Skip to main content Accessibility help

Hospital readmissions in frail older people

  • Emily Craven (a1) and Simon Conroy (a1)

The majority of hospital in-patients are older people, and many of these are at increased risk of readmission, which can be an adverse outcome for the patient. Currently there is poor understanding as to how best to reduce the risk of readmission. We searched MEDLINE, EMBASE and the Cochrane library for high quality review articles about readmissions. Each review was quality assessed by two reviewers. Grouped data and evidence from original papers is cited with 95% confidence intervals when possible. Nine review studies of sufficient quality were included. Two addressed risk factors for readmission, which included: age, poor functional status prior to admission, length of stay during the index admission, depression, cognitive impairment, malnutrition, social support and social networks/support. The seven other reviews addressed interventions to reduce readmission, which included: discharge planning, post-discharge support, post-discharge case management, and nutritional supplementation. It is possible to identify older people at risk of readmission using well-established risk factors; discharge planning, post-discharge support and nutritional interventions appear to be effective in reducing readmission. Combined interventions appear to be more effective than isolated interventions.

Corresponding author
Address for correspondence: Dr Simon Conroy, Geriatric Medicine, Room 034, Level 5, Windsor Building, Leicester Royal Infirmary, Leicester LE1 5WW. Email:
Hide All
1Zerdevas, P, Dobson, C. Emergency readmission rates: further analysis; 2008.
2Nuffield Trust. Predicting risk of hospital readmission with PARR-30; 2012: Available at:
3Hansen, L, Young, R, Hinami, K, Leung, A, Williams, M. Interventions to reduce 30-day rehospitalization: a systematic review. Ann Intern Med 2011; 155: 520–28.
4Billings, J, Blunt, I, Steventon, A, Georghiou, T, Lewis, G, Bardsley, M. Development of a predictive model to identify inpatients at risk of re-admission within 30 days of discharge (PARR-30). BMJ Open 2012; 2 (4).
5García-Pérez, L, Linertová, R, Lorenzo-Riera, A, Vázquez-Díaz, J, Duque-González, B, Sarría-Santamera, A. Risk factors for hospital readmissions in elderly patients: a systematic review. QJM 2011; 104: 639–51.
6Preyde, M, Brassard, K. Evidence-based risk factors for adverse health outcomes in older patients after discharge home and assessment tools: a systematic review. J Evid Based Soc Work 2011; 8: 445–68.
7Shepperd, S, Lannin, N, Clemson, L, McCluskey, A, Cameron, I, Barras, S. Discharge planning from hospital to home. Cochrane Database Syst Rev 2013; 1.
8Conroy, SP, Stevens, T, Parker, SG, Gladman, JRF. A systematic review of comprehensive geriatric assessment to improve outcomes for frail older people being rapidly discharged from acute hospital: ‘interface geriatrics’. Age Ageing 2011; 40: 436–43.
9Linertová, R, García-Pérez, L, Vázquez-Díaz, J, Lorenzo-Riera, A, Sarría-Santamera, A. Interventions to reduce hospital readmissions in the elderly: in-hospital or home care. A systematic review. J Eval Clin Pract 2011; 17: 1167–75.
10Ellis, G, Whitehead, M, O’Neill, D, Robinson, D, Langhorne, P. Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Library 2011.
11Stratton, R, Hébuterne, X, Elia, M. A systematic review and meta-analysis of the impact of oral nutritional supplements on hospital readmissions. Ageing Res Rev 2013; 4: 884–97.
12Cawood, A, Elia, M, Stratton, R. Systematic review and meta-analysis of the effects of high protein oral nutritional supplements. Ageing Res Rev 2012; 2: 278–96.
13Braes, T, Moons, P, Lipkens, P, Sterckx, W, Sabbe, M, Flamaing, Jet al.Screening for risk of unplanned readmission in older patients admitted to hospital: predictive accuracy of three instruments. Aging Clin Exp Res 2010; 22: 345–51.
14Kansagara, D, Englander, H, Salanitro, A. Risk prediction models for hospital readmission: a systematic review. JAMA 2011; 306: 1688–98.
15Conroy, SP, Ansari, K, Williams, M, Laithwaite, E, Teasdale, B, Dawson, Jet al.A controlled evaluation of comprehensive geriatric assessment in the emergency department: the ‘Emergency Frailty Unit’. Age Ageing 2014; 43: 109–14.
16Rockwood, K, Andrew, M, Mitnitski, A. A comparison of two approaches to measuring frailty in elderly people. J Gerontol A Biol Sci Med Sci 2007; 62: 738–43.
17Rockwood, K, Mitnitski, A. Frailty in relation to the accumulation of deficits. J Gerontol A Biol Sci Med Sci 2007; 62: 722–27.
18Rubenstein, LZ, Rubenstein, LV. Multidimensional assessment of elderly patients. Adv Intern Med 1991; 36: 81108.
19Wright, PN, Tan, G, Iliffe, S, Lee, D. The impact of a new emergency admission avoidance system for older people on length of stay and same-day discharges. Age Ageing 2014; 43: 116–21.
20Foo, CL, Siu, VW, Tan, TL, Ding, YY, Seow, E. Geriatric assessment and intervention in an emergency department observation unit reduced re-attendance and hospitalisation rates. Australas J Ageing 2012; 31: 4046.
21Gravelle, H, Dusheiko, M, Sheaff, R, Sargent, P, Boaden, R, Pickard, Set al.Impact of case management (Evercare) on frail elderly patients: controlled before and after analysis of quantitative outcome data. BMJ 2006; 334: 31.
22Lewis, G, Georghiou, T, Steventon, A, Vaithianathan, R, Chitnis, X, Billings, Jet al.Analysis of virtual wards: a multidisciplinary form of case management that integrates social and health care. Final report. NIHR Service Delivery and Organisation programme. London: NIHR SDO; 2013.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Reviews in Clinical Gerontology
  • ISSN: 0959-2598
  • EISSN: 1469-9036
  • URL: /core/journals/reviews-in-clinical-gerontology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed