Posthospital Fall Injuries and 30-Day Readmissions in Adults 65 Years and Older

Hoffman, Geoffrey J.; Liu, Haiyin; Alexander, Neil B.; Tinetti, Mary E.; Braun, Thomas; Min, Lillian

doi:10.1001/jamanetworkopen.2019.4276

Cited by 56 publications

(63 citation statements)

References 48 publications

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“…1 Post-hospital fall-related injuries are a leading diagnosis upon readmission among Medicare patients, particularly for those originally admitted with fall-related injuries or cognitive impairment. 2 Approximately 14% of older adults aged 65 and over have experienced a fall within 1 month post-hospital discharge, 3 and 40% of older adults have fallen within 6 months after discharge. [3][4][5] Older adults may require additional assistance to remain independent in their homes as they age and remain fallfree within the first month post-hospital discharge.…”

Section: Introductionmentioning

confidence: 99%

<p>Barriers and Facilitators to Older Adults Participating in Fall-Prevention Strategies After Transitioning Home from Acute Hospitalization: A Scoping Review</p>

Tzeng

Okpalauwaekwe

Lyons

2020

CIA

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Purpose: Approximately, 14% of older adults aged 65 years and over experience a fall within 1 month post-hospital discharge. Adequate self-management may minimize the impact of these falls; however, research is lacking on why some older adults engage in self-management to prevent falls while others do not. Methods: We conducted a scoping review to identify barriers and facilitators to older adults participating in fall-prevention strategies after transitioning home from acute hospitalization. Eligibility criteria were peer-reviewed journal articles published during 2009-2019 which were written in English and contained any of the following keywords or their synonyms: "fall-prevention," "older adults," "post-discharge" and "transition care." We systematically and selectively summarized the findings of these articles using the Joanna Briggs Institute guidelines and the PRISMA-ScR reporting guidelines. Seven bibliographic databases were searched: PubMed/MEDLINE, ERIC, CINAHL, Cochrane Library, Scopus, PsycINFO, and Web of Science. We used the Capability-Opportunity-Motivation-Behavior (COM-B) model of health behavior change as a framework to guide the content, thematic analysis, and descriptive results. Results: Seventeen articles were finally selected. The most frequently mentioned barriers and facilitators for each COMB dimension differed. Motivation factors include such as older adults lacking inner drive and self-denial of being at risk for falls (barriers) and following-up with older adults and correcting inaccurate perceptions of falls and fall-prevention strategies (facilitators). Conclusion: This scoping review revealed gaps and future research areas in fall prevention relative to behavioral changes. These findings may enable tailoring feasible fall-prevention interventions for older adults after transitioning home from acute hospitalization.

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Section: Introductionmentioning

confidence: 99%

<p>Barriers and Facilitators to Older Adults Participating in Fall-Prevention Strategies After Transitioning Home from Acute Hospitalization: A Scoping Review</p>

Tzeng

Okpalauwaekwe

Lyons

2020

CIA

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“…Healthcare‐associated infections (HAIs) are preventable yet dangerous conditions with dire consequences including death . Septicemia, which can result from untreated HAIs, ranks first among all readmission diagnoses, and pneumonia and other infections (eg, postoperative and urinary tract) are also commonly observed reasons for readmission . Skilled nursing facilities (SNFs) and home health care (HHC) are characterized as contributors to the “revolving door” of rehospitalization often due to infections and other preventable conditions …”

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confidence: 99%

Role of Post‐Acute Care in Readmissions for Preexisting Healthcare‐Associated Infections

