Medication-Related Factors Affecting Discharge to Home

Abstract

To assess the reasons for barriers to home discharge by determining whether they were predicted by medication, clinical variables, and patient characteristics, the retrospective cohort study of 282 patients discharged from Kanazawa Red Cross Hospital in Kanazawa, Japan from January 2011 to December 2012 was performed. The percentage of patients discharged was 67.4%. By multivariate logistic analysis, significant differences in home discharge destination were determined by six factors: the duration of hospitalization before discharge (odds ratio (OR) 0.993; 95% 95% confidence interval (CI) 0.988-0.999), the presence of excretion assistance (OR 0.115; 95% CI 0.043-0.308), individual payment of medical expense (OR 0.344; 95% CI 0.146-0.811), the degree of independent living for the demented elderly (OR4.570; 95% CI 1.969-10.604), presence of the primary caregiver (OR 8.638; 95% CI 3.121-23.906), and admission to a hospital from home (OR 5.483; 95% CI 2.589-11.613). This study suggests that necessity of excretion assistance, long duration of hospitalization, and high individual payment of medical expense were barriers to home discharge. In contrast, three factors i.e., admission to a hospital form home, low degree of independent living for the demented elderly, and presence of the primary caregiver, favored home discharge. The relation between a patient's status (cognitive status and incontinence) and a caregiver has an important effect on the home discharge. However, medication characteristics appeared to have little effect on recuperation destination.

Clinical characteristics of participants enrolled in an early identification and healthcare management program for dementia based on cluster analysis and the effectiveness of associated support efforts

“…For the assessment of physical condition and ADL, the independence level for ADL in the disabled elderly was used. This metric has five categories: Independent (independent in daily living), J (having some physical disability but capable of going out from the house without assistance), A (incapable of going out from the house without assistance), B (spending most of the time in bed), and C (bedridden) (Hashimoto et al, 2014). The status of ADL and IADL was assessed using the independence level for ADL in elderly patients with dementia, which includes the following seven categories: I (some cognitive impairment but almost independent in daily living), IIa (dementia with some difficulty in social activities but independent in daily living with minimal observation), IIb (dementia with some difficulty at home but independent in daily living with minimal observation), IIIa (dementia with some difficulty during daytime and requiring partial care), IIIb (dementia with some difficulty in daily life and requiring partial care), IV (severe dementia with difficulty in communicating and requiring complete care), and M (severe dementia with difficulty in daily life and requiring specialized medical support for dementia) (Hashimoto et al, 2014).…”