• Ivy Benjenk, Eva H DuGoff, Gwen C Jacobsohn, Nia Cayenne, JonesCourtney M CCMCthe, Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA., Thomas V Caprio, Jeremy T Cushman, Rebecca K Green, KindAmy J HAJHthe, Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.and the, William S. Middleton Veterans Affairs Geriatrics Research, Education, and Clinical , Michael Lohmeier, Ranran Mi, and Manish N Shah.
• From the, Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, MD, USA.
• Acad Emerg Med. 2021 Feb 1; 28 (2): 215-225.

ObjectiveOlder adults discharged from the emergency department (ED) are at high risk for adverse outcomes. Adherence to ED discharge instructions is necessary to reduce those risks. The objective of this study is to determine the individual-level factors associated with adherence with ED discharge instructions among older adult ED outpatients.MethodsWe performed a secondary analysis of data from the control group of a randomized controlled trial testing a care transitions intervention among older adults (age ≥ 60 years) discharged home from the ED in two states. Taking data from patient surveys and chart reviews, we used multivariable logistic regression to identify patient characteristics associated with adherence to printed discharge instructions. Outcomes were patient-reported medication adherence, provider follow-up visit adherence, and knowledge of "red flags" (signs of worsening health requiring further medical attention).ResultsA total 824 patients were potentially eligible, and 699 had data in at least one pillar. A total of 35% adhered to medication instructions, 76% adhered to follow-up instructions, and 35% recalled at least one red flag. In the multivariate analysis, no factors were significantly associated with failure to adhere to medications. Participants with poor health status (adjusted odds ratio [AOR] = 0.55, 95% confidence interval [CI] = 0.31 to 0.98) were less likely to adhere to follow-up instructions. Participants who were older (AORs trended downward as age category increased) or depressed (AOR = 0.39, 95% CI = 0.17 to 0.85) or had one or more functional limitations (AOR = 0.62, 95% CI = 0.41 to 0.94) were less likely to recall red flags.ConclusionOlder adults discharged home from the ED have mixed rates of adherence to discharge instructions. Although it is thought that some subgroups may be higher risk than others, given the opportunity to improve ED-to-home transitions, EDs and health systems should consider providing additional care transition support to all older adults discharged home from the ED.© 2020 Society for Academic Emergency Medicine.

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