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Doctors should target chronic disease and functioning among frail older patients to lower the risk of hospitalization

Interventions that target chronic disease and physical functioning among frail older adults may reduce the likelihood that they will be hospitalized. Those that focus on nutrition may also benefit elderly patients who are ill, especially those with lower body mass index (BMI), suggests a new study. According to the researchers, conditions and factors that place these vulnerable patients at risk of being hospitalized are congestive heart failure, diabetes, and anemia; taking several medications; low BMI; and emergency department visits in the past year. Better physical functioning reduces their risk of hospitalization. The six risk factors are usually noted in the patient's medical record, making it easier to target patients for an intervention designed to reduce their need for hospitalization, suggests lead investigator Teresa M. Damush, Ph.D., of the Regenstrief Institute for Health Care in Indianapolis.

In the study, which was supported in part by the Agency for Healthcare Research and Quality (HS07632), Dr. Damush and her colleagues analyzed a dataset of 1,041 patients (more than half of whom were African-American) of an inner city primary care practice, who were either 75 years of age or older or 50 years of age or older with severe disease. They followed the patients for 1 year and recorded nonelective hospitalizations during that time. They used regression analysis to identify factors that would predict hospitalization.

Overall, 46 percent of the patients had heart disease, 45.5 percent had chronic obstructive pulmonary disease, and 34.9 percent had congestive heart failure. On average, patients took 5.6 medications. Many were obese or anemic and had physical functioning, general health, and vitality scores below the 50th percentile. One in five patients (21 percent) had one or more nonelective hospital admissions during the followup period.

See "Risk factors for nonelective hospitalization in frail and older adult, inner-city outpatients," by Dr. Damush, David M. Smith, M.D., Anthony J. Perkins, M.S., and others, in the February 2004 Gerontologist 44(1), pp. 68-75.

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