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Journal of General Internal Medicine
Published in: Journal of General Internal Medicine 11/2014

01-11-2014 | Original Research

Hospital Discharge Instructions: Comprehension and Compliance Among Older Adults

Authors: J. S. Albrecht, PhD, A. L. Gruber-Baldini, PhD, J. M. Hirshon, MD, MPH, PhD, C. H. Brown, PhD, R. Goldberg, PhD, J. H. Rosenberg, BS, A. C. Comer, MPH, J. P. Furuno, PhD

Published in: Journal of General Internal Medicine | Issue 11/2014

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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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Metadata
Title
Hospital Discharge Instructions: Comprehension and Compliance Among Older Adults
Authors
J. S. Albrecht, PhD
A. L. Gruber-Baldini, PhD
J. M. Hirshon, MD, MPH, PhD
C. H. Brown, PhD
R. Goldberg, PhD
J. H. Rosenberg, BS
A. C. Comer, MPH
J. P. Furuno, PhD
Publication date
01-11-2014
Publisher
Springer US
Published in
Journal of General Internal Medicine / Issue 11/2014
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-014-2956-0

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