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Supporting at-risk older adults transitioning from hospital to home: who benefits from an evidence-based patient-centered discharge planning intervention? Post-hoc analysis from a randomized trial
- Source :
- BMC Geriatrics, Vol 20, Iss 1, Pp 1-10 (2020), BMC Geriatrics
- Publication Year :
- 2020
- Publisher :
- BMC, 2020.
-
Abstract
- Background Subgroups of older patients experience difficulty performing activities of daily living (ADL) following hospital discharge, as well as unplanned hospital readmissions and emergency department (ED) presentations. We examine whether these subgroups of “at-risk” older patients benefit more than their counterparts from an evidence-based discharge planning intervention, on the following outcomes: (1) independence in ADL, (2) participation in life roles, (3) unplanned re-hospitalizations, and (4) ED presentations. Trial design and methods This study used data from a randomized control trial involving 400 hospitalized older patients with acute and medical conditions, recruited through 5 sites in Australia. Participants receive either HOME, a patient-centered discharge planning intervention led by an occupational therapist; or a structured in-hospital consultation. HOME uses a collaborative approach for goal setting and includes pre and post-discharge home visits as well as telephone follow-up. Characteristics associated with higher risks of adverse outcomes were recorded and at-risk subgroups were created (mild cognitive impairment, walking difficulty, comorbidity, living alone and no support from family). Independence in ADL and participation in life roles were assessed with validated questionnaires. The number of unplanned re-hospitalizations and ED presentations were extracted from medical files. Linear regression models were conducted to detect variation in response to the intervention at 3-months, according to patients’ characteristics. Results Analyses revealed significant interaction effects for intervention by cognitive status for unplanned re-hospitalization (p = 0.003) and ED presentations (p = 0.021) at 3 months. Within the at-risk subgroup of mild cognitively impaired, the HOME intervention significantly reduced unplanned hospitalizations (p = 0.027), but the effect did not reach significance in ED visits. While the effect of HOME differed according to support received from family for participation in life roles (p = 0.019), the participation observed in HOME patients with no support was not significantly improved. Conclusions Findings show that hospitalized older adults with mild cognitive impairment benefit from the HOME intervention, which involves preparation and post-discharge support in the environment, to reduce unplanned re-hospitalizations. Improved discharge outcomes in this at-risk subgroup following an occupational therapist-led intervention may enable best care delivery as patients transition from hospital to home. Trial registration The trial was registered before commencement (ACTRN12611000615987).
- Subjects :
- Male
Occupational therapy
medicine.medical_specialty
Activities of daily living
medicine.medical_treatment
Aftercare
lcsh:Geriatrics
law.invention
03 medical and health sciences
0302 clinical medicine
Randomized controlled trial
law
Patient-Centered Care
Intervention (counseling)
Activities of Daily Living
Post-hoc analysis
Humans
Medicine
Cognitive Dysfunction
030212 general & internal medicine
Aged
Aged, 80 and over
Rehabilitation
Home visit
business.industry
030503 health policy & services
Australia
Emergency department
medicine.disease
Comorbidity
Patient Discharge
lcsh:RC952-954.6
Outcome and Process Assessment, Health Care
Treatment Outcome
Cognitive impairment
Older adults
Physical therapy
Female
Geriatrics and Gerontology
0305 other medical science
business
Discharge planning
Research Article
Subjects
Details
- Language :
- English
- ISSN :
- 14712318
- Volume :
- 20
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- BMC Geriatrics
- Accession number :
- edsair.doi.dedup.....15f369b8772cde3fc2660c327c2c99c0