Understanding the role of informal caregivers in postoperative care transitions for older patients.

Autor: Sokas CM; Center for Surgery and Public Health, Brigham and Woman's Hospital, Boston, Massachusetts, USA., Hu FY; Center for Surgery and Public Health, Brigham and Woman's Hospital, Boston, Massachusetts, USA., Dalton MK; Center for Surgery and Public Health, Brigham and Woman's Hospital, Boston, Massachusetts, USA., Jarman MP; Center for Surgery and Public Health, Brigham and Woman's Hospital, Boston, Massachusetts, USA., Bernacki RE; Department of Medicine, Division of Palliative Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA., Bader A; Department of Anesthesia, Brigham & Women's Hospital, Boston, Massachusetts, USA., Rosenthal RA; Department of Surgery, Yale University, New Haven, Connecticut, USA., Cooper Z; Center for Surgery and Public Health, Brigham and Woman's Hospital, Boston, Massachusetts, USA.; Department of Surgery, Brigham and Woman's Hospital, Boston, Massachusetts, USA.
Jazyk: angličtina
Zdroj: Journal of the American Geriatrics Society [J Am Geriatr Soc] 2022 Jan; Vol. 70 (1), pp. 208-217. Date of Electronic Publication: 2021 Oct 19.
DOI: 10.1111/jgs.17507
Abstrakt: Background: Older adults may have new care needs and functional limitations after surgery. Many rely on informal caregivers (unpaid family or friends) after discharge but the extent of informal support is unknown. We sought to examine the role of informal postoperative caregiving on transitions of care for older adults undergoing routine surgical procedures.
Materials and Methods: We performed a retrospective cohort study using ACS NSQIP Geriatric Pilot Project data, 2014-2018. Patients were ≥65 years and underwent an inpatient surgical procedure. Patients who lived at home alone were compared with those who lived with support from informal caregivers (family and/or friends). Primary outcomes were discharge destination (home vs. post-acute care) and readmission within 30 days. Multivariable logistic regression was used to determine the association between support at home, discharge destination, and readmission.
Results: Of 18,494 patients, 25% lived alone before surgery. There was no difference in loss of independence (decline in functional status or new use of mobility aid) after surgery between patients who lived alone or with others (18.7% vs. 19.5%, p = 0.24). Nevertheless, twice as many patients who lived alone were discharged to a non-home location (10.2% vs. 5.1%; OR: 2.24, CI: 1.93-2.56). Patients who lived alone and were discharged home with new informal caregivers had increased odds of readmission (OR: 1.43, CI: 1.09-1.86).
Conclusion: Living alone independently predicts discharge to post-acute care, and patients who received new informal caregiver support at home have higher odds of readmission. These findings highlight opportunities to improve discharge planning and care.
(© 2021 The American Geriatrics Society.)
Databáze: MEDLINE
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