Elderly/Long-term Care

Elderly individuals with financial problems face more disability and risk of death after hospital discharge

Over 10 percent of older Americans live below the Federal poverty line, with little ability to pay for medicine and other medical expenses after they have been hospitalized. Financial problems make the elderly particularly vulnerable to functional decline and death when they are discharged from the hospital, concludes a new study supported in part by the Agency for Healthcare Research and Quality (KO2 HS00006). Researchers led by Kenneth E. Covinsky, M.D., M.P.H., of the University of California, San Francisco, followed 2,200 patients 70 years and older, who were admitted to two teaching hospitals in Ohio. The researchers interviewed patients at hospital discharge to determine their financial ability to pay for six needs: groceries, general bills, medications, medical bills, a small emergency, and a major emergency. They also determined functional decline in ability to perform activities of daily living from discharge to 90 days after discharge, and death 1 year after discharge. One out of five patients (21 percent) had severe financial disability and was unable to pay for three to six needs, while 36 percent of patients had moderate disability and were unable to pay for one to two needs.

Only 15 percent of elderly patients with no financial disability showed functional decline three months after hospital discharge, compared with 20 percent of those who had moderate financial disability, and 25 percent with severe financial disability. Corresponding 1-year mortality rates were 24 percent, 27 percent, and 32 percent, respectively. Alleviating the financial disability of elderly individuals may improve their health outcomes following hospital discharge, conclude the researchers.

See "Reports of financial disability predict functional decline and death in older patients discharged from the hospital," by Alexander K. Li, M.D., Dr. Covinsky, Laura P. Sands, Ph.D., and others, in the Journal of General Internal Medicine 20, pp. 168-174, February 2005.

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