Older adults hospitalized for a medical illness and discharged with less ability to take care of themselves are at high risk for death and continued disability in the following year. Additionally, how these patients do in the first month after discharge predicts their overall recovery. These observations raise significant health policy questions about the support these patients should receive.
This study tracked outcomes of patients older than age 70 who were admitted to two Ohio hospitals for medical illness (as compared to stroke or surgery), stayed longer than two days but were not admitted into intensive care. Of the 2,279 patients studied, 1,480 had similar or better abilities to take care of themselves at discharge than they had two weeks before their hospital admission, but 799 patients had diminished abilities. Periodic interviews in the year after discharge tracked patient outcomes.
- By the one year anniversary of discharge, more than 41 percent of patients less able to take care of themselves at discharge had died (compared to just 18% of the group whose self-care abilities had not declined); and an additional 28 percent still had less function than before the hospitalization. Only 15 percent in the group without a hospitalization-related decline had diminished function a year later.
- Of the 30 percent of patients who had lost function during hospitalization but recovered in the following year, an overwhelming percentage of those patients (62%) recovered within the first month after discharge.
- Moreover, how patients were doing one month after discharge predicted how they would be doing one year later. Over 56 percent of those who had suffered decline but recovered in the first month were still at the same level of function a year later. In contrast, more than 82 percent of patients who had not recovered function by one month had passed away or still had not recovered a year later.
The findings of this study, along with the accessibility and usage patterns of rehabilitation services, suggest older adults are not receiving sufficient care and support immediately post-discharge and in the longer term. The authors call for additional research to help practitioners and policy-makers determine how to better target and deliver acute and long-term rehabilitation services, in-home health care and palliative care to older adults living in a variety of situations.