Compliance of Frail Elderly With Health Services Prescribed at Discharge From an Acute-Care Geriatric Ward

OBJECTIVES: A model of compliance by frail elderly with prescribed healthcare services was developed and tested. The discrepancy between primary care, geriatric and community health center (CLSC) services prescribed at discharge after comprehensive geriatric evaluation and treatment was measured, as were those services actually used during a 6-week interval (compliance). In this model, compliance was directly related to elders' intention to adhere to prescribed services, but this relationship was modified by organizational factors, reinforcing factors, and changes in health status during the observation period. Intention to adhere resulted from individual and reinforcing factors existing before discharge. METHODS: This model was tested on 211 patients discharged to community settings from an acute-care hospital geriatrics ward. Information was obtained through interviews with the patients or care givers and from hospital, outpatient, and local community health center charts. RESULTS: On average, patients used 56.9% of services prescribed; 13% of patients did not use any of the services prescribed for them, whereas 22% used all the services prescribed. Intention to adhere was influenced by patients' perception of the benefits of prescribed services and by their perception of the ease of access to transportation. Intention itself was not found to be an important determinant of overall compliance. Among organizational factors, having the ward staff make a follow-up appointment with the patients' family doctor and with the geriatric clinic before discharge and communication with the local community health center increased overall compliance. Moreover, patients who perceived they had access to transportation and to an accompanying person were more likely to comply. CONCLUSIONS: The results suggest that when discharging patients to the community, steps taken for them by the discharging healthcare providers will improve compliance

Acute care · Compliance (psychology) · Family medicine · Geriatrics · Health care · Medical emergency · Psychiatry · Frailty in Older Adults · Geriatric Care and Nursing Homes · Medication Adherence and Compliance · Medicine · Nursing · Psychology · Gerontology

• Social Support and Patient Adherence to Medical Treatment

  M Robin Dimatteo, M Siewers et al.•Health Psychology•2004

  Añadir item

• Models of attitude–behavior relations.

  Peter M Bentler, George Speckart•Psychological Review•1979

  Añadir item

• Societal and Individual Determinants of Medical Care Utilization in the United States

  Ronald Andersen, John F Newman•The Milbank Memorial Fund…•1973

  Añadir item

• “Mini-mental state”

  Open Access•Marshal F Folstein, Susan E Folstein et al.•Journal of Psychiatric Research•1975

  Añadir item

• Patient Adherence to Prescribed Therapies

  Marshall H Becker•Medical Care•1985

  Añadir item

• Utilization Patterns Among Long-term Enrollees in a Prepaid Group Practice Health Maintenance Organization

  Bentson H Mcfarland, Donald K Freeborn et al.•Medical Care•1985

  Añadir item

• Prediction of goal-directed behavior

  Open Access•Icek Ajzen, Thomas J Madden•Journal of Experimental Social…•1986

  Añadir item

• Assessment of Older People

  M P Lawton, Elaine Brody et al.•The Gerontologist•1969

  Añadir item

• Intention, perceived control, and weight loss

  Deborah E Schifter, Deborah Schifter et al.•Journal of Personality and Social…•1985

  Añadir item

• The Influence of Family Caregivers on Elder's Use of In-Home Services

  David M Ba, David M Bass et al.•Journal of Health and Social…•1987

  Añadir item

• Use of Social and Health Services by the Elderly

  Claudia Coulton, Abbie K Frost•Journal of Health and Social…•1982

  Añadir item