Hospitalization is more than a purely medical event. Hospitalization is a complex interplay of medical and social circumstance, particularly in older persons. The need for hospitalization varies widely depending on patients' social circumstance. On the one hand, a patient with a well-functioning support network may be cared for at home, even if they have rather severe medical illness. On the other hand, a patient with limited social support or stressed caregivers may require hospitalization for even minor exacerbations of their medical illness. For example, hospitalization for congestive heart failure is related to many social factors besides congestive heart failure severity. This phenomenon is nicely illustrated by Dong and Simon, who show that persons with a history of elder abuse are at much higher risk of being hospitalized, even after controlling for medical severity, functional status, and cognitive function. This illustrates the importance of understanding the social circumstances that made continued care at home impossible, in addition to understanding the trajectory of their medical illness. Addressing the social circumstances will often prove at least as important as addressing the medical diagnosis in terms of preventing readmission and addressing what is really ailing the patient.
Covinsky KE. Hospitalization in Older Persons: Not Just a Medical Outcome, a Social Outcome as WellComment on “Elder Abuse as a Risk Factor for Hospitalization in Older Persons”. JAMA Intern Med. 2013;173(10):919. doi:10.1001/jamainternmed.2013.248