Older patients with a psychiatric diagnosis, cognitive impairment or unexpected weight loss are more likely to require extra health measures in order to avoid developing new illnesses or injuries when recovering from a hospital stay, according to a new study from Advocate Aurora Health investigators.
Based on their findings, the researchers recommend new criteria be validated and used to determine the likelihood of new health problems during post-acute rehabilitation instead of relying on commonly used indicators (functional level and comorbidities).
“Many elderly patients are at their most vulnerable following a hospital stay, when they face a high risk for new illness, injury and rehospitalization,” said lead author Michelle Simpson, PhD, RN, director of Advocate Aurora Research Institute’s Ed Howe Center for Health Care Transformation. “Researchers have not focused enough attention on how these new problems, many of which do not require rehospitalization, may have cumulative effects on older patients that lead to cascading dependency and an increased use of health care resources.”
Christine Kovach, PhD, RN, former Howe Center visiting scholar, coauthored the publication.
The results of the study, “New problems and iatrogenic events among older adults in the first 30 days of post-acute rehabilitation,” were recently published in the journal Research in Gerontological Nursing.
An iatrogenic event is any unintended injury, harm or complication that results more from health care management than underlying disease. The most common examples from the study population fell into two categories: Medication-related iatrogenic events, which usually resulted in constipation, nausea and vomiting, and bleeding; and falls, which usually resulted in fractured and dislocated hips.
Other newly developed health problems included skin breaks or tears, pressure sores, and infections; behavioral changes, such as refusing care, anxiety and aggression; and cardiovascular issues, such as water retention and weight gain resulting from heart failure or peripheral vascular disease, high or low blood pressure, arrythmias or palpitations, and chest pain.
The objectives of the study were to detail the new problems and iatrogenic events found within the 30-day period following hospitalization and to explain the role of age, length of stay in post-acute rehabilitation, comorbidities, cognitive level, functional level or psychiatric condition in the number and severity of new problems and iatrogenic events.
“Patients discharged to post-acute rehabilitation facilities tend to be older than patients discharged to their homes and have more physical disabilities and comorbidities,” Dr. Simpson said. “What’s more, previous studies have shown patients are being discharged from hospitals earlier and with more clinical instability, all of which create the need for potential predictors of new health problems in post-acute rehabilitation patients.”
The researchers enrolled 126 participants in the prospective study. The study team then analyzed data from their electronic health records.
The sample of 126 patients had a total of 578 new health problems develop during their stay in post-acute rehabilitation. Of those 578 new problems, 381 (66%) were not related to a patient’s primary health problem treated at the hospital, and 241 (41.7%) were considered iatrogenic events.
The median problem-free duration was three days and the median duration to a problem that had a severity rating of three or four was eight days.
The researchers also found that a patient’s development of new health problems was affected by their length of stay in post-acute rehabilitation, their cognitive status, a psychiatric diagnosis treated with psychotropic medication and unintentional weight loss.
“Advocate Aurora Research Institute is proud to support the work of Dr. Simpson and her colleagues at the Ed Howe Center for Health Care Transformation as they strive to improve clinical practice in the areas of transitions of care and geriatrics,” said Amit Acharya, PhD, chief research officer and system vice president.
To learn more about Advocate Aurora’s research, visit aurora.org/research.