title: Geriatric Syndromes in Hospitalized Older Adults Discharged to Skilled Nursing Facilities.
abstract: OBJECTIVE
  To determine the prevalence, recognition, co-occurrence, and recent onset of geriatric syndromes in individuals transferred from the hospital to a skilled nursing facility (SNF).
  
  
  METHODS
  Quality improvement project.
  
  
  METHODS
  Acute care academic medical center and 23 regional partner SNFs.
  
  
  METHODS
  Medicare beneficiaries hospitalized between January 2013 and April 2014 and referred to SNFs (N = 686).
  
  
  METHODS
  Project staff measured nine geriatric syndromes: weight loss, lack of appetite, incontinence, and pain (standardized interview); depression (Geriatric Depression Scale); delirium (Brief Confusion Assessment Method); cognitive impairment (Brief Interview for Mental Status); and falls and pressure ulcers (hospital medical record using hospital-implemented screening tools). Estimated prevalence, new-onset prevalence, and common coexisting clusters were determined. The extent to which treating physicians commonly recognized syndromes and communicated them to SNFs in hospital discharge documentation was evaluated.
  
  
  RESULTS
  Geriatric syndromes were prevalent in more than 90% of hospitalized adults referred to SNFs; 55% met criteria for three or more coexisting syndromes. The most-prevalent syndromes were falls (39%), incontinence (39%), loss of appetite (37%), and weight loss (33%). In individuals who met criteria for three or more syndromes, the most common triad clusters were nutritional syndromes (weight loss, loss of appetite), incontinence, and depression. Treating hospital physicians commonly did not recognize and document geriatric syndromes in discharge summaries, missing 33% to 95% of syndromes present according to research personnel.
  
  
  CONCLUSIONS
  Geriatric syndromes in hospitalized older adults transferred to SNFs are prevalent and commonly coexist, with the most frequent clusters including nutritional syndromes, depression, and incontinence. Despite the high prevalence, this clinical information is rarely communicated to SNFs on discharge.
authors.affiliation: Center for Quality Aging, Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, Tennessee.|Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University, Nashville, Tennessee.
authors.forename: Susan P
authors.initials: SP
authors.lastname: Bell
authors.affiliation: Center for Quality Aging, Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, Tennessee.|Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, Tennessee.|Geriatric Research Education and Clinical Center, Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, Tennessee.
authors.forename: Eduard E
authors.initials: EE
authors.lastname: Vasilevskis
authors.affiliation: Center for Quality Aging, Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, Tennessee.|Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University, Nashville, Tennessee.
authors.forename: Avantika A
authors.initials: AA
authors.lastname: Saraf
authors.affiliation: Center for Quality Aging, Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, Tennessee.|Geriatric Research Education and Clinical Center, Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, Tennessee.|Center for Health Services Research, Vanderbilt University, Nashville, Tennessee.
authors.forename: J M L
authors.initials: JM
authors.lastname: Jacobsen
authors.affiliation: Center for Quality Aging, Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, Tennessee.|Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, Tennessee.|Center for Health Services Research, Vanderbilt University, Nashville, Tennessee.|Center for Clinical Quality and Implementation Research, Vanderbilt University, Nashville, Tennessee.
authors.forename: Sunil
authors.initials: S
authors.lastname: Kripalani
authors.affiliation: Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, Tennessee.|Geriatric Research Education and Clinical Center, Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, Tennessee.
authors.forename: Amanda S
authors.initials: AS
authors.lastname: Mixon
authors.affiliation: Center for Quality Aging, Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, Tennessee.|Geriatric Research Education and Clinical Center, Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, Tennessee.|Division of Geriatrics, Department of Medicine, Vanderbilt University, Nashville, Tennessee.
authors.forename: John F
authors.initials: JF
authors.lastname: Schnelle
authors.affiliation: Center for Quality Aging, Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, Tennessee.|Geriatric Research Education and Clinical Center, Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, Tennessee.|Division of Geriatrics, Department of Medicine, Vanderbilt University, Nashville, Tennessee.
authors.forename: Sandra F
authors.initials: SF
authors.lastname: Simmons
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015577:Geriatric Assessment; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D006278:Medicare; D010351:Patient Discharge; D015995:Prevalence; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012866:Skilled Nursing Facilities; D013577:Syndrome; D014481:United States
keywords: care transitions; geriatric syndromes; older adults; skilled nursing facility