Abstract
In this study we assess the mortality risk after 6 months, 1 year, and 2 years of follow-up in a sample of frail patients diagnosed with delirium who had been readmitted to hospital before 30 days after discharge (premature readmission). We compute Kaplan Meier estimates of survival probability functions at the selected censoring times for the premature readmission cohort versus the non-premature readmission cohort. Addtionally, we compute Independent Samples T-Test, Logistic Regression, Random Forest and Boosting Classification to indetify significant risk factors for premature hospital readmission. We find that premature hospital readmission is associated with increased mortality at 6 months, 1 year, and 2 years. The study identifies as high risk factor for premature hospital readmission the following ones: suffering congestive heart failure (CHF), diabetes, the use of anti-arrhythmic and antidepressant drugs as well as variables that are indicators of frailty such as older age, low weight, male sex, polypharmacy, lack of balance, weight loss measured through calf circumference, and high dependency to perform activities of daily living are indicative of higher risk of premature hospital readmission.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Angraal, S., et al.: Digoxin use and associated adverse events among older adults. Am. J. Med. 132(10), 1191–1198 (2019)
Artetxe, A., Ayerdi, B., Graña, M., Rios, S.: Using anticipative hybrid extreme rotation forest to predict emergency service readmission risk. J. Comput. Sci. 20, 154–161 (2017)
Artetxe, A., Beristain, A., Graña, M.: Predictive models for hospital readmission risk: a systematic review of methods. Comput. Methods Programs Biomed. 164, 49–64 (2018)
Artetxe, A., Beristain, A., Graña, M., Besga, A.: Predicting 30-day emergency readmission risk. In: Graña, M., López-Guede, J.M., Etxaniz, O., Herrero, Á., Quintián, H., Corchado, E. (eds.) SOCO/CISIS/ICEUTE -2016. AISC, vol. 527, pp. 3–12. Springer, Cham (2017). https://doi.org/10.1007/978-3-319-47364-2_1
Artetxe, A., Graña, M., Beristain, A., Ríos, S.: Balanced training of a hybrid ensemble method for imbalanced datasets: a case of emergency department readmission prediction. Neural Comput. Appl. 32, 5735–5744 (2020)
Barakat, A., Mittal, A., Ricketts, D., Rogers, B.A.: Understanding survival analysis: actuarial life tables and the Kaplan-Meier plot. Br. J. Hosp. Med. 80(11), 642–646 (2019)
Behlke, L.M., Lenze, E.J., Carney, R.M.: The cardiovascular effects of newer antidepressants in older adults and those with or at high risk for cardiovascular diseases. CNS Drugs 34(11), 1133–1147 (2020)
Cano-Escalera, G., Graña, M., Irazusta, J., Labayen, I., Besga, A.: Risk factors for prediction of delirium at hospital admittance. Expert. Syst. 39(4), e12698 (2021)
Cano-Escalera, G., Graña, M., Irazusta, J., Labayen, I., Besga, A.: Survival of frail elderly with delirium. Int. J. Environ. Res. Public Health 19(4), 2247 (2022)
Chang, S.-F., Lin, P.-L.: Frail phenotype and mortality prediction: a systematic review and meta-analysis of prospective cohort studies. Int. J. Nurs. Stud. 52(8), 1362–1374 (2015)
Chang, T.I., et al.: Polypharmacy, hospitalization, and mortality risk: a nationwide cohort study. Sci. Rep. 10(1), 18964 (2020)
Clegg, A., Young, J., Iliffe, S., Rikkert, M.O., Rockwood, K.: Frailty in elderly people. Lancet 381(9868), 752–762 (2013)
Dharmarajan, K., Rich, M.W.: Epidemiology, pathophysiology, and prognosis of heart failure in older adults. Heart Fail. Clin. 13(3), 417–426 (2017)
