Unplanned Hospital Care Use in Older Adults: The Role of Psychological and Social Well‐Being - American Geriatric Society

OBJECTIVES

To explore the association of psychological and social well‐being with unplanned hospital utilization in an older Swedish population.

DESIGN

Data for this study were gathered from the Swedish National Study on Aging and Care in Kungsholmen (SNAC‐K). Information on hospital care use was extracted from the Stockholm County Council Inpatient Register for up to 4 years after the baseline SNAC‐K assessment (2001‐2007). Participants with dementia or living in institutions were excluded from the study sample.

SETTING

Community‐based study of randomly selected adults, aged 60 years or older, living in the Kungsholmen district of Stockholm.

PARTICIPANTS

A complete case analysis was performed on 2139 individuals.

MEASUREMENTS

We created standardized indexes of psychological well‐being (integrating life satisfaction and positive and negative affect) and social well‐being (integrating social connections, support, and participation). Negative binomial models were used to estimate the association of psychosocial well‐being with unplanned admissions, hospital days, and 30‐day readmissions, considering potential sociodemographic, lifestyle, personality, and clinical confounders.

RESULTS

Individuals with psychological well‐being scores above the median had lower rates of unplanned hospital admissions (incidence rate ratio [IRR] = 0.67; 95% confidence interval [CI] = 0.55‐0.82) and hospital days (IRR = 0.67; 95% CI = 0.49‐0.92) compared to those with scores below the median. High levels of social well‐being were also protective for unplanned admissions and hospital days, but the statistical significance was lost in the fully adjusted models. Relative to individuals with low well‐being on both indexes, the rate of unplanned admissions and hospital days was lowest in those with both high psychological and social well‐being (IRR = 0.72; 95% CI = 0.55‐0.93; and IRR = 0.57; 95% CI = 0.39‐0.85, respectively). For 30‐day readmissions, a statistically significant negative association was found with psychological well‐being, but only when operationalized as a continuous variable.

CONCLUSION

Given their association with unplanned admissions and hospital days, targeting aspects of psychosocial well‐being could be a viable strategy for reducing healthcare use and, eventually, costs.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2sGYA5R
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