July 22, 2019
By Lisa Rapaport
(Reuters Health) - Many nursing home residents who are hospitalized develop preventable health problems after they go back to the nursing facilities, a new study suggests.
Researchers examined data on 555 such people who were discharged from hospitals back to nursing homes in 2016 and 2017. Overall, there were 379 complications after 762 discharges.
More than half of the complications were related to poor residential care resulting in preventable conditions like pressure ulcers, skin tears and falls, the study found. Another 28% of adverse events involved infections.
Overall, 38% of the complications were serious, 7.4% were life-threatening, and 2.1% were fatal.
About 70% of the adverse events were preventable, researchers reported July 22 online in JAMA Internal Medicine.
"Adverse events are occurring due to transition related issues (such as being released from the hospital too soon as well as deconditioning requiring increased support from nursing home staff including monitoring to prevent falls, turning in bed to prevent/heal pressure ulcers, and gentler handling to prevent skin tears," said Dr. Alok Kapoor, lead author of the study and a researcher at the University of Massachusetts Medical School in Worcester.
"Families should advocate for their loved ones and make sure they do not leave the hospital too early," Kapoor said by email. "At the same time many of these patients had multiple hospitalizations and very poor prognoses suggesting that a more palliative approach focused on comfort and quality of life may have avoided some unnecessary trips to the emergency department and hospital."
Patients in the study were 82 years old on average when they were discharged from hospitals. They were all residents at one of 32 nursing homes in Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont.
Four out of five patients had multiple chronic medical problems, and almost three in four were taking 10 or more medications.
Almost one in five complications were already present the day patients were discharged.
"Improved hospital care, with specific attention paid to minimizing stressors for frail older adults, should help," said Dr. Kumar Dharmarajan, chief scientific officer at Clover Health and a researcher at Yale School of Medicine in New Haven, Connecticut, who wasn't involved in the study.
"In addition, since most adverse events happened in the week after hospitalization, both hospitals and nursing homes should consider dedicating additional resources to this highest risk period of vulnerability to ensure that valuable information is not lost in transition, patients are adequately monitored for new complications, and treatments are instituted swiftly when needed," Dharmarajan said by email.
One limitation of the study is that researchers lacked access to patients' complete hospital records, the study team notes. Researchers were also unable to look at the associations between individual patient characteristics or care preferences and the risk of complications.
"The majority of nursing home residents are elderly, frail, and chronically ill which puts them at high risk for complications and readmission after a hospital stay," said Dr. Jennifer Goldstein, a hospitalist with Christiana Care Hospitalist Partners who wasn't involved in the study.
"Because these patients often cannot communicate the full details of their hospital stay or discharge plans, care providers in the nursing homes rely on discharge paperwork and instructions from the hospital staff, which may be of variable quality," Goldstein said by email. "When communication fails, patients don't get the care they need."
Families may need to step in to make sure communication happens, said Dr. Deepak Bhatt, a researcher at Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School in Boston who wasn't involved in the study.
"It is important to realize that a nursing home patient who was recently hospitalized is at very high risk for problems over the next several weeks," Bhatt said by email. "So don't think they are out of the woods yet."
JAMA Intern Med 2019.
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