Postdischarge Falls and Readmissions: Associations with Insufficient Vision and Low Health Literacy among Hospitalized Seniors

Abstract

The role of patient-level risk factors such as insufficient vision has been under-studied. Because insufficient vision may interfere with health literacy assessments, the full impact of low health literacy among older patients with impaired vision is unknown. We sought to determine whether senior inpatients’ insufficient vision and low health literacy are associated with adverse outcomes post-discharge, specifically falls and readmissions. We conducted an observational study of adult medicine inpatients at an urban hospital. Visual acuity and health literacy were screened at bedside. Outcomes data were collected by telephone 30 days post-discharge. Among 1,900 participants, 1,244 (65%) were reached post-discharge; 44% had insufficient vision and 43% had low health literacy. Insufficient vision was associated with post-discharge falls among participants ≥65 years (adjusted odds ratio [AOR] 3.38, 95% confidence interval [CI] 1.42-8.05), but not among participants <65 years (AOR 1.44, 95% CI 0.89-2.32. Low health literacy was associated with readmissions among participants ≥65 years (AOR 3.15, 95% CI 1.77-5.61), but not among participants <65 years (AOR 0.78, 95% CI 0.56-1.09). The results suggest the need to implement screening for older inpatients’ vision and health literacy. Developing effective interventions to reduce these risks is critical given national priorities to reduce falls and readmissions.

Health Literacy and Hospital Length of Stay: An Inpatient Cohort Study

“…5 Among outpatient cohorts, HL has been associated with worse outcomes and acute care utilization. 6 Associations with low HL include increased hospitalizations, 7 rehospitalizations, 8,9 emergency department visits, 10 and decreased preventative care use. 11 Among the elderly, low HL is associated with increased mortality 12 and decreased self-perception of health.…”

“…6 There have been very few studies assessing effects of low HL in an acute-care setting. 7,14 These studies have evaluated postdischarge outcomes, including admissions or readmissions, [7][8][9] and medication knowledge. 14 To the best of our knowledge, there are no studies evaluating associations between HL and hospital length of stay (LOS).…”

“…32 Those with low HL may lack the self-efficacy to participate in discharge planning; in fact, previous work has related low HL to posthospital readmissions. 8,9 Conversely, patients with low HL might struggle to engage in the inpatient milieu, advocating for shorter LOS if they feel alienated by the inpatient experience.…”

Association between vision-specific quality of life and falls in community-dwelling older adults: LOHAS

“…Third, we excluded participants younger than 65 years from the study population. Jaffee EG et al reported that insufficient vison was significantly associated with post-discharge falls among the participants aged ≥65 years but not among those aged <65 years[ 22 ]. The association of vision-specific QOL with falls could be stronger among older adults than younger adults.…”

Occupational Therapy’s Value in Provision of Quality Care to Prevent Readmissions

“…Decreased functional ability as a result of vision correlates with a higher likelihood of acute care readmission and higher overall costs of care (Jaffee et al, 2016;Morse et al, 2019). Occupational therapy practitioners have multiple options to address vision deficits, including connecting patients with a vision specialist such as an optometrist, ophthalmologist, or occupational therapy practitioner with vision specialty skills.…”