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Unplanned Hospital Care Use in Older Adults: The Role of Psychological and Social Well-Being
Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
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Number of Authors: 52020 (English)In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVES To explore the association of psychological and social well-being with unplanned hospital utilization in an older Swedish population. DESIGN Data for this study were gathered from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K). Information on hospital care use was extracted from the Stockholm County Council Inpatient Register for up to 4 years after the baseline SNAC-K assessment (2001-2007). Participants with dementia or living in institutions were excluded from the study sample. SETTING Community-based study of randomly selected adults, aged 60 years or older, living in the Kungsholmen district of Stockholm. PARTICIPANTS A complete case analysis was performed on 2139 individuals. MEASUREMENTS We created standardized indexes of psychological well-being (integrating life satisfaction and positive and negative affect) and social well-being (integrating social connections, support, and participation). Negative binomial models were used to estimate the association of psychosocial well-being with unplanned admissions, hospital days, and 30-day readmissions, considering potential sociodemographic, lifestyle, personality, and clinical confounders. RESULTS Individuals with psychological well-being scores above the median had lower rates of unplanned hospital admissions (incidence rate ratio [IRR] = 0.67; 95% confidence interval [CI] = 0.55-0.82) and hospital days (IRR = 0.67; 95% CI = 0.49-0.92) compared to those with scores below the median. High levels of social well-being were also protective for unplanned admissions and hospital days, but the statistical significance was lost in the fully adjusted models. Relative to individuals with low well-being on both indexes, the rate of unplanned admissions and hospital days was lowest in those with both high psychological and social well-being (IRR = 0.72; 95% CI = 0.55-0.93; and IRR = 0.57; 95% CI = 0.39-0.85, respectively). For 30-day readmissions, a statistically significant negative association was found with psychological well-being, but only when operationalized as a continuous variable. CONCLUSION Given their association with unplanned admissions and hospital days, targeting aspects of psychosocial well-being could be a viable strategy for reducing healthcare use and, eventually, costs.

Place, publisher, year, edition, pages
2020.
Keywords [en]
hospital care use, older adults, psychological well-being, social well-being
National Category
Geriatrics Gerontology, specialising in Medical and Health Sciences
Identifiers
URN: urn:nbn:se:su:diva-178805DOI: 10.1111/jgs.16313ISI: 000507971800001PubMedID: 31956993OAI: oai:DiVA.org:su-178805DiVA, id: diva2:1393565
Available from: 2020-02-17 Created: 2020-02-17 Last updated: 2020-02-17

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GeriatricsGerontology, specialising in Medical and Health Sciences

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