Living alone after being hospitalized may strike a blow to the independence of older adults, suggest the results of a study.
Although many studies have focused on the effects of hospitalization on older adults, few examined what happens when patients return home. "For many patients, the posthospitalization period is one of dynamic flux," noted lead author Jane E. Mahoney, MD.
This may be particularly true for those who live alone and receive assistance only from home health aides, according to Mahoney, of the Department of Medicine at the University of Wisconsin School of Medicine in Madison.
Mahoney and colleagues analyzed more than 300 recently hospitalized older adults, approximately half of whom lived alone. While all the study participants had more trouble carrying out daily activities, such as bathing, walking, and eating when they first left the hospital, the members of the group that lived alone were more likely to be still struggling a month later.
"Lacking encouragement from an in-home caregiver, patients living alone may be reluctant to assume independence in basic tasks, continuing instead to rely on support from outside the home," suggested Mahoney.
Also, those who returned to empty homes following their hospital visit were more likely to be admitted to a nursing home during the following month, the researchers found. The study results appear in the September 2000 issue of the Journal of General Internal Medicine.
Visits from family and friends helped somewhat. Those living alone who received informal visits from a family member, friend, or neighbor were more likely to make functional improvements than those without visitors. Informal visits may provide support in a number of ways, Mahoney suggested.
"Frequent informal support from an outside source may encourage rehabilitation, improve compliance with medical and physical therapy, and decrease patients' fear of falling," she said.
Interestingly, the researchers also found that those living alone who received more informal visits were at higher risk of being admitted to a nursing home within a month after discharge than those who lived alone with less outside support. "One explanation for this could be that closely involved family, friends, or neighbors have a greater responsibility for the person's well-being and are more apt to seek out living arrangements that provide more supervision," said Mahoney.
According to the researchers, more planning is needed when elderly patients are released from the hospital to make sure those living alone get the help they need. Home nursing services, including physical and occupational therapy, may not be enough.
"Patients who live alone may require more intensive resources to maintain community living and improve in function," Mahoney said.
This study was funded by grants from the National Institute on Aging, the American Physical Therapy Foundation, the Dean Foundation, and the University of Wisconsin Medical School and Graduate School.
The Journal of General Internal Medicine, a monthly peer-reviewed journal of the Society of General Internal Medicine, publishes original articles on research and education in primary care. For information about the journal, contact Renee F. Wilson at (410) 955-9868.
Posted by the Center for the Advancement of Health http://www.cfah.org. For information about the Center, call Petrina Chong, pchong@cfah.org (202) 387-2829.
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Journal of General Internal Medicine