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.
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Acknowledgements
This work was supported by Agency for Healthcare Research and Quality grant R36HS021068-01 (J.S.A), National Institutes of Health grants T32AG000262-14 (J.S.A.), K01AI071015-05 (J.P.F.), National Heart, Lung, & Blood Institute grant R01 HL085706 (A.L.G.-B.).
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The authors declare that they do not have a conflict of interest.
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Albrecht, J.S., Gruber-Baldini, A.L., Hirshon, J.M. et al. Hospital Discharge Instructions: Comprehension and Compliance Among Older Adults. J GEN INTERN MED 29, 1491–1498 (2014). https://doi.org/10.1007/s11606-014-2956-0
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DOI: https://doi.org/10.1007/s11606-014-2956-0