Improving Care Transitions for Hospitalized Veterans Discharged to Skilled Nursing Facilities: A Focus on Polypharmacy and Geriatric Syndromes

Abstract

Geriatric syndromes and polypharmacy are common in older patients discharged to skilled nursing facilities (SNFs) and increase 30-day readmission risk. In a U.S.A. Department of Veterans Affairs (VA)-funded Quality Improvement study to improve care transitions from the VA hospital to area SNFs, Veterans (N = 134) were assessed for geriatric syndromes using standardized instruments as well as polypharmacy, defined as five or more medications. Warm handoffs were used to facilitate the transfer of this information. This paper describes the prevalence of geriatric syndromes, polypharmacy, and readmission rates. Veterans were prescribed an average of 14.7 medications at hospital discharge. Moreover, 75% of Veterans had more than two geriatric syndromes, some of which began during hospitalization. While this effort did not reduce 30-day readmissions, the high prevalence of geriatric syndromes and polypharmacy suggests that future efforts targeting these issues may be necessary to reduce readmissions among Veterans discharged to SNF.

Predictors of 30-day hospital readmission: The direct comparison of number of discharge medications to the HOSPITAL score and LACE index

“…10,16,17 Identifying and evaluating potentially modifiable risk factors for readmission, such as polypharmacy, is a focus of active investigation. 2,18,19 The role of polypharmacy as an independent risk factor predicting 30-day readmission is a recent debate. 20,21 Morandi et al studied the risk of readmission to elderly patients admitted to a rehabilitation facility and found that having a prescription of seven or more medications significantly increased the risk of hospital readmission within 30 days (hazard ratio (HR) 3.94; 95% confidence interval (CI) 1.62-9.54; p = 0.002).…”

Predictors of improvement in urinary incontinence in the postacute setting: A Canadian cohort study

“…Most patients in this longer‐stay study cohort (74%) had some level of UI on admission, a very high prevalence more similar to long‐term care (nursing home) settings 24 , 25 than rates cited for all length of stay patients in other post‐acute settings. 2 Patients in this cohort were somewhat more likely to develop UI between admission and 90‐day reassessment (20%) than they were to improve in UI during the same period (18%). Though 18% of patients who were incontinent on admission improved in UI, only 6.4% regained complete bladder control.…”

“…Urinary incontinence (UI), any involuntary loss of urine, is a common problem for patients in postacute settings, with reported prevalence rates from 36.2% to 40% 1,2 . UI has a detrimental effect on hospitalized patients as it is associated with poor quality of life and self‐image, falls and fractures, and dermatitis and skin breakdown 3–5 .…”

“…Urinary incontinence (UI), any involuntary loss of urine, is a common problem for patients in postacute settings, with reported prevalence rates from 36.2% to 40%. 1 , 2 UI has a detrimental effect on hospitalized patients as it is associated with poor quality of life and self‐image, falls and fractures, and dermatitis and skin breakdown. 3 , 4 , 5 Development and persistence of UI during hospitalization can also influence discharge location or the need for additional care if a person cannot independently manage their incontinence.…”

Geriatric Care Models

“…Facilitation of a smooth and seamless transition relies on the abilities of skilled nursing facilities (SNFs) and primary care teams, as well as community agencies, to coordinate together in a patient-centered manner [10]. Geriatric syndromes and polypharmacy are common in older adults discharged to SNFs and increase 30-day readmission risk [11]. The continuity of care, interdisciplinary team, and advanced open access provided by GeriPACT can contribute to improved outcomes in 30-day all-cause readmissions [12].…”