Alzheimer's, Dementia & Mental Health
Cognitively Impaired Seniors Less Likely to Return
to Hospital if Released to Nursing Home
Nursing home ensures medication adherence; know how
to handle social and behavioral issues
Nov. 19, 2013 - Cognitively impaired senior
citizens released from the hospital are less likely to be rehospitalized
within 30 days if they go to a nursing home than if they return to their
own home or the home of a family member, according to an Indiana
University and Regenstrief Institute study.
Discharge destination following hospitalization and
cognitive status are co-dependent factors, according to the study, which
followed 976 men and women, age 65 and older.
The study findings are reported in "Interaction
Between Cognitive Impairment and Discharge Destination and Its Impact on
Rehospitalizations," published in the November issue of the Journal
of the American Geriatrics Society.
"Why do nursing home residents who are cognitively
impaired get readmitted to hospitals less often than those released to a
community setting? There may be several explanations," said study first
author Arif Nazir, M.D., an assistant clinical professor of medicine at
the IU School of Medicine who is on the Board of the American Medical
Directors Association. "The nursing home ensures medication adherence,
which can be very difficult for cognitively impaired residents who
reside at home, even sometimes with support from their families.
"And at home, the physical problems of the
cognitively impaired may not be recognized. These are health issues
which, if known, would send them back to the hospital."
In additional to being less likely to be readmitted
to the hospital than their counterparts who are discharged to the
community, the study found that cognitively impaired nursing home
residents are also less likely than nursing home residents with healthy
brains to be readmitted to a hospital within 30 days of discharge.
But the reverse is true if older adults are sent
home rather than to an institution. Cognitively impaired individuals
released from a hospital to a community setting are more likely to be
readmitted to the hospital than those with a healthy brain.
"Patients discharged to nursing homes with
Alzheimer's disease and other cognitive impairments may be less
physically ill than those who are in a nursing home because of pure
physical ailments like heart failure or an infection. The cognitively
impaired individuals who end up getting discharged to an institution
such as a nursing home typically have social and behavioral issues which
these facilities know how to handle," Dr. Nazir said.
The study demonstrates that cognitive impairment is
not independently associated with rehospitalizations and that this
relationship is modified by discharge destination. The results provide
unique and useful insights regarding the interaction of two important
risk factors for the rehospitalization of the elderly population, mental
status and the discharge destination.
In both nursing homes and in the community setting,
the physical problems of the cognitively impaired may not be recognized.
"In some cases families refuse aggressive care for
their loved one, but such care may be harder to do when the older adult
is living at home," said study senior author Malaz Boustani, M.D., MPH,
Regenstrief Investigator, associate professor of medicine at the IU
School of Medicine and associate director of the IU Center for Aging
Research. He also directs the Healthy Aging Brain Center at
Wishard-Eskenazi Health. "And when the cognitively impaired individual
is being taken care of at home rather than in a facility, the family,
like the family of the physically ill patient with a healthy brain, may
just feel unable to handle the burden after release from the hospital."
"To our knowledge," Dr. Nazir said, "this is the
first study to investigate whether discharge destination of older adults
makes a difference in rehospitalization rate. Our findings - that it
does have an effect - is yet another factor that families and hospital
administrators as well as state and national policy makers will want to
take into account for many reasons."
"The fact that odds of rehospitalization are higher
if the cognitively impaired individual is sent home from the hospital
rather than to a nursing home strongly suggests the importance of
developing a personalized transitional care model based on the brain
health of older adults as well as the severity of their medical
illness," said Dr. Boustani, the chief innovation and implementation
officer at IU Health.
Co-authors of the study in addition to Drs. Nazir
and Boustani are Regenstrief Institute investigators Michael LaMantia,
M.D., MPH, assistant professor of medicine at IU; Babar Khan M.D., M.S.,
assistant professor of medicine at IU; Noll Campbell, Pharm.D., of
Purdue University; Siu Hui, Ph.D., professor of statistics at IU; and
Joshua Chodosh, M.D., MSHS, of the David Geffen School of Medicine and
the VA Greater Los Angeles Healthcare System.
This work was supported by awards from the Health
Resources and Services Administration, from the National Institute on
Aging of the National Institutes of Health [R01AG034205, and
K23-AG043476], and the John A. Hartford Foundation Center for Excellence
in Geriatric Medicine.
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