JAGS
APRIL 2014–VOL. 62, NO. 4
LETTERS TO THE EDITOR
CONCLUSION Even after short stays in the hospital, older adults experience decline that can be substantial. This may inform discharge planning given that Medicare guidelines prevent coverage of postacute skilled care for any hospital stay that is shorter than 3 days. Therefore, individuals who meet the inclusion criteria of this study must be discharged to home with only the limited Medicare home healthcare benefit. Furthermore, as Medicare’s two-midnight rule takes effect, hospitals and clinicians must recognize that even individuals presumptively classified as hospital outpatients receiving observation services may experience adverse effects of hospitalization, despite their outpatient status. This study showed what clinicians and discharge planners know intuitively; ADL decline corresponds with greater caregiving load on family, friends, and professional aides of older adults. It also showed that a detailed history of the preadmission caregiving needs of an individual can help clinicians predict how their patients will fare weeks after discharge, as prior need for help strongly implies that the individual will experience significant functional decline and will have a low ADL score after being sent home. Interestingly, participants who stayed for 1 day as opposed to 2 experienced greater decline despite having a similar CMI. Further research is needed to determine whether these are two different groups of individuals admitted for different reasons and types of care or whether individuals with similar reasons for hospitalization receive a functional benefit from remaining a second day in the hospital. Limitations included small sample size, study in a single institution, lack of verification of self-reported ADL capacity, and interview of only 27% of individuals meeting inclusion criteria.
Table 1. Duke Activity Status Index Score According to Subject Characteristic Characteristic
Before Admission
At Interview
Sex Female 25.0 21.0 Male 32.8 25.9 P-value .03 .18 Age
APRIL 2014–VOL. 62, NO. 4
LETTERS TO THE EDITOR
CONCLUSION Even after short stays in the hospital, older adults experience decline that can be substantial. This may inform discharge planning given that Medicare guidelines prevent coverage of postacute skilled care for any hospital stay that is shorter than 3 days. Therefore, individuals who meet the inclusion criteria of this study must be discharged to home with only the limited Medicare home healthcare benefit. Furthermore, as Medicare’s two-midnight rule takes effect, hospitals and clinicians must recognize that even individuals presumptively classified as hospital outpatients receiving observation services may experience adverse effects of hospitalization, despite their outpatient status. This study showed what clinicians and discharge planners know intuitively; ADL decline corresponds with greater caregiving load on family, friends, and professional aides of older adults. It also showed that a detailed history of the preadmission caregiving needs of an individual can help clinicians predict how their patients will fare weeks after discharge, as prior need for help strongly implies that the individual will experience significant functional decline and will have a low ADL score after being sent home. Interestingly, participants who stayed for 1 day as opposed to 2 experienced greater decline despite having a similar CMI. Further research is needed to determine whether these are two different groups of individuals admitted for different reasons and types of care or whether individuals with similar reasons for hospitalization receive a functional benefit from remaining a second day in the hospital. Limitations included small sample size, study in a single institution, lack of verification of self-reported ADL capacity, and interview of only 27% of individuals meeting inclusion criteria.
Table 1. Duke Activity Status Index Score According to Subject Characteristic Characteristic
Before Admission
At Interview
Sex Female 25.0 21.0 Male 32.8 25.9 P-value .03 .18 Age
