Identifying specific subgroups of older patients at risk of repeated hospital readmissions and death after discharge in a prospective multicentre cohort in France.

Objective: To identify specific subgroups of older patients at risk of repeated hospital readmissions and death.

Design: Prospective, multicentre, DAMAGE (Patient Outcomes After Hospitalization in Acute Geriatric Unit) cohort of adults aged 75 and over, discharged from an acute geriatric unit (AGU) and followed up for 12 months.

Setting: Six recruiting hospital centres in the Hauts-de-France and Normandie regions of France.

Main Outcome Measures: We performed a latent class analysis to identify subgroups at risk of repeated hospital readmissions and death, followed by a logistic regression analysis to determine the characteristics associated with the identified subgroups.

Results: 3081 patients were included (mean (SD) age: 86.4 (5.5)) and two subgroups were identified. In subgroup 1 (n=2169, 70.4%), only 619 (28.5%) patients were readmitted to hospital once during the follow-up, and 495 (22.5%) died. In subgroup 2 (n=912, 29.6%), all patients were readmitted to hospital at least twice, and 523 (57.8%) died. Subgroup 2 accounted for 29.6% of patients but 74.4% of hospital readmissions, with longer lengths of stay, and 51.6% of deaths. A multivariate logistic regression analysis identified only four characteristics weakly associated with the risk of being in subgroup 2 (at least one hospital admission in the 6 months preceding the index hospital admission, cancer, polymedication and weight changes (gain or loss) during the index hospital admission). The area under the receiver operating characteristic curve was 63%.

Conclusion: A latent class analysis showed that a population of older adults hospitalised in an AGU is divided into two subgroups with regard to the postdischarge outcomes: one subgroup (70% of the individuals) will have a low rate of hospital readmission and a moderate death rate, whereas the other will have a high rate of hospital readmission and a very high death rate. There is a need for predictive scores for both events, with a view to better targeting at-risk patients.

Trial Registration Number: Trial registration number was approved by the local independent ethics committee (CPP Nord-Ouest IV, Lille, France) on 13 February 2015, with an amendment approved on 21 January 2016 (reference: IDRCB 2014 A01670 47, CNIL bxA15352514).