17002.CrossRefGoogle Scholar
Singh, S, Eguchi, M, Sung-Joon, M, et al. (2021) Post-acute care outcomes of oncology patients discharged to a SNF. Journal of the National Comprehensive Cancer Network 18(7), 856–865. doi: 10.6004/jnccn.2020.7534.CrossRefGoogle Scholar
Stille, K, Temmel, N, Hepp, J, et al. (2020) Validation of the clinical frailty scale for retrospective use in acute care. European Geriatric Medicine 11(6), 1009–1015. doi: 10.1007/s41999-020-00370-7.CrossRefGoogle ScholarPubMed