Risk for death five times higher after first unplanned hospital admission
Older adults who were hospitalized unexpectedly for the first time faced a 5-fold increased risk for death compared with those who were not hospitalized, according to a study published in CMAJ.
“This study addresses existing knowledge gaps by estimating the risk of death after a first acute care encounter in a population of previously healthy older adults cared for in Ontario, Canada,” Kieran L. Quinn, MD, a general internist and palliative care physician and health services researcher at Sinai Health System, and colleagues wrote.
To measure 5-year mortality rates in older adults who were hospitalized, Quinn and colleagues conducted a population-based cohort study of 922,074 adults aged 66 years and older who were residents of Ontario, Canada. Those included in the study had not presented to an ED or hospital in the 5 years leading up to enrollment.
During the follow-up period of 3,112,528 person-years, 12.7% of patients died.
Researchers found that among those with an unplanned first hospital admission, 39.7% died within 5 years. Of those who had a planned first hospitalization, 13% (n = 10,775) died within 5 years, along with 10.9% (n = 35,663) of those with a first visit to the ED.
In comparison, just 3.1% (n = 10,775) of participants who were not hospitalized and did not visit the ED died within 5 years.
Just over half (50.7%) of all 116,904 deaths that occurred during follow-up were among participants whose first hospital visit was unplanned.
The most common causes of death among all participants were cancer and cardiovascular disease. Quinn and colleagues found that among those with an unplanned first admission, the risk for death increased by 15% to 20% per decade of life at the time of admission.
The mortality rate increased significantly with age at the time of admission — the rate was approximately 20% among those aged 66 to 70 years, 60% among those aged 86 to 90 years and 90% among those aged 96 to 100 years.
“In a population of healthier people without previous use of acute care, unexpected hospital admission should be recognized as a sentinel event that likely signifies an increased risk of death in the long term,” Quinn and colleagues wrote. “Recognition of this risk may trigger important discussions among patients, caregivers and health care providers about health preferences for future care.” – by Erin Michael
Disclosure: The authors report no relevant financial disclosures.