title: Hospital discharge instructions: comprehension and compliance among older adults.
abstract: BACKGROUND
  Little is known regarding the prevalence or risk factors for non-comprehension and non-compliance with discharge instructions among older adults.
  
  
  OBJECTIVE
  To quantify the prevalence of non-comprehension and non-compliance with discharge instructions and to identify associated patient characteristics.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Four hundred and fifty adults aged ≥ 65 admitted to medical and surgical units of a tertiary care facility and meeting inclusion criteria.
  
  
  METHODS
  We collected information on demographics, psycho-social factors, discharge diagnoses, and medications using surveys and patient medical records. Domains within discharge instructions included medications, follow-up appointments, diet, and exercise. At 5 days post-discharge, we assessed comprehension by asking patients about their discharge instructions, and compared responses to written instructions from medical charts. We assessed compliance among patients who understood their instructions.
  
  
  RESULTS
  Prevalence of non-comprehension was 5 % for follow-up appointments, 27 % for medications, 48 % for exercise and 50 % for diet recommendations. Age was associated with non-comprehension of medication [odds ratio (OR) 1.07; 95 % confidence interval (CI) 1.04, 1.12] and follow-up appointment (OR 1.08; 95 % CI 1.00, 1.17) instructions. Male sex was associated with non-comprehension of diet instructions (OR 1.91; 95 % CI 1.10, 3.31). Social isolation was associated with non-comprehension of exercise instructions (OR 9.42; 95 % CI 1.50, 59.11) Depression was associated with non-compliance with medication (OR 2.29; 95 % CI 1.02, 5.10) and diet instructions (OR 3.30; 95 % CI 1.24, 8.83).
  
  
  CONCLUSIONS
  Non-comprehension of discharge instructions among older adults is prevalent, multi-factorial, and varies by domain.
authors.affiliation: Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, 12th floor, Room 01-234, Baltimore, MD, 21201, USA, jalbrecht@rx.umaryland.edu.
authors.forename: J S
authors.initials: JS
authors.lastname: Albrecht
authors.forename: A L
authors.initials: AL
authors.lastname: Gruber-Baldini
authors.forename: J M
authors.initials: JM
authors.lastname: Hirshon
authors.forename: C H
authors.initials: CH
authors.lastname: Brown
authors.forename: R
authors.initials: R
authors.lastname: Goldberg
authors.forename: J H
authors.initials: JH
authors.lastname: Rosenberg
authors.forename: A C
authors.initials: AC
authors.lastname: Comer
authors.forename: J P
authors.initials: JP
authors.lastname: Furuno
mesh_terms: D000359:Aftercare / Q000592:standards; D000368:Aged; D032882:Comprehension; D005260:Female; D057220:Health Literacy / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008396:Maryland; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000592:standards*; D011446:Prospective Studies; D012307:Risk Factors; D016903:Drug Monitoring