An interim prospective secondary analysis from a parent trial at one university hospital followed 170 frail older adults after medical-ward discharge. A broad composite of emergency visits, unplanned outpatient visits, and readmissions rose from 34.7% at one month to 64.7% at six months. Better nutritional status was associated with lower return odds, and returners had higher direct medical costs. The observational analysis does not show that nutritional intervention prevents return.
Key findings
- Cumulative unplanned return was 34.7% at one month, 55.3% at three months, and 64.7% at six months.
- At six months, better nutritional status was associated with lower return odds (aOR 0.83 per score unit; 95% CI 0.72–0.97).
- At three months, better nutrition remained associated with lower odds (aOR 0.85), while in-hospital heart failure was associated with higher odds (aOR 2.36).
- Returners had higher outpatient, post-discharge inpatient, and total direct medical costs. Direct nonmedical costs were numerically higher but not statistically different.
Why this matters globally
Ageing health systems need post-discharge pathways for frail adults. The study shows that risk and costs continue beyond 30 days and motivates trials integrating nutrition, heart-failure, depression, and care coordination, with causal and cost-effectiveness evaluation.
Thai researcher contribution
Researchers from Siriraj Hospital, Mahidol University, and Lampang Hospital analyzed real Thai patient trajectories and costs. Titima Wongviriyawong is corresponding author, and the parent trial is registered as TCTR20190910002.
Limitations to consider
This single-center interim secondary analysis included 170 participants. The composite mixes events of different severity, and time-specific associations may be sensitive to event counts, multiple analyses, and unmeasured factors. Although sourced from a parent RCT, this analysis was not a randomized intervention comparison; adjusted odds ratios are not treatment effects.