The impact of social isolation on delayed hospital discharges of older hip fracture patients and associated costs

Landeiro, Filipa; Leal, José; Gray, Alastair

doi:10.1007/s00198-015-3293-9

Cited by 67 publications

(74 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Patients living independently may live as much or even more in social isolation as patients in nursing homes do. In the literature there is some evidence that the presence of family members in the hospital will help to reduce the incidence of delirium [30], moreover, that social isolation leads to a prolonged hospitalization [31]. …”

Section: Discussionmentioning

confidence: 99%

Complications after hip fracture surgery: are they preventable?

Flikweert

Wendt

Diercks

et al. 2017

Eur J Trauma Emerg Surg

114

View full text Add to dashboard Cite

PurposeSurgery for hip fractures is frequently followed by complications that hinder the rehabilitation of patients. The aim of this study was to describe the incidence rate and type of complications, including mortality, after hip fracture surgery, and to identify the risk factors of these complications that may be amenable to prevention.MethodsProspective cohort study of all consecutive patients aged ≥60 treated for a hip fracture at University Medical Center Groningen between July 2009 and June 2013. All patients were treated in a comprehensive multidisciplinary care pathway. Logistic regression analyses were used to investigate which variables were significant risk factors for the occurrence of complications. Additional analyses were conducted to investigate whether the independent variables were significant risk factors for several specific complications and mortality.ResultsThe study population consisted of 479 patients with a mean age of 78.4 (SD 9.5) years; 33% were men. The overall complication rate was 75%. Delirium was the complication seen most frequently (19%); the incidence of surgical complications was 9%. Most risk factors for complications were not preventable (high comorbidity rate, high age and dependent living situation). However, general anesthesia (OR 1.51; 95% CI 0.97–2.35) and delay in surgery (OR 3.16; 95% CI 1.43–6.97) may be risk factors that can potentially be prevented. Overall, the mortality risk was not higher in patients with a complication, but delirium and pneumonia were risk factors for mortality.ConclusionThe overall complication rate after hip fracture surgery was high. Only few complications were potentially preventable.

show abstract

Section: Discussionmentioning

confidence: 99%

Complications after hip fracture surgery: are they preventable?

Flikweert

Wendt

Diercks

et al. 2017

Eur J Trauma Emerg Surg

114

View full text Add to dashboard Cite

show abstract

“…Patients with ALC are commonly characterized by cognitive impairment [4, 6–10] including dementia [6, 11], behavioral challenges [12], functional decline [4, 7–9], social vulnerability [13, 14] and advanced age [15–17]. Contextual risk factors for ALC include lack of community services [8, 18] or LTC beds [11, 19–21], lack of timely coordinated care, lack of presence or willingness of family carers [4, 22] and hospital discharge policies which influence length of stay and discharge planning capacity.…”

Section: Introductionmentioning

confidence: 99%

“It’s a waiting game” a qualitative study of the experience of carers of patients who require an alternate level of care

Kuluski

McGeown

2017

BMC Health Serv Res

View full text Add to dashboard Cite

BackgroundDelayed hospital discharge (also known as Alternate Level of Care or ALC) is a global health care quality issue with negative implications for people (e.g., functional decline) and the health care system (e.g., costly interruptions in hospital flow and procedures). ALC disproportionately impacts people with cognitive impairment, and insight into the needs and experiences of this specific sub population and their carers is lacking. The purpose of this study was to understand the hospital experience of carers (e.g., family members) of patients with ALC and cognitive impairment who were waiting for long-term care from the hospital.MethodsThis is a qualitative descriptive study entailing 12 semi-structured interviews with 15 carers of patients with ALC from three hospitals in Northwestern Ontario. Interviews were conducted between October 2015 and February 2016. Two reviewers thematically analyzed the interview data.ResultsFive core themes were identified from the interview data: patient over person, uncertain and confusing process, inconsistent quality in care delivery, carers addressing gaps in the system, and personalization of long-term care.ConclusionsWaiting for long-term care from the hospital is a stressful and uncertain time for family carers. ALC is an ‘in-between’ phase when patients and carers may be at their most vulnerable yet receive the least care from the formal care system. Carers provide critical insight into the needs and behaviors of patients as well as processes that need to be improved to enhance their experience. Such insights will help health systems internationally as they grapple with the issue of ALC whilst trying to optimize engagement with patients and their families.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2272-6) contains supplementary material, which is available to authorized users.

show abstract

“…9 Cognitive decline, depression, and functional limitations have each been associated with social isolation. [10][11][12][13] Socially isolated older adults may encounter more challenges at the end of life (EOL) due to the absence of an appropriate healthcare agent. Prior studies have suggested that social isolation hinders ACP.…”

mentioning

confidence: 99%

Advance Care Planning: Social Isolation Matters

Cudjoe

Boyd

Wolff

et al. 2019

J American Geriatrics Society

View full text Add to dashboard Cite

BACKGROUND Social isolation is a risk factor for poor health that influences the well‐being older adults. OBJECTIVE We compare advance care planning (ACP) engagement of older adults who were severely socially isolated, socially isolated, and not socially isolated. DESIGN Cross‐sectional analysis of the 2012 National Health and Aging Trends Study (NHATS). SETTING United States of America. PARTICIPANTS A total of 2015 older adults (aged ≥65 years) randomly selected from a representative sample of community‐dwelling Medicare beneficiaries to participate in an ACP module as part of an annual in‐person interview. MEASUREMENTS We classified participants in three groups: severely socially isolated, socially isolated, or not socially isolated. ACP refers to three (yes/no) questions regarding whether a participant had a: (1) prior discussion about care preferences in the case of serious illness (EOL Discussion); (2) durable power of attorney (DPOA); and (3) advance directive (AD). We performed logistic regression analyses to examine the association between social isolation and ACP. RESULTS Approximately 23% of older adults were either severely socially isolated or socially isolated. Older adults who experienced social isolation were less likely to engage in ACP than those who were not socially isolated. In adjusted analysis, older adults who were socially isolated had lower odds of having an EOL discussion (adjusted odds ratio [AOR] = 0.65; 95% confidence interval [CI] = 0.49‐0.87) or having a DPOA (AOR = 0.71; 95% CI = 0.53‐0.96) compared to those who were not socially isolated. CONCLUSION Social isolation is associated with lower engagement in ACP. Clinicians should identify older adults who are at risk for or experience social isolation as they may benefit from targeted ACP efforts. J Am Geriatr Soc 68:841–846, 2020

show abstract

The impact of social isolation on delayed hospital discharges of older hip fracture patients and associated costs

Abstract: High risk of social isolation, social isolation and referral to public-funded rehabilitation units increase delays in patients' discharges from acute care hospitals.

Cited by 67 publications

References 27 publications

Complications after hip fracture surgery: are they preventable?

Complications after hip fracture surgery: are they preventable?

“It’s a waiting game” a qualitative study of the experience of carers of patients who require an alternate level of care

Advance Care Planning: Social Isolation Matters

Contact Info

Product

Resources

About