Sage Journals: Discover world-class research

Abstract

Objective:

The aim of this study was to test and compare the effect of (1) a systematic discharge assessment with targeted advice and (2) a motivational interview followed by a home visit.

Design:

This was a three-armed randomized controlled study.

Setting:

This study was conducted in the Medical department in a university hospital.

Subjects:

Patients ⩾65 years of age with health problems at discharge participated in the study.

Interventions:

Group A (n = 117): patients were informed of health problems and self-care interventions; Group B (n = 116): a motivational conversation targeting activities of daily living with a home care nurse and a home visit.

Main measures:

The main measures of this study were readmissions, handgrip strength, chair-to-stand test, health-related quality of life, depression signs, mortality, and call on municipality services.

Results:

Risk of readmission was reduced for intervention groups by 30% (A; P = 0.26) and 22 % (B; P = 0.46). Mean number of days to first readmission was 49.5 (±51.0) days for the control group (n = 116) and 57.9 (±53.6) and 67.2 (±58.1) days for the intervention groups A (P = 0.43) and B (P = 0.10), respectively. Mean loss of handgrip strength was 10.6 (±16.6) kg for men in the control group and 7 (±19.2) and 1.4 (±17.1) kg for the intervention groups A (P = 0.38) and B (P = 0.01), respectively. Health-related quality of life improved with 0.3 (±23.7) points in the control group and 7.4 (±24.4) and 3.2 (±22.3) points in the intervention groups A (P = 0.04) and B (P = 0.37), respectively. In total, 17 (16.3%) in the control group were provided with assistive devices after three months and 8 (7.3%) and 19 (17.6%) in the intervention groups A (P = 0.04) and B (P = 0.81), respectively.

Conclusion:

The interventions reduced the risk of readmission and improved handgrip strength, quality of life, and use of assistive devices.

Keywords

Older adults hospital discharge readmissions randomized controlled trial targeted assessment

Get full access to this article

View all access options for this article.

References

Covinsky

Palmer

Fortinsky

et al. Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age 59. J Am Geriatr Soc 2003; 51: 451–458.

Danish Municipalities, Ministry of Health and Ministry of Finance. Prevention of admissions: Visible results [Forebyggelse af indlæggelser: synlige resultater]. Report, Ministry for Health and Prevention [Ministeriet for Sundhed og Forebyggelse], olbergsgade 6, DK-1057 København K, 28 May 2014.

Hansen

. Development in mean length of hospital stay among young, adult and older people from 2008 till 2013 [Udvikling i gennemsnitlig indlæggelsestid blandt unge, voksne og ældre fra 2008 til 2013]. Report of the Danish Association of Municipalities [Kommunernes Landsforening], Weidekampsgade 10, DK-2300 København S, August 2015.

Gonçalves-Bradley

Lannin

Clemson

et al. Discharge planning from hospital (Review). Cochrane Database Syst Rev 2016; 1: CD000313.

Purdy

Paranjothy

Huntley

et al. Interventions to reduce unplanned hospital admission: a series of systematic reviews. Report, NHS Bristol, Cardiff University, University of Bristol, June 2012.

Edmans

Bradshaw

Gladman

JRF

et al. The Identification of Seniors at Risk (ISAR) score to predict clinical outcomes and health service costs in older people discharged from UK acute medical units. Age Ageing 2013; 42(6): 747–753.

Moons

DeRidder

Geyskens

et al. Screening for risk of readmission of patients aged 65 years and above after discharge from the emergency department: predictive value of four instruments. Eur J Emerg Med 2007; 14(6): 315–323.

Braet

Weltens

Sermeus

Effectiveness of discharge interventions from hospital to home on hospital readmissions : a systematic review. JBI Database System Rev Impement Rep 2016; 14: 106–173.

Wetzels

Harmsen

VanWeel

et al. Interventions for improving older patients’ involvement in primary care episodes. Cochrane Database Syst Rev 2007; 1: CD004273.

10.

Roberts

Denison

Martin

et al. A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach. Age Ageing 2011; 40(4): 423–429.

11.

Macfarlane

Chou

Cheng

et al. Validity and normative data for thirty-second chair stand test in elderly community-dwelling Hong Kong Chinese. Am J Hum Biol 2006; 18(3): 418–421.

