Dementia Increases the Risk of 30-Day Readmission to the Hospital After Discharge

Journal of the American Geriatrics Society Research Summary

About 25 percent of older adults admitted to hospitals have dementia and are at increased risk for serious problems like in-hospital falls and delirium (the medical term for an abrupt, rapid change in mental function). As a result, older adults with dementia are more likely to do poorly during hospital stays compared to older adults without dementia.

Until now, little was known about the effects of dementia on early hospital readmission. Researchers in Japan recently published the results of a study to learn more about the effects of dementia and being admitted to the hospital within 30 days of a previous hospital discharge (the medical term for leaving the hospital once your care is considered complete). Their study was published in the Journal of the American Geriatrics Society.

The researchers studied information from people 65-years-old and older who had been discharged from hospitals between 2014 and 2015, and then followed them for six months. The researchers were looking for unplanned readmissions to the hospital within 30 days of the patient’s discharge. Continue reading

Recovering after Surgery: Perspectives from a Patient and Healthcare Professional (Part Two)

Barb Resnick HeadshotBarbara Resnick, PhD, CRNP
Professor
Sonya Ziporkin Gershowitz Chair in Gerontology
University of Maryland School of Nursing

Introduction

This is the latest in a series of blog posts by Barbara Resnick, PhD, CRNP, written from her perspective as both a healthcare professional and as a patient during the course of intensive treatment for esophageal cancer.  This two-part article was written about two months following her surgery. Part One discusses the importance of preparing for going home throughout the course of a hospital stay following surgery.  Part Two addresses managing ongoing recovery at home.  These blog posts will be helpful to older adults undergoing surgery and their families, as well as to hospital administrators and healthcare providers.

Part Two: Healing, Getting Stronger, Eating and Sleeping Better – Trial and Error and a Pinch of Patience

Because everyone’s recovery from surgery is different, your healthcare team can only give you basic information and guidance based on what they see and hear from other patients. Knowing what to expect in terms of wound healing, fatigue following surgery, physical activity, and eating and sleeping—all things which are essential to the healing process—is where trial and error and waiting may come into play.

Wound healing takes time. You can aid the health process by getting enough protein and calories, treating any anemia you might have, and keeping the wound and the surrounding area clean. These are all things that you can do with the help of a caregiver. Protein intake should ideally include 30 grams of protein with each meal for an average size adult male and less for a smaller female (30 grams includes a piece of meat, chicken, or fish the size of your fist, or several eggs). If you continue to feel unusually tired at home, tell your healthcare provider. They may do a blood test to check for anemia (an insufficient number of red blood cells, sometimes called “iron-poor blood”). If you have some anemia, your provider may have you take an iron supplement. Eating iron-rich foods is always a good idea when healing. Try dark leafy greens, dried fruit, beans, enriched breads and cereals, meat, eggs, and some fish. Keeping your wound clean with soap and water and showering as soon as you are able to will also help with healing. Then sit back and let the healing take place! Continue reading

Recovering after Surgery: Perspectives from a Patient and Healthcare Professional (Part One)

Barb Resnick HeadshotBarbara Resnick, PhD, CRNP
Professor
Sonya Ziporkin Gershowitz Chair in Gerontology
University of Maryland School of Nursing

Introduction

This is the latest in a series of blog posts by Barbara Resnick, PhD, CRNP, written from her perspective as both a healthcare professional and as a patient during the course of intensive treatment for esophageal cancer. This two-part article was written about two months following her surgery. Part One discusses the importance of preparing for going home throughout the course of a hospital stay following surgery. Part Two addresses managing ongoing recovery at home. These blog posts will be helpful to older adults undergoing surgery and their families, as well as to hospital administrators and healthcare providers.

Part One: Preparing for Life at Home throughout Your Hospital Stay
My recent experience in the hospital following surgery for esophageal cancer has made me aware that healthcare professionals (of which I am one) have much they can learn to support their patients’ day-to-day recovery following surgery, as well as to help them prepare for going home. This learning can be enhanced by acknowledging that patients know a lot about their own bodies and preferences, and by valuing the knowledge and experience patients and caregivers gain each day in the hospital. Therefore, you and your caregivers can be a valuable source of information to your healthcare team.
Although people’s responses to surgery are individualized, there are some basic approaches that can be applied to most types of surgeries and hospital stays. My experience was rather intensive, as the original surgery was an esophagectomy. This is a procedure where the esophagus (the tube that moves food from your throat to your stomach) is removed and then rebuilt from part of your stomach or large intestine. I had several complications and had to have a second surgery, all of which resulted in almost five weeks in the hospital!

My experience taught me the importance of thinking ahead and preparing for life at home while I was still in the hospital. Patients and families need to take an active part in this process, because the hospital care team is understandably often more focused on their patients’ immediate medical problems and needs. Patients and families need to ask and remind the healthcare team to teach them things that they’ll have to do when they go home, such as how to care for surgical incisions, what to do with a wound drain, or how to use a feeding tube. Patients and families need to practice these things while in the hospital, under the guidance of their care team. The healthcare team should also explain each medication when it is first given, including the name, what it’s for, how to take it, and what possible side effects to watch out for.

Also, practicing basic daily activities while you are still in the hospital is key to your recovery and in helping you know what you can do safely once you home. These activities include things such as bathing, dressing, eating, grooming, and walking, I was fortunate to have a family caregiver with me throughout my hospital stay. I made sure that I bathed and dressed daily with someone standing by me to help as needed. I walked through the hallways at least a few times a day because my family member could help carry tubes and push the IV pole. If you don’t have someone with you in the hospital, it’s important to ask the nursing staff to help with you these activities. On the actual day of my discharge, I insisted that the nurse teach me and my family how to set up the tube feedings I needed when I first went home and to practice with us.

Continue reading