CHANGE IN VULNERABILITY AMONG OLDER CARDIAC ADULTS AFTER HOSPITAL DISCHARGE: ROLE OF POST-ACUTE HOME HEALTH

摘要

Vulnerability to functional decline after hospitalization is high among older cardiac patients. Few studies have quantified the changes in vulnerability after hospital discharge among patients who do or do not receive post-acute services (i.e., home health care). In this prospective study, we aimed to: 1) compare changes in vulnerability after hospital discharge in older patients discharged home with/without a home health care (HHC) referral, and 2) examine factors associated with changes in vulnerability during this period. The sample included 834 patients aged 65 or older, hospitalized for acute coronary syndromes and/or acute decompensated heart failure. Vulnerability was assessed using the Vulnerable Elders Survey-13 at baseline (prior to hospitalization), 30 days and 90 days post-discharge. Linear regression analyses with propensity score matching showed that relative to non-HHC-referred patients, patients referred to post-acute HHC, despite having more vulnerability at baseline and delayed recovery in vulnerability in the initial 30 days after hospital discharge, showed comparable improvement in their vulnerability at 90 days after hospital discharge. Baseline vulnerability and HHC referral accounted for 14%-16% of the variance in 90-day vulnerability change after hospital discharge (p<0.001). Patient characteristics (age, number of outpatient visits in the past 12 months, depressive symptoms, race/ethnicity [African American]) contributed 6% variance (p<0.001). Our findings suggest that post-acute HHC facilitates functional recovery in the most vulnerable older patients, however additional studies are warranted. Future research should examine the impact of the timing and intensity (frequency, visit pattern and types of services) of post-acute HHC on vulnerability changes after hospital discharge.