Background:
Among elders, low functional health status (vulnerability) is a significant risk factor for poor outcomes, including functional decline and death. Assessment of vulnerability in hospitalized patients may identify at‐risk individuals, who could benefit from increased post–acute care services such as home health nursing or rehabilitation. We assessed the prevalence of vulnerability among elders hospitalized with acute cardiovascular conditions, as well as their characteristics, prior health care utilization, and referral for post–acute care services.
Methods:
Individuals older than age 65 hospitalized with acute coronary syndromes (ACS) or acute decompensated heart failure (ADHF) were enrolled in a prospective cohort study. Participants completed a series of validated measurements to assess demographics, education, cognition, psychosocial factors, and prior health care utilization. Functional health status was measured by the Vulnerable Elders Survey (VES‐13), a validated method for identifying vulnerable elders in community settings. With a possible range of 0–10, a VES‐13 score ≥ 3 represents vulnerability, and scores ≥ 4 represent extreme vulnerability. Disposition and home health services were recorded by chart abstraction.
Results:
Among 228 participants, the median VES‐13 score was 3 (IQR, 1–7), 129 (56%) met criteria for vulnerability, and 83 (36%) were classified as extremely vulnerable. Increasing vulnerability was associated with age, female sex, lower education level, lower health literacy (P = 0.023), and lower health numeracy (P = 0.01). More vulnerable patients were more likely to have moderate or severe depression (P < 0.001) and greater difficulty paying bills (P = 0.006). ER visits, clinic visits, and hospitalization in the prior 12 months were more frequent in vulnerable adults. However, low utilization of home health and rehabilitation facilities was present, with the majority of patients being discharged home with self‐care. Vulnerable elders were no more likely to receive home health (2%) or transfer to a rehabilitation facility (2%) than nonvulnerable patients. Only patients classified as extremely vulnerable received higher levels of post–acute care services (33%).
Conclusions:
Reduced functional health status is highly prevalent in older adults hospitalized with ACS or ADHF. Vulnerability is associated with other risk factors, such as low health literacy and depression, as well as higher levels of health care utilization. Despite this, there is little referral for post–acute care services for adults identified as vulnerable.