Elderly Medicare inpatients with substance use disorders: Characteristics and predictors of hospital readmissions over a four-year interval

Objective: (1) To describe the characteristics and 4-year readmissions of elderly Medicare inpatients with substance use disorders; (2) to determine whether their readmissions are elevated relative to case controls'; and (3) to examine gender differences in characteristics and predictors of readmissions among elderly inpatients with substance use disorders. Method: Health Care Financing Administration Medicare Provider Analysis and Review data were used to identify elderly patients with substance use disorders and their case controls, and to determine patient characteristics and readmissions over a 4-year interval following hospital discharge. Results: Of elderly inpatients with substance use disorders (N = 22,768), 378 were women. 11% were black, 22% had previous, substance-related hospitalizations, 14% had concomitant psychiatric disorders and 9% had accident-related diagnoses. Among surviving patients with substance use disorders (N = 12,417), 73% were rehospitalized, a higher rate than among case controls (69%). Women with substance use disorders were more likely to have a psychiatric or accident diagnosis at the index episode than were men with substance use disorders. Conclusions: Many women and a disproportionate number of blacks constitute elderly Medicare inpatients with substance use disorders. These patients often have prior substance-related hospitalizations, psychiatric comorbidities, and accidents involving poisoning, adverse drug reactions and falls. They make costly, relatively heavy use of inpatient health services. Elderly women with substance use disorders may benefit from treatment that focuses on their psychiatric disorders and accident risk. Diagnostic information available at discharge can be used to identify patients at higher risk for subsequent rehospitalization and to plan treatment accordingly.