Helping Seniors Plan for Posthospital Discharge Needs Before a Hospitalization Occurs: Results from the Randomized Control Trial of PlanYourLifespan.org
BACKGROUND: Hospitalized seniors are frequently too sick to make informed decisions about their postdischarge care. Subsequently, loved ones often make support choices (eg, skilled nursing facility placement, caregivers) at discharge. We sought to advance the timeline for postacute care decisions to before a hospitalization occurs.
OBJECTIVE: Investigate the effect of PlanYourLifespan.org (PYL) on knowledge of posthospital discharge options.
DESIGN: Multisite randomized controlled trial.
SETTING/PATIENTS: Nonhospitalized adults, aged ≥65 years, living in urban, suburban, and rural areas of Texas, Illinois, and Indiana.
INTERVENTION: PYL is a national, publicly available tool that provides education on posthospital therapy choices and local home-based resources.
MEASUREMENTS: Participants completed an in-person baseline survey, followed by exposure to intervention or attention control (AC) websites, then 1-month and 3-month telephone surveys. The primary knowledge outcome was measured with 6 items (possible 0-6 points) pertaining to hospital discharge needs.
RESULTS: Among 385 participants randomized, mean age was 71.9 years (standard deviation 5.6) and 79.5% of participants were female. At 1 month, the intervention group had a 0.6 point change (standard deviation = 1.6) versus the AC group who had a −0.1 point change in knowledge score. Linear mixed modeling results suggest sex, health literacy level, level of education, income, and history of high blood pressure/kidney disease were significant predictors of knowledge over time. Controlling for these variables, treatment effect remained significant (P < 0.0001).
CONCLUSION: Seniors who used PYL demonstrated an increased understanding of posthospitalization and home services compared to the control group.
TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT02256072.
© 2017 Society of Hospital Medicine
When seniors are discharged from the hospital, many will require additional support and therapy to regain their independence and return safely home.1,2 Most seniors do not understand what their support needs will entail or the differences between therapy choices.3 To complicate the issue, seniors are often incapacitated and unable to make discharge selections for themselves.
Consequently, discharge planners and social workers often explain options to family members and loved ones, who frequently feel overwhelmed.4,5 While often balancing jobs, loved ones are divided between wanting to stay with the senior in the hospital and driving to area skilled nursing facilities (SNFs) for consideration. Discharges are delayed waiting for families to make visits and choose an SNF. Longer lengths of stay are detrimental to seniors due to the increased risks of infection, functional loss, and cognitive decline.6
Although seniors comprised only 12% of the US population in 2003,7 they accounted for one-third of all hospitalizations, over 13.2 million hospital stays.8 Hospital stays for seniors resulted in hospital charges totaling nearly $329 billion, or 43.6% of national hospital bills in 2003.7 Seniors are also high consumers of postacute care services. By 2050, the number of individuals using long-term care services in any setting (eg, at home, assisted living, or SNFs) will be close to 27 million.9-11 With the knowledge that many seniors will be hospitalized and subsequently require services thereafter, we sought to assist seniors in planning for their hospital discharge needs before they were hospitalized.
Our team developed PlanYourLifespan.org (PYL) to facilitate this planning for postdischarge needs and fill the knowledge gap in understanding postdischarge options. With funding from the Patient Centered Outcomes Research Institute, we aimed to test the effectiveness of PYL on improving knowledge of hospital discharge resources among seniors.
METHODS
PlanYourLifespan.org
PlanYourLifespan.org (PYL) educates users on the health crises that often occur with age and connects them to posthospital and home-based resources available locally and nationally. PYL is personalized, dynamic, and adaptable in that all the information can be changed per the senior’s wishes or changing health needs.
Content of PYL
Previously, we conducted focus groups with seniors about current and perceived home needs and aging-in-place. Major themes of what advanced life events (ALEs) would impact aging-in-place were identified as follows: hospitalizations, falls, and Alzheimer’s.12 We organized PYL around these health-related ALEs. Our multidisciplinary team of researchers, seniors, social workers, caregiver agencies, and Area Agencies on Aging representatives then determined what information and resources should be included.
Each section of PYL starts with a video of a senior discussing their real-life personal experiences, with subsections providing interactive information on what seniors can expect, types of resources available to support home needs, and choices to be made. Descriptions of types of settings for therapy, options available, and links to national/local resources (eg, quality indicators for SNFs) are also included. For example, by entering their zip code, users can identify their neighborhood SNFs, closest Area Agency on Aging, and what home caregiver agencies exist in their area.
Users can save their preferences and revisit their choices at any time. To support communication between seniors and their loved ones, a summary of their choices can be printed or e-mailed to relevant parties. For example, a senior uses PYL and can e-mail these choices to family members, which can stimulate a conversation about future posthospital care expectations.
As inadequate health literacy and cognitive impairment are prevalent among seniors, PYL presents information understandable at all levels of health literacy and sensitive to cognitive load.9 There is simplified, large-font, no mouse scrolling and audio available for the visually impaired.
