Influence of comorbidities, geriatric syndromes, and frailty on mortality risk by discharge destination in older adults after acute hospitalization: a nationwide cohort study

TL;DR

This study shows that older adults discharged to certain facilities after hospitalization face higher mortality risks, especially if they have comorbidities, frailty, or geriatric syndromes.

Contribution

The study identifies how discharge destination interacts with geriatric factors to influence mortality risk in older adults.

Findings

Discharge to long-term care hospitals was linked to the highest mortality risk (aHR 2.922).

Frailty, geriatric syndromes, and high comorbidity index independently increased mortality risk.

Tailored post-discharge strategies are needed for frail and multimorbid patients in community settings.

Abstract

This study investigated its impact of discharge destination on mortality risk among older adults following acute hospital discharge, focusing on the effects of frailty, geriatric syndromes, and comorbidities.

Nationwide claims data from the South Korean National Health Insurance Service of individuals aged ≥65 years who were discharged from acute care hospitals in 2017 were retrospectively analyzed, with participants followed for mortality outcomes over 4 years. Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios (aHR) for mortality according to discharge destination and geriatric status.

This study included 1,115,556 participants (mean age, 75.5 years; 45.6% men). The most common discharge destination was home (76.5%), followed by tertiary/general hospitals (15.2%), long-term care hospitals (5.2%), hospitals (2.3%), and other facilities (0.8%). Patients discharged to long-term care hospitals were older, had a higher comorbidity burden, and more frequently had disabilities or geriatric syndromes than their counterparts. Mortality risk was significantly higher among those discharged to tertiary/general hospitals (aHR 1.806, 95% CI: 1.793–1.820), general hospitals (aHR 1.480, 95% CI: 1.453–1.507), and long-term care hospitals (aHR 2.922, 95% CI: 2.892–2.952) than among those discharged to home. Higher Charlson comorbidity index (≥3), more geriatric syndromes, and severe frailty were all independently associated with increased mortality risk.

Discharge destination, frailty, geriatric syndromes, and comorbidities independently and interactively influenced the mortality risk in older adults after acute hospitalization. Tailored post-discharge management strategies are necessary, particularly for patients with frailty and multimorbidity in community settings.

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