Hospital readmissions among older people with intellectual disability in comparison with the general population.
Adults with ID over 55 bounce back to hospital far more often for nerve and bone troubles, so tighten their after-care plan.
01Research in Context
What this study did
Researchers tracked every hospital stay in Sweden for adults with intellectual disability who were 55 or older. They matched each person with someone from the general population of the same age and sex.
The team then counted who came back to the hospital within 30 days and for which body system.
What they found
Nervous-system and muscle-bone returns were almost twice as high in the ID group. Breathing and stomach returns were also higher.
Yet returns for heart problems and mental-health crises were lower than in the general group.
How this fits with other research
Eggleston et al. (2018) saw that having four or more chronic illnesses doubled death risk in the same older-ID group. The new readmission data add a middle step: many of those illnesses first pull people back into hospital.
Prigge et al. (2013) showed that adults with mild ID already stay far longer once admitted. Pitchford et al. (2019) now show they also come back faster, so the hospital door keeps revolving.
Lin et al. (2011) warned that services are unprepared for early ageing in ID. The Swedish numbers prove the warning was correct: discharge plans built for the general population miss the extra nervous-system and muscle-bone risks that hit this group.
Why it matters
If you support an older adult with ID, ask the discharge team to book a follow-up visit within two weeks for any nerve, bone, breathing or stomach problem. A quick check can catch the issues that send them back to the ward.
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02At a glance
03Original abstract
BACKGROUND: Older people with intellectual disability have high multimorbidity and poor physical and mental health compared with the general population. Consequently, they have a greater need for health care. Hospital readmissions may be an indicator of the quality of health care. However, so far, only a few studies have investigated this outcome in populations of people with intellectual disability. None has focused on older people. METHOD: We identified a cohort of people with intellectual disability aged 55+ years and alive at the end of 2012 (n = 7936). Moreover, we established a reference cohort from the general population, one-to-one matched by sex and year of birth. Data on hospital visits during the period 2002-2012 were collected from the Swedish National Patient Register. Readmissions were defined as unplanned visits with the same diagnosis occurring within 30 days of discharge and with no planned visit for the same diagnosis during this time. RESULTS: Compared with the general population, people with intellectual disability had increased risk of readmissions for diseases of the nervous system [relative risk (RR) 2.62], respiratory system (RR 1.48), digestive system (RR 1.40) and musculoskeletal system and connective tissue (RR 2.10). Within these diagnostic groups, increased risks were found for arthropathies (RR 3.73), disorders of gallbladder, biliary tract and pancreas (RR 1.78), other diseases of intestines (RR 1.30), and other forms of heart disease (RR 1.23). Decreased risk of readmissions was found for mental and behavioural disorders (RR 0.78) and diseases of the circulatory system (RR 0.64). CONCLUSIONS: The increased risk for readmissions related to diseases of the nervous and musculoskeletal systems has a clear relation to the prevalence of comorbidities in these areas. People with intellectual disability often also have inborn limitations and damages in these systems which with time lead to complications and risk for diseases, which can be difficult to discover. The increased risk for readmissions for disease of the respiratory system, together with the already known increased prevalence of such diagnoses and their occurrence as a cause for death, warrants further investigations and considerations of potential preventive measures. The pattern of readmissions among older people with intellectual disability cannot be explained solely by a higher prevalence of disorders in this group. Our finding of increased risks for readmissions for diseases in the digestive system could be interpreted as communication problems, which sometimes result in too rapid discharges and their consequential early readmissions.
Journal of intellectual disability research : JIDR, 2019 · doi:10.1111/jir.12601