Dovjak, P.: Polypharmacy in elderly people. Wien. Med. Wochenschr. 172(5–6), 109–113 (2022)
Erkinjuntti, T., Sulkava, R., Wikström, J., Autio, L.: Short portable mental status questionnaire as a screening test for dementia and delirium among the elderly. J. Am. Geriatr. Soc. 35(5), 412–416 (1987)
Everitt, B.S., Hothorn, T.: A Handbook of Statistical Analyses Using R. CRC Press, Boca Raton (2010)
Faye, A.S., et al.: Increasing prevalence of frailty and its association with readmission and mortality among hospitalized patients with IBD. Dig. Dis. Sci. 66(12), 4178–4190 (2021)
Fried, L.P., et al.: Frailty in older adults: evidence for a phenotype. J. Gerontol. A Biol. Sci. Med. Sci. 56(3), M146-56 (2001)
Friedrich, M.-E., et al.: Predictors of hospital readmission for patients diagnosed with delirium: An electronic health record data analysis. Acta Psychiatr. Scand. 147(5), 506–515 (2022)
Gary, R.: Evaluation of frailty in older adults with cardiovascular disease: incorporating physical performance measures. J. Cardiovasc. Nurs. 27(2), 120–131 (2012)
Goldgrab, D., Balakumaran, K., Kim, M.J., Tabtabai, S.R.: Updates in heart failure 30-day readmission prevention. Heart Fail. Rev. 24(2), 177–187 (2018)
Gómez, C., Vega-Quiroga, S., Bermejo-Pareja, F., Medrano, M.J., Louis, E.D., Benito-León, J.: Polypharmacy in the elderly: a marker of increased risk of mortality in a population-based prospective study (NEDICES). Gerontology 61(4), 301–309 (2015)
Graña, M., Besga, A.: Fragility and delirium data from UHA. zenodo.org (2021)
Guralnik, J.M., et al.: A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J. Gerontol. 49(2), M85–M94 (1994)
Hall, C., et al.: Impact of frailty and anticoagulation status on readmission and mortality rates following falls in patients over 80. Baylor Univ. Med. Center Proc. 32(2), 181–186 (2019)
Inouye, S.K., van Dyck, C.H., Alessi, C.A., Balkin, S., et al.: Clarifying confusion: the confusion assessment method. Ann. Intern. Med. 113(12), 941–948 (1990). PMID: 2240918
Inouye, S.K., Westendorp, R.G., Saczynski, J.S.: Delirium in elderly people. Lancet 383(9920), 911–922 (2014)
Jujo, K., et al.: Impact of social frailty in hospitalized elderly patients with heart failure: A FRAGILE-HF registry subanalysis. J. Am. Heart Assoc. 10(17), e019954 (2021)
Kaiser, M.J., et al.: Validation of the mini nutritional assessment short-form (MNA-SF): a practical tool for identification of nutritional status. JNHA - J. Nutr. Health Aging 13(9), 782 (2009)
Keeney, T., Jette, D.U., Cabral, H., Jette, A.M.: Frailty and function in heart failure: predictors of 30-day hospital readmission? J. Geriatr. Phys. Therapy 44(2), 101–107 (2019)
Kim, D.J., Massa, M.S., Potter, C.M., Clarke, R., Bennett, D.A.: Systematic review of the utility of the frailty index and frailty phenotype to predict all-cause mortality in older people. Syst. Rev. 11(1), 187 (2022)
Kühn, T., et al.: Glaucoma and mortality risk: findings from a prospective population-based study. Sci. Rep. 11(1), 11771 (2021)
Mahoney, F.I., Barthel, D.W.: Functional evaluation: the Barthel index. Md. State Med. J. 14, 61–65 (1965)
Maldonado, J.R.: Acute brain failure. Crit. Care Clin. 33(3), 461–519 (2017)
McGuinness, M.B., Karahalios, A., Finger, R.P., Guymer, R.H., Simpson, J.A.: Age-related macular degeneration and mortality: a systematic review and meta-analysis. Ophthalmic Epidemiol. 24(3), 141–152 (2017)
Ohl, I.C.B., et al.: Evaluation of delirium in aged patients assisted at emergency hospital service. Rev. Bras. Enferm. 72(suppl 2), 153–160 (2019)
