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Examining trajectories of hospital readmission in older adults hospitalised with hip fracture from residential aged care and the community

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Abstract

Summary

Hip fracture trajectories have not been examined for older adults in aged care or living in the community. Trajectories of health care use were defined by distinct predictive factors. These results can inform the development of targeted strategies to reduce health service use following hip fracture.

Objective

To examine hospital service use trajectories of older adults who were hospitalised for hip fracture and living in a residential aged care facility (RACF) or the community, and to identify factors predictive of trajectory group membership. These findings may inform future programmes aimed at reducing unexpected hospitalisations and subsequently reduce health care costs.

Methods

A group-based trajectory analysis of hospitalisations was conducted for adults aged ≥ 65 years hospitalised for hip fracture during 2008–2009 in New South Wales, Australia. Linked hospitalisation and RACF data were examined for a 5-year period. Group-based trajectory models were derived for RACF and community-dwelling older adults based on the number of subsequent hospital admissions following the index hip fracture. Multinomial logistic regression examined predictors of trajectory group membership for subsequent hospital admissions.

Results

There were 5752 hip fracture hospitalisations, with two-thirds of hip fractures occurring in community-dwellers. Key predictors of trajectory group membership for both RACF residents and community-dwellers were age group, sex, hospital length of stay and cognitive impairment. Assistance with activities of daily living and complex health care needs were also predictive of group membership in RACF residents. Location of residence and time to move to a RACF were additional predictors of group membership for community-dwellers.

Conclusion

Health service use trajectories differed for RACF residents and community-dwellers; however, there were similar patient characteristics that defined trajectory group membership. Low users of hospital services living in RACFs or the community included older adults with generally unfavourable health conditions, potentially indicating that palliative care or advanced care directives and community-care initiatives, respectively, have played a part in the lowered frequency of rehospitalisation.

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Acknowledgements

The authors wish to thank the NSW Ministry of Health for providing access to the NSW hospitalisation data, the National Aged Care Data Clearinghouse for providing access to the Residential Aged Care data, and the CHeReL for hospitalisation data extraction and the AIHW Data Linkage Unit for conducting the record linkage. The data were analysed within the Secure Unified Research Environment.

Funding

This research was part-funded by the Dementia Centre for Research Collaboration. RM was supported by a career fellowship from the NSW Ministry of Health under the NSW Health Early-Mid Career Fellowships Scheme.

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Authors and Affiliations

  1. Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie Park, NSW, 2109, Australia

    Vu Quang Do, Jeffrey Braithwaite & Rebecca Mitchell

  2. Prince of Wales Clinical School, University of New South Wales, Sydney, Australia

    Brian Draper & Henry Brodaty

  3. Dementia Centre for Research Collaboration - Assessment and Better Care, University of New South Wales, Sydney, Australia

    Brian Draper & Henry Brodaty

  4. Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia

    Lara Harvey

  5. Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia

    Lara Harvey & Tim Driscoll

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  1. Vu Quang Do
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Correspondence to Vu Quang Do.

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Do, V.Q., Draper, B., Harvey, L. et al. Examining trajectories of hospital readmission in older adults hospitalised with hip fracture from residential aged care and the community. Arch Osteoporos 16, 120 (2021). https://doi.org/10.1007/s11657-021-00966-x

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