Problems of older adults living alone after hospitalization

OBJECTIVE: To describe functional deficits among older adults living alone and receiving home nursing following medical hospitalization, and the assoc iation of living alone with lack of functional improvement and nursing home utilization 1 month after hospitalization. DESIGN: Secondary analysis of a prospective cohort study. PARTICIPANTS: Consecutive sample of patients age 65 and over receiving home nursing following medical hospitalization, Patients were excluded for new diagnosis of myocardial infarction or stroke in the previous 2 months, diag nosis of dementia if living alone, or nonambulatory status. Of 613 patients invited to participate, 312 agreed. MEASUREMENTS: One week after hospitalization, patients were assessed in the home for demographic information, medications, cognition, and self-report of prehospital and current mobility and function in activities of daily liv ing (ADLs) and independent activities of daily living (IADLs). One month la ter, patients were asked about current function and nursing home utilizatio n. The outcomes were lack of improvement in ADL function and nursing home u tilization 1 month after hospitalization. RESULTS: One hundred forty-one (45%) patients lived alone. After hospital d ischarge, 40% of those living alone and 62% of those living with others had at least 1 ADL dependency (P = .0001). Patients who were ADL dependent and lived alone were 3.3 (95% confidence interval [95% CI], 1.4 to 7.6) times less likely to improve in ADLs and 3.5 (95% CI, 1.0 to 11.9) times more lik ely to be admitted to a nursing home in the month after hospitalization. CONCLUSION: Patients who live alone and receive home nursing after hospital ization are less likely to improve in function and more likely to be admitt ed to a nursing home, compared with those who live with others. More intens ive resources may be required to continue community living and maximize ind ependence.