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Hospital Discharge Instructions: Comprehension and Compliance Among Older Adults

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  • 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 and identify patient characteristics associated with non-comprehension and non-compliance with discharge instructions. RESEARCH DESIGN: Prospective cohort study SUBJECTS: 450 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, 1.120) 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.
  • Keywords: Older adults, Comprehension, Hospital discharge instructions, Compliance
  • Keywords: Older adults, Comprehension, Hospital discharge instructions, Compliance
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  • Albrecht, J. S., Gruber-Baldini, A. L., Hirshon, J. M., Brown, C. H., Goldberg, R., Rosenberg, J. H., ... & Furuno, J. P. (2014). Hospital discharge instructions: comprehension and compliance among older adults. Journal of General Internal Medicine, 29(11), 1491-1498. doi:10.1007/s11606-014-2956-0
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  • 29
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  • 11
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  • 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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