title: High rates and the risk factors for emergency room visits and hospitalization in Parkinson's disease.
abstract: BACKGROUND
  Parkinson's disease (PD) patients are hospitalized more frequently than their peers as a result of falls, psychosis, infections and other medical complications. However, patient-specific risk factors for hospitalization are unclear.
  
  
  OBJECTIVE
  To identify rates and risk factors for hospital encounters (Emergency Room [ER] visits or hospitalization) among people with PD.
  
  
  METHODS
  3415 PD participants (mean age 67 ± 10 years, disease duration 9 ± 6 years, H&Y 2 47%, H&Y 3 26%) enrolled in the prospective international multicenter NPF-QII Study. One-year follow-up data was available for 1030 patients. Rates and risk factors for hospital encounters were determined at baseline and after one year follow-up.
  
  
  RESULTS
  Of 3415 PD participants at study entry, 1120 (33%) reported at least one hospital encounter. Associations were: longer timed up-and-go test (OR: 1.33), increased comorbidities (OR: 1.25), motor fluctuations (OR: 1.32), and deep brain stimulation (DBS) (OR: 2.49). Of these 1120 persons, 311 had follow-up data and 158 (51%) had a repeat encounter one year later, associated with higher H&Y stage, fluctuations, and lower health-related quality-of-life. Of 2295 participants without a hospital encounter at baseline, 719 had follow-up data and 178 (25%) had a first hospital encounter one year later. Risk factors were female gender, comorbidities, lower cognition, fluctuations, and DBS.
  
  
  CONCLUSIONS
  One-third of people with PD had a hospital encounter each year, and one-half of those had a repeat encounter. These high rates correlated with disease severity, comorbidities and DBS. There is an urgent need to develop programs to reduce PD hospital encounters.
authors.affiliation: Center for Movement Disorders & Neurorestoration, University of Florida, Gainesville, FL, USA; Department of Neurology, Mayo Clinic, Rochester, MN, USA. Electronic address: hassan.anhar@mayo.edu.
authors.forename: Anhar
authors.initials: A
authors.lastname: Hassan
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Wu
authors.forename: Peter
authors.initials: P
authors.lastname: Schmidt
authors.forename: Yunfeng
authors.initials: Y
authors.lastname: Dai
authors.forename: Tanya
authors.initials: T
authors.lastname: Simuni
authors.forename: Nir
authors.initials: N
authors.lastname: Giladi
authors.forename: Bastiaan R
authors.initials: BR
authors.lastname: Bloem
authors.forename: Irene A
authors.initials: IA
authors.lastname: Malaty
authors.forename: Michael S
authors.initials: MS
authors.lastname: Okun
mesh_terms: D000368:Aged; D004636:Emergency Service, Hospital / Q000191:economics / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000191:economics / Q000639:trends*; D006801:Humans; D038622:Internationality; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000191:economics / Q000453:epidemiology* / Q000628:therapy*; D011446:Prospective Studies; D012307:Risk Factors
keywords: Admissions; Comorbidities; Emergency care; Hospitalization; Parkinson's disease