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Hospitals Focus on Seniors to Prevent Readmissions

Direct observation before ED discharge is critical, study shows

Seniors overestimate their ability to perform tasks, such as getting in and out of bed, after discharge from the emergency department, putting them at greater risks for falls, complications, and readmissions, according to an article posted on the FierceHealthcare website. 

Seniors are already at high risk for complications, falls, and readmissions –– and hospitals are taking note, according to writer Glenna Shaw. Some have created special emergency centers to cater to the growing senior population. For example, Ohio State University’s Wexner Medical Center has staffed its new elder emergency care facility with nurses, social workers, case managers, therapists, and geriatricians.

But direct observation before discharge is a critical step that emergency clinicians often miss, according to a new study published in the Annals of Emergency Medicine.

Researchers in two academic emergency departments conducted a cross-sectional investigation of cognitively intact patients aged 65 years and older who were neither nursing home residents nor critically ill. Consenting participants were asked whether they could get out of bed, walk 10 feet, turn around, and get back in bed without assistance, and if not, whether they could perform this task with a cane, walker, or assistance. Each participant was then asked to perform the task and was provided with a mobility device or assistance as needed.

Of the 272 subjects, 161 (59%) said they could do the task unassisted; 45 (17%) said they could do it with a cane or walker; 21 (8%) said they could do it with assistance; and 45 (17%) said they would be unable to do it even with assistance.

Among those who said they could do the task either with or without assistance and who were subsequently willing to attempt the task (n = 172), discrepancies between self-reported ability and actual performance were common. Of those who said they could perform the task without assistance, 12% required some assistance or were unable to complete the task. Of those who said they could perform the task with a cane or walker, 48% required either assistance or were unable to perform the task. Of those who said they could perform the task with assistance, 24% were unable to perform the task even with assistance.

“For older adults being considered for discharge who report a need for assistance with mobility, direct observation of the patient’s mobility by a member of the emergency care team should be considered,” the authors concluded. “We suggest that this assessment be made early during the ED visit because disposition momentum and the challenge of arranging additional outpatient care may make it difficult for emergency providers to change disposition late during the ED visit.”

Sources: FierceHealthcare; August 3, 2015; and Annals of Emergency Medicine; July 31, 2015.


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