Post-acute care for frail older people decreases 90-day emergency room visits, readmissions and mortality: An interventional study

Abstract

Background To evaluate the effects of post-acute care (PAC) on frail older adults after acute hospitalization in Taiwan. Methods This was a multicenter interventional study. Frail patients aged ≥ 75 were recruited and divided into PAC or control group. The PAC group received comprehensive geriatric assessment (CGA) and multifactorial intervention including exercise, nutrition education, and medicinal adjustments for two to four weeks, while the control group received only CGA. Outcome measures included emergency room (ER) visits, readmissions, and mortality within 90 days after PAC. Results Among 254 participants, 205 (87.6±6.0 years) were in the PAC and 49 (85.2±6.0 years) in the control group. PAC for more than two weeks significantly decreased 90-day ER visits (odds ratio [OR] 0.21, 95% confidence interval [CI] 0.10–0.43; p = 0.024), readmissions (OR 0.30, 95% CI 0.16–0.56; p < 0.001), and mortality (OR 0.20, 95% CI 0.04–0.87; p = 0.032). Having problems in self-care was an independent risk factor for 90-day ER visits (OR 2.11, 95% CI 1.17–3.78; p = 0.012), and having problems in usual activities was an independent risk factor for 90-day readmissions (OR 2.69, 95% CI 1.53–4.72; p = 0.001) and mortality (OR 3.16, 95% CI 1.16–8.63; p = 0.024). Conclusion PAC program for more than two weeks could have beneficial effects on decreasing ER visits, readmissions, and mortality after an acute illness in frail older patients. Those who perceived severe problems in self-care and usual activities had a higher risk of subsequent adverse outcomes.