Risk Factors for Early Hospital Readmission in Low-Income Elderly Adults

ObjectivesTo identify risk factors for early hospital readmission in low-income community-dwelling older adults. DesignProspective cohort study. SettingUniversity-affiliated urban safety-net healthcare system in Indianapolis, Indiana. ParticipantsCommunity-dwelling adults aged 65 and older with annual income less than 200% of the federal poverty level and enrolled in the Geriatric Resources for Assessment and Care of Elders (GRACE) randomized controlled trial (N=951). MeasurementsParticipant health and functional status at baseline and 6, 12, 18, and 24months. Early readmission was defined as a repeat hospitalization occurring within 30days of a prior hospital discharge. Candidate risk factors included sociodemographic characteristics, health and functional status, prior care, lifestyle, and satisfaction with care. ResultsOf 457 index admissions in 328 participants, 85 (19%) were followed by an early readmission. The independent risk factors for early readmission identified according to regression analysis were living alone (odds ratio (OR)=1.71, 95% confidence interval (CI)=1.02-2.87), fair or poor satisfaction with primary care physician (OR=2.12, 95% CI=1.01-4.46), not having Medicaid (OR=1.80, 95% CI=1.05-3.11), receiving a new assistive device in the past 6months (OR=2.26, 95% CI=1.26-4.05), and staying in a nursing home in the past 6months (OR=5.08, 95% CI=1.56-16.53). Age, race, sex, education, and chronic diseases were not associated with early readmission. ConclusionA broad range of nonmedical risk factors played a greater role than previously recognized in early hospital readmission of low-income seniors.