Pfeiffer, E.: A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J. Am. Geriatr. Soc. 23(10), 433–441 (1975)
Proietti, M., Cesari, M.: Frailty: what is it? In: Veronese, N. (ed.) Frailty and Cardiovascular Diseases. AEMB, vol. 1216, pp. 1–7. Springer, Cham (2020). https://doi.org/10.1007/978-3-030-33330-0_1
Qian, A.S., Nguyen, N.H., Elia, J., Ohno-Machado, L., Sandborn, W.J., Singh, S.: Frailty is independently associated with mortality and readmission in hospitalized patients with inflammatory bowel diseases. Clin. Gastroenterol. Hepatol. 19(10), 2054–2063 (2021)
Rich, J.T., et al.: A practical guide to understanding Kaplan-Meier curves. Otolaryngol.-Head Neck Surg. 143(3), 331–336 (2010)
Samuel, S.V., Viggeswarpu, S., Wilson, B.P., Ganesan, M.P.: Readmission rates and predictors of avoidable readmissions in older adults in a tertiary care centre. J. Fam. Med. Primary Care 11(9), 5246 (2022)
Setters, B., Solberg, L.M.: Delirium. Prim. Care 44(3), 541–559 (2017)
Shi, S.M., Olivieri-Mui, B., McCarthy, E.P., Kim, D.H.: Changes in a frailty index and association with mortality. J. Am. Geriatr. Soc. 69(4), 1057–1062 (2021)
Stolz, E., Hoogendijk, E.O., Mayerl, H., Freidl, W.: Frailty changes predict mortality in 4 longitudinal studies of aging. J. Gerontol. A Biol. Sci. Med. Sci. 76(9), 1619–1626 (2021)
Stolz, E., Mayerl, H., Hoogendijk, E.O: Frailty in the oldest old: is the current level or the rate of change more predictive of mortality? Age Ageing 51(2), afac020 (2022)
Tang, L., Li, K., Wu, C.J.: Thirty-day readmission, length of stay and self-management behaviour among patients with acute coronary syndrome and type 2 diabetes mellitus: a scoping review. J. Clin. Nurs. 29(3–4), 320–329 (2019)
Topinková, E.: Aging, disability and frailty. Ann. Nutr. Metab. 52(Suppl 1), 6–11 (2008)
Uchmanowicz, I., et al.: Frailty and the risk of all-cause mortality and hospitalization in chronic heart failure: a meta-analysis. ESC Heart Fail. 7(6), 3427–3437 (2020)
Vellas, B., et al.: The mini nutritional assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition 15(2), 116–122 (1999)
Vidula, M.K., et al.: Causes and predictors of early readmission after percutaneous coronary intervention among patients discharged on oral anticoagulant therapy. PLoS ONE 13(10), e0205457 (2018)
Xiao, Yu., et al.: Causes and risk factors of repeated hospitalization among patients with diabetic retinopathy. J. Diab. Res. 2022, 1–7 (2022)
Xue, Q.L., Bandeen-Roche, K., Varadhan, R., Zhou, J., Fried, L.P.: Initial manifestations of frailty criteria and the development of frailty phenotype in the women’s health and aging study ii. J. Gerontol. A Biol. Sci. Med. Sci. 63(9), 984–990 (2008)
Yang, X., et al.: Impact of frailty on mortality and hospitalization in chronic heart failure: a systematic review and meta-analysis. J. Am. Heart Assoc. 7(23), e008251 (2018)
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this paper
Cite this paper
Cano-Escalera, G., Grana, M., Besga, A. (2023). Risk Factors and Survival After Premature Hospital Readmission in Frail Subjects with Delirium. In: García Bringas, P., et al. Hybrid Artificial Intelligent Systems. HAIS 2023. Lecture Notes in Computer Science(), vol 14001. Springer, Cham. https://doi.org/10.1007/978-3-031-40725-3_59
Download citation
DOI: https://doi.org/10.1007/978-3-031-40725-3_59
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-40724-6
Online ISBN: 978-3-031-40725-3
eBook Packages: Computer ScienceComputer Science (R0)