Hoffman

Min

Liu

et al. 2019

J American Geriatrics Society

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OBJECTIVES Although preventable, healthcare‐associated infections (HAIs) are commonly observed in post‐acute care settings for at‐risk older adults and are a leading cause of hospital readmissions. However, whether HAIs resulting in avoidable readmissions for preexisting HAIs (the same HAI as at the index admission) are more common for patients discharged to post‐acute care as opposed to home is unknown. We examined the risk of preexisting HAI readmissions according to patient discharge disposition and comorbidity level. DESIGN We used 2013‐2014 national hospital discharge data to estimate the likelihood of readmissions for preexisting HAIs according to patients' discharge disposition and whether the likelihood varies according to patient comorbidity level, across four common types of HAIs (not including respiratory infections). PARTICIPANTS A total of 702 304 hospital discharges for Medicare beneficiaries 65 years or older. MEASUREMENTS Our outcome was a 30‐day preexisting, or “linked,” HAI readmission (readmission involving the same HAI diagnosis as at the index admission). Patient discharge disposition was skilled nursing facility (SNF), home health care, and home care without home health care (“home”). RESULTS Of 702 304 index admissions involving HAI treatment, 353 073 (50%) were discharged to a SNF, 179 490 (26%) to home health care, and 169 872 (24%) to home. Overall, 17 523 (2.5%) of preexisting HAIs resulted in linked HAI readmissions, which were more common for Clostridioides difficile infections (4.0%) and urinary tract infections (2.4%) than surgical site infections (1.1%; P < .001). Being discharged to a SNF compared to home or to home health care was associated with a 1.15 percentage point (95% confidence interval = −1.29 to −1.00), or 38%, lower risk of a linked HAI readmission. This risk difference was observed to increase with greater patient comorbidity. CONCLUSIONS SNF discharges were associated with fewer avoidable readmissions for preexisting HAIs compared with home discharges. Further research to identify modifiable mechanisms that improve posthospital infection care at home is needed. J Am Geriatr Soc 68:370–378, 2020

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“…38,39 A large proportion (66%) of participants from both groups were found to have unmet needs following hospital discharge, 3 indicating they did not take the time to gradually recommence their usual daily activities in a safe manner. 2,35,40 The presence of unmet needs in older adults may contribute to falls incidence, 3 rehospitalization, 41,42 and other negative consequences, including reduced food intake, dehydration, delirium, and pain. 43 Other indications that participants were struggling to regain their function during their recovery 38,39 were in the features of their exercise engagement.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Tailored Falls Education on Older Adults' Behavior Following Hospitalization

Naseri

McPhail

Haines

et al. 2019

J American Geriatrics Society

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BACKGROUND Older adults recently discharged from the hospital are known to be at risk of functional decline and falls. This study evaluated the effect of a tailored education program provided in the hospital on older adult engagement in fall prevention strategies within 6 months after hospital discharge. METHODS A process evaluation of a randomized controlled trial that aimed to improve older adult fall prevention behaviors after hospital discharge. Participants (n = 390) were aged 60 years and older with good cognitive function (greater than 7 of 10 Abbreviated Mental Test Score), discharged home from three hospital rehabilitation wards in Perth, Australia. The primary outcomes were engagement in fall prevention strategies, including assistance with daily activities, home modifications, and exercise. Data were analyzed using generalized linear modeling. RESULTS There were 76.4% (n = 292) of participants who completed the final interview (n = 149 intervention, n = 143 control). There were no significant differences between groups in engagement in fall prevention strategies, including receiving instrumental activity of daily living (IADL) assistance (adjusted odds ratio [AOR] = 1.3 [95% confidence interval {CI} = 0.7‐2.1]; P = .3), completion of home modifications (AOR = 1.2 [95% CI = 0.7‐1.9]; P = .4), and exercise (AOR = 1.3 [95% CI = 0.7‐2.2]; P = .3). There was a high proportion of unmet ADL needs within both groups, and levels of participant dependency remained higher at 6 months compared to baseline levels at admission. The proportion of all participants who engaged in exercise following hospital discharge increased by 30%; however, the mean duration of exercise reduced from 3 hours per week at baseline to 1 hour per week at 6‐month follow‐up (SD = 1.12 hours per week). CONCLUSION Tailored education did not increase older adult engagement in fall prevention strategies after hospital discharge compared to usual care. Further research is required to evaluate older adults’ capacity to change their behaviors once they return home from hospital, which may enable a safer recovery of their independence. J Am Geriatr Soc 67:2274–2281, 2019

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Posthospital Fall Injuries and 30-Day Readmissions in Adults 65 Years and Older

Cited by 56 publications

References 48 publications

<p>Barriers and Facilitators to Older Adults Participating in Fall-Prevention Strategies After Transitioning Home from Acute Hospitalization: A Scoping Review</p>

<p>Barriers and Facilitators to Older Adults Participating in Fall-Prevention Strategies After Transitioning Home from Acute Hospitalization: A Scoping Review</p>

Role of Post‐Acute Care in Readmissions for Preexisting Healthcare‐Associated Infections

Evaluation of Tailored Falls Education on Older Adults' Behavior Following Hospitalization

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