GERIATRIC HOME ASSESSMENT AFTER HOSPITAL DISCHARGE

OBJECTIVES: To evaluate the feasibility of an intervention involving p ost-discharge geriatric home assessment and follow-up and to describe the spectrum of significant clinical problems identified during the ho me assessment. DESIGN: Prospective observational study nested within a randomized controlled trial. SETTING: Inpatient service of a large ac ademic medical center in Southern California. PATIENTS: There were 152 adults aged 65 or greater who had one or more specific risk factors f or functional decline or increased mortality, who were awaiting discha rge from the hospital, and who were assigned to the intervention arm o f a randomized controled trial of post-discharge comprehensive geriatr ic home assessment. MAIN RESULTS: During the home assessment, the gero ntologic nurse practitioner (GNP) identified new or worsening problems in 150 patients (99%); 61 problems leg, serum sodium 125 mg/dL; sever e orthostatic hypotension) were considered by a reviewing physician to require urgent medical attention. Older age, non-white race, and new incontinence were associated independently with a greater number of fi ndings (P < 0.05). Based on the findings, an interdisciplinary team ma de an average of 3.4 recommendations per patient; only two of 111 requ ests for written approval of recommendations were rejected. CONCLUSION S: Post-discharge visitation by a GNP to patients at high risk is capa ble of detecting a high yield of important and potentially reversible clinical problems. This multidisciplinary approach is acceptable to ph ysicians. Research is needed to identify additional links between shor t hospital stays, impairment or instability at discharge, and adverse outcomes.