Readmission of older patients after hospital discharge for hip fracture: a multilevel approach

ABSTRACT OBJECTIVE To identify individual and hospital characteristics associated with the risk of readmission in older inpatients for proximal femoral fracture in the period of 90 days after discharge. METHODS Deaths and readmissions were obtained by a linkage of databases of the Hospital Information System of the Unified Health System and the System of Information on Mortality of the city of Rio de Janeiro from 2008 to 2011. The population of 3,405 individuals aged 60 or older, with non-elective hospitalization for proximal femoral fracture was followed for 90 days after discharge. Cox multilevel model was used for discharge time until readmission, and the characteristics of the patients were used on the first level and the characteristics of the hospitals on the second level. RESULTS The risk of readmission was higher for men (hazard ratio [HR] = 1.37; 95%CI 1.08–1.73), individuals more than 79 years old (HR = 1.45; 95%CI 1.06–1.98), patients who were hospitalized for more than two weeks (HR = 1.33; 95%CI 1.06-1.67), and for those who underwent arthroplasty when compared with the ones who underwent osteosynthesis (HR = 0.57; 95%CI 0.41–0.79). Besides, patients admitted to state hospitals had lower risk for readmission when compared with inpatients in municipal (HR = 1.71; 95%CI 1.09–2.68) and federal hospitals (HR = 1.81; 95%CI 1.00–3.27). The random effect of the hospitals in the adjusted model remained statistically significant (p < 0.05). CONCLUSIONS Hospitals have complex structures that reflect in the quality of care. Thus, we propose that future studies may include these complexities and the severity of the patients in the analysis of the data, also considering the correlation between readmission and mortality to reduce biases

Prevenção de câncer de mama em mulheres idosas: uma revisão La prevención de cáncer de mama en mujeres ancianas: una revisión Prevention of breast cancer in elderly women: a review

Trata-se de um estudo de revisão bibliográfica nacional, que objetivou refletir sobre a prevenção do câncer de mama em idosas. Esta curiosidade surgiu a partir da constatação da transição demográfica brasileira e da evidente feminização da velhice, o que impõe demandas assistênciais específicas e integrais para este segmento populacional. Ressalta-se a necessidade de ampliar o conhecimento a cerca da problemática, bem como a superação do negligenciamento na prevenção desta patologia, especialmente na velhice. Focalizaram-se dois tópicos reflexivos: Envelhecimento Feminino, Saúde e Gênero e Lacuna na integralidade da assistência à mulher idosa: conscientizar para libertar. Espera-se com esta reflexão possa subsidiar melhorias na assistência, favorecer a inclusão desta temática no ensino e estimular novas investigações.<br>Se trata de una revisión bibliografica nacional que tuvo por objeto reflexionar sobre la prevención de cáncer de mama en las mujeres ancianas. Esta curiosidad surgió de la observación de la transición demográfica brasileña y del evidente feminización de la vejez, que impone demandas específicas e integrales para la ayuda a este grupo de población. Se insiste en la necesidad de ampliar el conocimiento sobre el problema, así como la superación de la negligencia en la prevención de esta enfermedad, especialmente en la vejez. Se centró dos temas de reflexión: El envejecimiento de Mujeres, Salud y Género y la Brecha de la exhaustividad de la asistencia a la mujer mayor: poner en libertad a la conciencia. Se espera con esta reflexión subvencionar la mejora de la asistencia, promover la inclusión de esta cuestión en la educación y estimular nuevas investigaciones.<br>This is a national literature review that aimed to reflect on the prevention of breast cancer in the elderly woman. This curiosity arose from the observation of demographic transition and of course Brazilian feminisation of old age, which imposes specific demands assists and integrals for this population segment. It is emphasized the need to extend the knowledge about the problem, as well as overcoming the negligence in the prevention of this disease, especially in old age. Focused are two topics reflective: Aging Women, Health and Gender Gap and the completeness of assistance to the elderly woman: awareness to release. It is expected with this reflection subsidize quality improvement of the assistance, promote the inclusion of this issue in education and stimulate new research