Factors Related to Hospita! Readmission of Elderly Cardiac Patients

STUDIES HAVE shown that a highpercentage of admissions of elderly patients to acute care hospitals are actual-ly readmissions for the same or related problems. Depending on the type of hos-pita!, the readmission rate can be at least a quarter of all admissions. ' The patients most frequently readmitted are those with diseases that require the greatest changes in lifestyle, such as dietary changes, tak-ing multiple medications, restrictions in mobility, and necessary changes in the home environment. 2 Such changes require compliance with medical recommendations and adaptations in lifestyle that have been found to be key factors in the success or failure of medical treatment and post-hospital recovery. 3 It is estimated that elderly patients ac-count for 38 percent of all days in short-stay hospitals. Those elderly with cardiac problems account for 18 percent of all short-stay hospita! days and 45 percent of all deaths. 4 Elderly patients with cardiac disease are at especially high risk for physical deterioration during posthospital recovery and have been identified as be-ing at high risk for frequent readmission because of the severity of the illness, their age, and the impact of psychological and social stresses on the course of the dis-ease.5 These patients frequently incur major life changes due to chronic func-tional disability. For the elderly person, a hospital admis-sion for cardiac disease exacerbates his or her worst fears: loss of independent phys-ical functioning, heightened dependence on family members, and concomitant loss of self-esteem. 6 Multiple readmissions in-tensify the complex interplay between medical, psychological, and social factors affecting the patient, family, and care-givers. Hospitalization, discharge, and re-admission are not only emotionally diffi-cult to handle but increase the risk of the patient becoming confused, disoriented