Readmission to the hospital within 30-days has a high cost and represents a gap in care for older adults. Older adults are at significant risk for depression, particularly given their medical comorbidities and social factors such as isolation due to SARS-CoV-2. Many patients who screen positive for depression may have no known history of depression. This investigation examines the relationship between a positive geriatric depression screen and chief complaint as a function of 30- and 90-day readmission risk.
We examined the electronic medical record of 329 older adults aged 65 and older from February 1, 2020, to January 31, 2021, with a positive depression screen during an emergency department visit at a Midwest Geriatric Emergency Department. Their admission and final ICD-10 diagnosis coding groups (used as a surrogate to standardize chief complaint), social factors such as marital status, living environment, Orientation-Memory-Concentration Test score, and level of independence, were analyzed and considered as potential contributory factors.
In total, this group of patients was found to have readmission rates reaching 42.6% within 30-days, 61.7% within 90 days, and 22.2% with readmission within both 30- and 90-days. Two diagnosis groups were associated with an increased risk for readmission: (1) endocrine, nutritional, and metabolic diseases had a 1.72-fold increase in odds of 90-day readmission (OR: 1.72, p=0.03), and (2) circulatory system diseases had 2.45-fold increased odds for both 30- and 90-day readmission (OR: 2.45, p=0.02). Two diagnosis groups were associated with a decreased risk for readmission: (1) mental, behavioral, or neurocognitive disorders had a 57.0% lower odds of 30-day readmission (OR: 0.43, p=0.01), and 51.1% for 90-day readmission (OR: 0.49, p=0.02) and (2) factors influencing health status or contact with health services had an 88.2% lower odds of 90-day readmission (OR: 0.12, p=0.02).
Our results suggest an interplay between a positive depression finding and specific concurrent diagnosis groups increased the risk for 30- and 90-day readmission. These findings support further investigation into the importance of depression identification followed by actions to address social determinants of health that could lower the odds of readmission, specifically with endocrine, nutritional, and metabolic diseases. Emergency providers can better meet the needs of this population by assessing for depression followed by referral protocols.