Hospital discharge instructions: comprehension and compliance among older adults

J Gen Intern Med. 2014 Nov;29(11):1491-8. doi: 10.1007/s11606-014-2956-0. Epub 2014 Jul 12.


Background: Little is known regarding the prevalence or risk factors for non-comprehension and non-compliance with discharge instructions among older adults.

Objective: To quantify the prevalence of non-comprehension and non-compliance with discharge instructions and to identify associated patient characteristics.

Research design: Prospective cohort study.

Subjects: Four hundred and fifty adults aged ≥ 65 admitted to medical and surgical units of a tertiary care facility and meeting inclusion criteria.

Measures: We collected information on demographics, psycho-social factors, discharge diagnoses, and medications using surveys and patient medical records. Domains within discharge instructions included medications, follow-up appointments, diet, and exercise. At 5 days post-discharge, we assessed comprehension by asking patients about their discharge instructions, and compared responses to written instructions from medical charts. We assessed compliance among patients who understood their instructions.

Results: Prevalence of non-comprehension was 5 % for follow-up appointments, 27 % for medications, 48 % for exercise and 50 % for diet recommendations. Age was associated with non-comprehension of medication [odds ratio (OR) 1.07; 95 % confidence interval (CI) 1.04, 1.12] and follow-up appointment (OR 1.08; 95 % CI 1.00, 1.17) instructions. Male sex was associated with non-comprehension of diet instructions (OR 1.91; 95 % CI 1.10, 3.31). Social isolation was associated with non-comprehension of exercise instructions (OR 9.42; 95 % CI 1.50, 59.11) Depression was associated with non-compliance with medication (OR 2.29; 95 % CI 1.02, 5.10) and diet instructions (OR 3.30; 95 % CI 1.24, 8.83).

Conclusions: Non-comprehension of discharge instructions among older adults is prevalent, multi-factorial, and varies by domain.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aftercare / standards
  • Aged
  • Comprehension*
  • Female
  • Health Literacy / statistics & numerical data*
  • Humans
  • Male
  • Maryland
  • Medication Adherence / statistics & numerical data
  • Patient Compliance / statistics & numerical data*
  • Patient Discharge / standards*
  • Prospective Studies
  • Risk Factors