First unplanned hospital admission associated with 5-fold increased risk of death in older adults

Unexpected admission to hospital could be an early warning indicator of death within 5 years for seniors. New research in CMAJ (Canadian Medical Association Journal) found that a first unplanned admission to hospital for any reason was associated with a 5-fold increased risk of death in adults over the age of 65.

The study of more than 900,000 community-dwelling adults aged 65 and older looked at the relationship between first unplanned admission to hospital and risk of death over a 10-year study period (2007 to 2017) in Ontario, Canada’s largest province. Researchers included only people who had not been admitted to hospital or visited an emergency department within 5 years. After their first unplanned hospital admission, nearly 40 per cent of people died within 5 years (59,234 people). This was a substantial difference compared to about 10 per cent of people who died within 5 years of their first planned hospital admission (10,775 people) or in those who visited an emergency department and were sent home (35,663 people). Among those who were neither admitted to hospital nor visited the emergency department, only 3 per cent died within 5 years (11,268 people).

“This study addresses existing knowledge gaps by estimating the risk of death after a first acute care encounter in a population of previously healthy older adults cared for in Ontario, Canada,” writes Dr. Chaim Bell, physician-in-chief at Sinai Health System, and professor at the University of Toronto, Toronto, Ontario, with coauthors.


Cancer and heart disease were the most common causes of death in all age groups, and more than 50 per cent of all deaths in the study were among those with their first unplanned hospital admission.

“In a population of healthier people without previous use of acute care, unexpected hospital admission should be recognized as a sentinel event that likely signifies an increased risk of death in the long term,” writes lead author Dr. Kieran Quinn, a general internist and palliative care physician and health services researcher at Sinai Health System, with coauthors. “Recognition of this risk may trigger important discussions among patients, caregivers and health care providers about health preferences for future care.”

The risk of death increased with age, with a 15–20 per cent increase per decade of life. In people aged 66–70 years, the death rate was about 20 per cent, compared with more than 60 per cent in people aged 86–90 years and 90 per cent in people aged 96–100 years.

Other studies have looked at short-term outcomes following hospital admission as well as 5-year death rates for specific conditions, such as heart failure and lung cancer. This study builds on these prior studies by estimating the long-term risk of death for all conditions among older adults without prior hospital admission or emergency department visits.

These findings may be useful in the following ways:

  • To allow patients, families and their doctors to make informed decisions and advanced planning for health care by estimating risk of death;
  • To help physicians estimate an individual patient’s risk by use of population-level risk;
  • To help health services researchers in adjusting risk in future studies;
  • To help health care system planning for health care delivery.

“Our hope is that this simple information can inform complex health care decisions,” concludes Dr. Quinn, with coauthors.

“The risk of death within 5 years of first hospital admission in older adults” was published December 16, 2019