12.

Hammond

O’Keeffe

Barer

DH.

Development and validation of a brief observer-rated screening scale for depression in elderly medical patients. Age Ageing 2000; 29(6): 511–515.

13.

EuroQol Group. EuroQol—a new facility for the measurement of health-related quality of life. Health Policy 1990; 16(3): 199–208.

14.

Bech

Lauritsen

Ovesen

et al. The verbal rating scale is reliable for assessment of postoperative pain in hip fracture patients. Pain Res Treat 2015; 2015: 676212–676217.

15.

Freire

Pedagogy of the oppressed. London: Bloomsbury Publishing PLC, 2017.

16.

Rubak

Sandbaek

Lauritzen

et al. Motivational interviewing : a systematic review and meta-analysis. Br J Gen Pr 2005; 55: 305–312.

17.

Lainscak

Kadivec

Kosnik

et al. Discharge coordinator intervention prevents hospitalizations in patients with COPD: a randomized controlled trial. J Am Med Dir Assoc 2017; 14(6): 450.e1–450.e6.

18.

Norman

Likert scales, levels of measurement and the “laws” of statistics. Adv Health Sci Educ Theory Pract 2010; 15(5): 625–632.

19.

McCaffrey

Griffin

Almirall

et al. A tutorial on propensity score estimation for multiple treatments using generalized boosted models. Stat Med 2014; 32(19): 3388–3414.

20.

OECD/European Union. Health at a glance: Europe. Report, OECD Publishing, Paris, December 2014. https://doi.org/10.1787/health_glance_eur-2014-en.

21.

Sørensen

Davidsen

Gudex

et al. Danish EQ-5D population norms. Scand J Public Health 2009; 37(5): 467–474, http://www.ncbi.nlm.nih.gov/pubmed/19535407

22.

Gunther

Burger

Rickert

et al. Grip strength in healthy Caucasian adults: reference values. J Hand Surg Am 2008; 33(4): 558–565.

23.

Rikli

Jones

Development and validation of a functional fitness test for community-residing older adults. J Aging Phys Act 1999; 7: 129–161, http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:Development+and+validation+of+a+functional+fitness+test+for+community+residing+older+adults#0

24.

The Danish National Board of Health (Sundhedsstyrelsen). The older medical patient—National Plan of Action (Styrket indsats for den ældre medicinske patient—agligt oplæg til en national handlingsplan). Report, 2011, http://www.sst.dk/publ/Publ2011/BOS/DenAeldreMedicinskePatient/DAEMP.pdf

25.

Hendriksen

Vass

[Uncertain efficiency of follow-up home visits among older patients after hospital discharge]. Ugeskr Laeger(Danish Med Journal) 2014; 176(5A): V04130264 (in Danish).

26.

Simmonds

Syddall

Westbury

et al. Grip strength among community-dwelling older people predicts hospital admission during the following decade. Age Ageing 2015; 44(6): 954–959.

27.

Norman

Stobaus

Gonzalez

et al. Hand grip strength: outcome predictor and marker of nutritional status. Clin Nutr 2011; 30: 135–142.

28.

Sharma

Miller

Kaambwa

et al. Malnutrition and its association with readmission and death within 7 days and 8 – 180 days postdischarge in older patients : a prospective observational study. BMJ Open 2017; 7(11): e018443.

29.

Mezuk

Edwards

Lohman

et al. Depression and frailty in later life: A systematic review. Int J Geriatr Psychiatry 2012; 9: 879–892.

30.

Kinmonth

Woodcock

Griffin

et al. Randomised controlled trial of patient centred care of diabetes in general practice: impact on current wellbeing and future disease risk. BMJ 1998; 317(7167): 1202–1208.

31.

Williams

Katon

Lin

EHB

et al. Improving patient care: the effectiveness of depression care management on diabetes-related outcomes in older patients. Ann Intern Med 2004; 140(12): 1015–1024.

32.

Fried

Tangen

Walston

et al. Frailty in older adults : evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56(3): M146–M156.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.23 MB

A targeted assessment and intervention at the time of discharge reduced the risk of readmissions for short-term hospitalized older patients: a randomized controlled study