• Diabetes & Metabolic Syndrome
• Diabetes & Endocrinology Clinical Trials
• Nursing
• Diabetes Mellitus

• Endocrinology
• Diabetes & Metabolic Syndrome
• Diabetes & Endocrinology Clinical Trials
• Nursing
• Diabetes Mellitus

Jacqueline LaManna, PhD, APRN, University of Central Florida College of Nursing, Orlando, Florida, USA, presented results from a study demonstrating that the hospital-to-home transition in older adults with diabetes mellitus (DM) is affected by a variety of personal, hospital, and community factors. Recidivism within 30 days of discharge was associated with increased coping difficulty in elders, and common complications included medication management, trouble controlling glucose, and regulating another chronic illness.

More than 5 million older adults with DM are hospitalized each year [Centers for Disease Control and Prevention. National Diabetes Fact Sheet, 2011]. Although diabetes is not always the cause of the hospitalization, diabetes control often deteriorates during the hospital stay and requires changes in home self-care plans. The specific transitional care needs of this patient population are poorly understood.

With this in mind, Dr. LaManna conducted a simultaneous quantitative and qualitative mixed-methods design study in older adults with diabetes to determine factors that affected the home recovery transition and to identify common difficulties encountered by patients and their families during the early and intermediate postdischarge transition periods.

The study sample comprised 96 older adults (median age, 75 years; 80% white) with a preexisting diagnosis of DM (median duration, 11 years; range, 1 to 49 years).

On discharge from the hospital, 35.6% of patients required insulin therapy and 40% experienced a change in their diabetes treatment plan. More than 75% of patients had a preexisting diagnosis of a chronic diabetes-related health condition. The most frequently reported chronic health conditions were coronary artery disease (61.5%), diabetic neuropathy (57.3%), chronic kidney disease (45.8%), and heart failure (38.5%). Following discharge, 41.1% of patients (n= 30) experienced event recidivism and 21.9% (n=16) were rehospitalized within 30 days.

A qualitative analysis of information gathered during administration of the Post Discharge Coping Difficulty Scale (PDCDS) identified difficulties encountered by the older patients and their family caregivers during the first 30 days following discharge. These comprised 4 major themes (Table 1).

Quantitative analyses showed that patients who experienced an event of recidivism had lower predischarge assessments of readiness on the Readiness for Hospital Discharge Scale (p = .028), and higher PDCDS scores were found in patients who reported unmet discharge information needs (p = .023), experienced recidivism within 30 days of discharge (p = .003), and reported difficulties managing medication regimens (p = .031), controlling their diabetes (p = .036), or managing another chronic disease (p < .001).

Early and intermediate recidivism, however, were not related to age, gender, chronic disease pattern, diabetes-related health status variables, use of hospitalist services, length of hospital stay, quality of discharge teaching, availability of an in-home family caregiver, or use of home health services.

Dr. LaManna concluded that improved understanding of the sequential nature of the transition and the dynamic needs of older adults and their families during this time is essential, and diabetes educators have the potential to positively affect this transition.

• © 2014 MD Conference Express®