Rates and Reasons for Recurrent Emergency Hospitalizations Among Frail Residents With Diabetes Following First Admission to Long-Term Care Facilities

Abstract

Objectives: Frail residents with type 2 diabetes (T2D) living in long-term care facilities (LTCFs) are at high risk of emergency hospitalizations. We investigated rates and reasons for recurrent emergency hospitalizations by frailty status.

Design: Retrospective cohort study.

Setting and participants: Adults with T2D newly discharged to LTCFs following an emergency hospitalization in Victoria, Australia, from 2012 and 2018.

Methods: Using the Victorian Admitted Episodes Dataset we determined incidence rate (IR) and hospital-bed days per 1000 person-years (PY) for emergency hospitalizations over 24 months. Reasons for hospitalization were identified using International Classification of Diseases-10 Australian Modification codes. Frailty was defined using Hospital Frailty Risk Score. Poisson regression estimated age- and sex-adjusted incident rate ratios (aIRRs) and 95% confidence intervals (CIs). We compared the top 50 hospitalization reasons between frail and robust residents.

Results: Among 17,704 people with T2D (44.3% ≥85 years, 80% frail) discharged to LTCFs, 9949 (56.2%) had ≥1 recurrent emergency hospitalizations over 24 months (IR 1204 hospitalizations per 1000PY and 8489 hospital-bed days per 1000PY). Of these, 28.8% had ≥3, and 9.3% had >5 hospitalizations. Frail residents had more (aIRR, 1.27; 95% CI, 1.22-1.31) and longer (aIRR, 1.46; 95% CI, 1.44-1.48) hospitalizations than robust residents. Leading reasons for recurrent hospitalizations were T2D complications (40.8%), infectious diseases (20.7%), and geriatric syndromes (4.5%). Notably, 47.6% of hospitalizations were for 10 potentially preventable reasons including T2D complications, heart failure, hypertension, angina, anemia, chronic obstructive pulmonary disease, urinary disorders, cellulitis, viral hepatitis, and intestinal infections. Frailty was associated with higher recurrent hospitalization rates and longer stays for T2D complications and geriatric syndromes.

Conclusions and implications: More than half of residents had recurrent emergency hospitalizations within 24 months, with frail residents experiencing more frequent and prolonged episodes. Nearly half were potentially preventable, highlighting the need for targeted management and care coordination.

Keywords: Type 2 diabetes, frailty; causes; emergency; hospital admission; long-term care facility; nursing homes; preventable hospitalization; reasons; unplanned hospitalization.