Journal of General Internal Medicine

, Volume 29, Issue 11, pp 1491–1498

Hospital Discharge Instructions: Comprehension and Compliance Among Older Adults

  • J. S. Albrecht
  • A. L. Gruber-Baldini
  • J. M. Hirshon
  • C. H. Brown
  • R. Goldberg
  • J. H. Rosenberg
  • A. C. Comer
  • J. P. Furuno
Original Research

DOI: 10.1007/s11606-014-2956-0

Cite this article as:
Albrecht, J.S., Gruber-Baldini, A.L., Hirshon, J.M. et al. J GEN INTERN MED (2014) 29: 1491. doi:10.1007/s11606-014-2956-0

ABSTRACT

BACKGROUND

Little is known regarding the prevalence or risk factors for non-comprehension and non-compliance with discharge instructions among older adults.

OBJECTIVE

To quantify the prevalence of non-comprehension and non-compliance with discharge instructions and to identify associated patient characteristics.

RESEARCH DESIGN

Prospective cohort study.

SUBJECTS

Four hundred and fifty adults aged ≥ 65 admitted to medical and surgical units of a tertiary care facility and meeting inclusion criteria.

MEASURES

We collected information on demographics, psycho-social factors, discharge diagnoses, and medications using surveys and patient medical records. Domains within discharge instructions included medications, follow-up appointments, diet, and exercise. At 5 days post-discharge, we assessed comprehension by asking patients about their discharge instructions, and compared responses to written instructions from medical charts. We assessed compliance among patients who understood their instructions.

RESULTS

Prevalence of non-comprehension was 5 % for follow-up appointments, 27 % for medications, 48 % for exercise and 50 % for diet recommendations. Age was associated with non-comprehension of medication [odds ratio (OR) 1.07; 95 % confidence interval (CI) 1.04, 1.12] and follow-up appointment (OR 1.08; 95 % CI 1.00, 1.17) instructions. Male sex was associated with non-comprehension of diet instructions (OR 1.91; 95 % CI 1.10, 3.31). Social isolation was associated with non-comprehension of exercise instructions (OR 9.42; 95 % CI 1.50, 59.11) Depression was associated with non-compliance with medication (OR 2.29; 95 % CI 1.02, 5.10) and diet instructions (OR 3.30; 95 % CI 1.24, 8.83).

CONCLUSIONS

Non-comprehension of discharge instructions among older adults is prevalent, multi-factorial, and varies by domain.

KEY WORDS

hospital discharge instructionsolder adultscomprehensioncompliance

Copyright information

© Society of General Internal Medicine 2014

Authors and Affiliations

  • J. S. Albrecht
    • 1
  • A. L. Gruber-Baldini
    • 2
  • J. M. Hirshon
    • 2
    • 3
  • C. H. Brown
    • 2
    • 4
  • R. Goldberg
    • 4
    • 5
  • J. H. Rosenberg
    • 2
  • A. C. Comer
    • 2
  • J. P. Furuno
    • 6
  1. 1.Department of Pharmaceutical Health Services ResearchUniversity of Maryland School of PharmacyBaltimoreUSA
  2. 2.Department of Epidemiology and Public HealthUniversity of Maryland School of MedicineBaltimoreUSA
  3. 3.Department of Emergency MedicineUniversity of Maryland School of MedicineBaltimoreUSA
  4. 4.VA Capitol Healthcare Network (VISN 5)Mental Illness Research, Education, and Clinical CenterLinthicumUSA
  5. 5.Department of PsychiatryUniversity of Maryland School of MedicineBaltimoreUSA
  6. 6.Department of Pharmacy PracticeOregon State University/Oregon Health & Science University College of PharmacyPortlandUSA