Unexpected hospital admission could be an early warning sign of death for seniors
Unplanned hospitalization is associated with a higher risk of death in older adults, according to researchers at ICES, a non-profit research institute that uses population-based health information to produce knowledge on a broad range of health care issues.
The study, published today in the CMAJ, looked at more than 900, 000 Ontario adults aged 65 and older and the association between unplanned admission to hospital and risk of death over the 10-year study period (2007 to 2017). Researchers included only people who had not been hospitalized or visited an emergency department within five years. After their first unplanned hospital admission, nearly 40 per cent of people died within five years (59,234 people). Nearly 50 per cent of the deaths following first unplanned hospital admission were within the first year. This was a substantial difference compared to about 10 per cent of people who died within five years of their first planned hospital admission (10,775 people) or in those who visited an emergency department and were sent home (35,663 people). Among those who were neither hospitalized nor visited the emergency department, only three per cent died within five years (11,268 people).
“This study adds new findings by estimating the risk of death after a first acute care encounter in a population of previously healthy older adults cared for in a large health care system,” says senior author Dr. Chaim Bell, adjunct scientist at ICES, physician in chief at Sinai Health, and professor of medicine at the University of Toronto.
Cancer and heart disease were the most common causes of death in all age groups and more than 50 per cent of all deaths in the study were among those with their first unplanned hospital admission.
“Unplanned hospital admission likely indicates the presence of a health problem that is severe enough to warrant admission to hospital and project a window into a person’s future health,” says lead author Dr. Kieran Quinn, a general internist and palliative care physician and health services researcher at Sinai Health and an ICES PhD student. “Recognition of this risk may trigger important discussions among patients, caregivers and health care providers about health preferences for future care.”
The risk of death increased with age, with a 15 to 20 per cent increase per decade of life. In people aged 66 to 70 years, the death rate was about 20 per cent compared with more than 60 per cent in people aged 86 to 90 years and 90 per cent in people over age 96.
Other studies have looked at short-term outcomes following hospital admission as well as five-year death rates for specific conditions, such as heart failure and lung cancer. This study builds on these prior studies by estimating the long-term risk of death for all conditions among older adults without prior hospital admission or emergency department visits.
These findings may be useful to patients, families and health systems in four ways:
- Estimating risk of death allows patients, families and their doctors to make informed decisions and advanced planning for their health care
- As a population-level risk to help physicians estimate an individual patient’s risk
- To help health services researchers in adjusting risk in future studies
- To help health care system planning for health care delivery
“Our hope is that this simple information can inform complex health care decisions,” adds Quinn.
The study “The Risk of death within five years of first hospitalization in older adults,” was published by the CMAJ.
Author block: Kieran L. Quinn, Nathan M. Stall, Zhan Yao, Therese A. Stukel, Peter Cram, Allan S. Detsky and Chaim M. Bell.
ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting health care needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, follow us on Twitter: @ICESOntario
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