Department of General Medicine, Sengkang General Hospital, 110 Sengkang East Way, 544886, Singapore, Singapore.
Geriatric Education and Research Institute, Singapore, Singapore.
BMC Geriatr. 2022 Aug 2;22(1):634. doi: 10.1186/s12877-022-03343-6.
Readmission in older adults is typically complex with multiple contributing factors. We aim to examine how two prevalent and potentially modifiable geriatric conditions - depressive symptoms and malnutrition - relate to other geriatric syndromes and 30-day readmission in hospitalized older adults.
Consecutive admissions of patients ≥ 65 years to a general medical department were recruited over 16 months. Patients were screened for depression, malnutrition, delirium, cognitive impairment, and frailty at admission. Medical records were reviewed for poor oral intake and functional decline during hospitalization. Unplanned readmission within 30-days of discharge was tracked through the hospital's electronic health records and follow-up telephone interviews. We use directed acyclic graphs (DAGs) to depict the relationship of depressive symptoms and malnutrition with geriatric syndromes that constitute covariates of interest and 30-day readmission outcome. Multiple logistic regression was performed for the independent associations of depressive symptoms and malnutrition with 30-day readmission, adjusting for variables based on DAG-identified minimal adjustment set.
We recruited 1619 consecutive admissions, with mean age 76.4 (7.9) years and 51.3% females. 30-day readmission occurred in 331 (22.0%) of 1,507 patients with follow-up data. Depressive symptoms, malnutrition, higher comorbidity burden, hospitalization in the one-year preceding index admission, frailty, delirium, as well as functional decline and poor oral intake during the index admission, were more commonly observed among patients who were readmitted within 30 days of discharge (P < 0.05). Patients with active depressive symptoms were significantly more likely to be frail (OR = 1.62, 95% CI 1.22-2.16), had poor oral intake (OR = 1.35, 95% CI 1.02-1.79) and functional decline during admission (OR = 1.58, 95% CI 1.11-2.23). Malnutrition at admission was significantly associated with frailty (OR = 1.53, 95% CI 1.07-2.19), delirium (OR = 2.33, 95% CI 1.60-3.39) cognitive impairment (OR = 1.88, 95% CI 1.39-2.54) and poor oral intake during hospitalization (OR = 2.70, 95% CI 2.01-3.64). In minimal adjustment set identified by DAG, depressive symptoms (OR = 1.38, 95% CI 1.02-1.86) remained significantly associated with 30-day readmission. The association of malnutrition with 30-day readmission was no longer statistically significant after adjusting for age, ethnicity and depressive symptoms in the minimal adjustment set (OR = 1.40, 95% CI 0.99-1.98).
The observed causal associations support screening and targeted interventions for depressive symptoms and malnutrition during admission and in the post-acute period.
老年人的再入院通常较为复杂，涉及多个相关因素。本研究旨在探讨两种常见且潜在可改变的老年病状况——抑郁症状和营养不良——与其他老年综合征以及住院老年人 30 天内再入院的关系。
在 16 个月的时间里，连续招募了年龄≥65 岁的普通内科病房患者。在入院时对患者进行抑郁、营养不良、谵妄、认知障碍和衰弱的筛查。通过住院期间的不良口腔摄入和功能下降来评估患者。通过医院的电子病历和随访电话访谈追踪出院后 30 天内的非计划性再入院情况。我们使用有向无环图（DAG）来描述抑郁症状和营养不良与构成协变量的老年综合征之间的关系，以及 30 天再入院结果。使用多元逻辑回归分析抑郁症状和营养不良与 30 天再入院的独立关联，根据 DAG 确定的最小调整集，调整变量。
我们招募了 1619 名连续入院的患者，平均年龄为 76.4（7.9）岁，51.3%为女性。在有随访数据的 1507 名患者中，有 331 名（22.0%）在出院后 30 天内再次入院。与出院后 30 天内再次入院相关的因素包括抑郁症状、营养不良、更高的合并症负担、在指数入院前一年的住院情况、衰弱、谵妄，以及指数入院期间的功能下降和不良口腔摄入（P<0.05）。有明显抑郁症状的患者更容易出现衰弱（OR=1.62，95%CI 1.22-2.16），有不良口腔摄入（OR=1.35，95%CI 1.02-1.79）和功能下降（OR=1.58，95%CI 1.11-2.23）。入院时的营养不良与衰弱（OR=1.53，95%CI 1.07-2.19）、谵妄（OR=2.33，95%CI 1.60-3.39）、认知障碍（OR=1.88，95%CI 1.39-2.54）和住院期间的不良口腔摄入（OR=2.70，95%CI 2.01-3.64）显著相关。在 DAG 确定的最小调整集中，抑郁症状（OR=1.38，95%CI 1.02-1.86）与 30 天再入院仍有显著关联。在最小调整集中调整年龄、种族和抑郁症状后，营养不良与 30 天再入院的关联不再具有统计学意义（OR=1.40，95%CI 0.99-1.98）。
观察到的因果关系支持在入院期间和急性后期对抑郁症状和营养不良进行筛查和针对性干预。
