Study reveals factors associated with hospital discharges against doctors' advice

June 19, 2017
Credit: CC0 Public Domain

A new study has found that certain factors are linked with a person's decision to leave the hospital against the advice of his or her care provider. Also, some of these factors are more pronounced in older versus younger individuals. The findings, which are published in the Journal of the American Geriatrics Society, may help healthcare providers address this growing problem.

Discharge against is linked with an increased risk of readmission, higher morbidity and mortality, and increased costs. To examine the factors involved, a team led by Jashvant Poeran, MD, PhD, of the Icahn School of Medicine at Mount Sinai, analyzed national data on all US hospitalizations. They were especially interested in differences for patients aged >65 years compared with those aged 18-64 years.

Their analysis, which included more than 29 million hospital stays listed in the 2013 National Inpatient Sample, revealed that >50,000 older adults in the hospital (out of 12 million people under hospital care overall) left the hospital against medical advice that year; however, and women were 4 times less likely to do so than people aged 18-64 years. From 2003 to 2013, rates increased in those aged 18-64 from 1.44% to 1.78%, and in those aged ?65 from 0.37% to 0.42%. In both age groups, men, people insured by Medicaid or those without health insurance, and individuals living with mental health concerns had the highest risks of leaving the hospital against medical advice. In , race/ethnicity and poverty were more pronounced as , with older African American individuals at 65% increased risk and low-income older people at 57% increased risk of leaving the hospital against medical advice.

"One of the reasons mentioned in previous studies for leaving the hospital against medical advice is suboptimal communication, which may indeed affect older minority patients more," said Dr. Poeran. "More research is needed to find out why exactly race/ethnicity and poverty are more pronounced as risk factors in , especially since Medicare theoretically offers for patients aged 65 years or older."

The investigators noted that the findings are an important first step to additional studies that seek to determine the exact reasons why people may leave the hospital against medical advice and how these reasons differ between older and younger individuals. "The patients' social supports and functional and cognitive abilities were not measured in the original sample. Each of these could influence an older person's ability to leave the hospital against medical advice," said Rosanne Leipzig, MD, PhD, the study team's senior clinician. "This information will be important in order for hospitals and healthcare providers to address this issue."

Explore further: Drop in admission for aspiration pneumonia from 2002 to 2012

More information: "Discharge Against Medical Advice among Elderly Inpatients in the US." Carlijn Lelieveld, Rosanne Leipzig, Licia Gaber-Bayliss, Madhu Mazumdar, Stavros G. Memtsoudis, Nicole Zubizarreta, and Jashvant Poeran. Journal of the American Geriatrics Society; Published Online: June 19, 2017, DOI: 10.1111/jgs.14985

Related Stories

Drop in admission for aspiration pneumonia from 2002 to 2012

June 8, 2017
(HealthDay)—From 2002 to 2012 there was a decrease in the incidence of admission for aspiration pneumonia, according to research published in the June 1 issue of the Annals of the American Thoracic Society.

Sleep apnea reporting low among individuals aged 65+

May 24, 2017
(HealthDay)—From 1993 to 2011, physicians reported sleep apnea (SA) in 0.3 percent of all office visits among individuals aged 65 years and older, according to a study published online May 4 in the Journal of the American ...

Longer hospital stays might reduce readmissions from post-acute care facilities

March 7, 2017
More than 25 percent of Medicare beneficiaries who are admitted to the hospital are sent to a post-acute care facility (a health facility like a rehabilitation or skilled nursing center used instead of a hospital) after being ...

Shorter length of stay tied to earlier readmission for seniors

March 17, 2017
(HealthDay)—For older patients discharged from the hospital to post-acute care (PAC) facilities, shorter length of hospital stay is associated with earlier readmission, according to a study published online March 3 in the ...

Patients leaving hospital against medical advice more likely to be readmitted or die

August 26, 2013
People who leave hospital against their doctors' orders are more likely to be readmitted to hospital or die, according to a new study in CMAJ (Canadian Medical Association Journal).

Type of hospital doesn't impact thrombolysis outcomes in stroke

June 9, 2017
(HealthDay)—For older adults with acute stroke, treatment with intravenous thrombolysis (IVT) is associated with similar outcomes, irrespective of hospital characteristics, according to a study published online June 2 in ...

Recommended for you

One in 4 women and 1 in 6 men aged 65+ will be physically disabled in Europe by 2047

October 23, 2017
By 2047 one in four women and one in six men aged 65 and above is expected to be living with a physical disability that will severely restrict everyday activities, reveals an analysis published in the online journal BMJ Open.

Protein regulates vitamin A metabolic pathways, prevents inflammation

October 23, 2017
A team of researchers from Case Western Reserve University School of Medicine have discovered how uncontrolled vitamin A metabolism in the gut can cause harmful inflammation. The discovery links diet to inflammatory diseases, ...

New insights into controversial diagnosis of adolescent chronic fatigue

October 23, 2017
Crucial new research could provide some clarity around the controversy surrounding the diagnosis and treatment of chronic fatigue syndrome (CFS) in adolescents. The research by the Murdoch Children's Research Institute published ...

Do boys really have a testosterone spurt at age four?

October 23, 2017
The idea that four-year-old boys have a spurt of testosterone is often used to explain challenging behaviour at this age.

Our laws don't do enough to protect our health data

October 23, 2017
Have you ever wondered why your computer often shows you ads that seem tailor-made for your interests? The answer is big data. By combing through extremely large datasets, analysts can reveal patterns in your behavior.

New prevention exercise programme to reduce rugby injuries

October 23, 2017
A new dynamic 20-minute exercise programme, performed by rugby players before training and pre-match, could dramatically reduce injuries in the sport according to a benchmark study published today (Sunday 22 October).

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.