title: Postdischarge Falls and Readmissions: Associations with Insufficient Vision and Low Health Literacy among Hospitalized Seniors.
abstract: The role of patient-level risk factors such as insufficient vision has been understudied. Because insufficient vision may interfere with health literacy assessments, the full impact of low health literacy among older patients with impaired vision is unknown. We sought to determine whether senior inpatients' insufficient vision and low health literacy are associated with adverse outcomes postdischarge, specifically falls and readmissions. We conducted an observational study of adult medicine inpatients at an urban hospital. Visual acuity and health literacy were screened at bedside. Outcomes data were collected by telephone 30 days postdischarge. Among 1,900 participants, 1,244 (65%) were reached postdischarge; 44% had insufficient vision and 43% had low health literacy. Insufficient vision was associated with postdischarge falls among participants ≥65 years (adjusted odds ratio [AOR] 3.38, 95% confidence interval [CI] 1.42-8.05), but not among participants <65 years (AOR 1.44, 95% CI 0.89-2.32). Low health literacy was associated with readmissions among participants ≥65 years (AOR 3.15, 95% CI 1.77-5.61), but not among participants <65 years (AOR 0.78, 95% CI 0.56-1.09). The results suggest the need to implement screening for older inpatients' vision and health literacy. Developing effective interventions to reduce these risks is critical given national priorities to reduce falls and readmissions.
authors.affiliation: a Department of Psychiatry, Massachusetts General Hospital , Boston , Massachusetts , USA.
authors.forename: Ethan G
authors.initials: EG
authors.lastname: Jaffee
authors.affiliation: b Section of General Internal Medicine, Department of Medicine , University of Chicago , Chicago , Illinois , USA.
authors.forename: Vineet M
authors.initials: VM
authors.lastname: Arora
authors.affiliation: c Medicine-Pediatrics , Massachusetts General Hospital , Boston , Massachusetts , USA.
authors.forename: Madeleine I
authors.initials: MI
authors.lastname: Matthiesen
authors.affiliation: d Section of Ophthalmology and Visual Sciences, Department of Surgery , University of Chicago , Chicago , Illinois , USA.
authors.forename: Seenu M
authors.initials: SM
authors.lastname: Hariprasad
authors.affiliation: e Section of Hospital Medicine, Department of Medicine , University of Chicago , Chicago , Illinois , USA.
authors.forename: David O
authors.initials: DO
authors.lastname: Meltzer
authors.affiliation: e Section of Hospital Medicine, Department of Medicine , University of Chicago , Chicago , Illinois , USA.
authors.forename: Valerie G
authors.initials: VG
authors.lastname: Press
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D005260:Female; D057220:Health Literacy / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012307:Risk Factors; D014786:Vision Disorders / Q000453:epidemiology*