Abstract
BackgroundRecent research shows an increase in drug and alcohol-related hospitalizations in the USA, especially among older adults. However, no study examines trends in discharges to a skilled nursing facility (SNF) after a drug or alcohol-related hospitalization. Older adults are more likely to need post-hospital care in a SNF after a hospitalization due to an increased presence of chronic diseases and functional limitations. Therefore, the objective of this study was to estimate trends in drug or alcohol-related hospitalizations with discharge to a SNF among adults age 55 and older.MethodsWe analyzed data from New York State’s Statewide Planning and Research Cooperative System to calculate the number of cannabis, cocaine, opioid, and alcohol-related hospitalizations in New York City that resulted in discharge to a SNF from 2008 to 2014 among adults age 55 and older. Using New York City population estimates modified from US Census Bureau, we calculated age-specific rates per 100,000 adults. Trend tests were estimated using joinpoint regressions to calculate annual percentage change (APC) with 95% confidence intervals (CI) and stratified by adults age 55–64 and adults age 65 and older.ResultsDuring the study period, among adults age 55–64, there were significant increases in cocaine, cannabis, and opioid-related hospitalizations that resulted in discharge to a SNF. For adults ≥ 65 years, there were sharp increases across all substances with larger increases in opioids (APC of 10.66%) compared to adults 55–64 (APC of 6.49%). For both age groups and among the four substances, alcohol-related hospitalizations were the leading cause of discharge to a SNF.ConclusionsWe found an increase in hospital discharges to SNFs for patients age 55 and older admitted with alcohol or drug-related diagnoses. Post-acute and long-term care settings should prepare to care for an increase in older patients with substance use disorders by integrating a range of harm reduction interventions into their care settings.
Highlights
Recent research shows an increase in drug and alcohol-related hospitalizations in the USA, especially among older adults
Older adults have more chronic health conditions, functional impairments, and are more likely to be hospitalized [8], which increases the likelihood that older adults with substance use disorder (SUD) will need post-acute care after hospitalization
We reported the trends by substance type and age group (55–64 and ≥ 65 years) using annual percent change (APC), 95% confidence intervals, and p values, which identified whether the annual percent change differed from zero
Summary
Recent research shows an increase in drug and alcohol-related hospitalizations in the USA, especially among older adults. Older adults are more likely to need post-hospital care in a SNF after a hospitalization due to an increased presence of chronic diseases and functional limitations. Older adults with substance use disorder (SUD) are often medically complex with the presence of multiple chronic conditions [1, 2] and are especially vulnerable to the harms of drug and alcohol use including overdose [3]. Older adults may be hospitalized primarily for a drug and alcohol-related problem and have an exacerbation of a chronic medical disease. Older adults may have a SUD that is stable (e.g., taking methadone or buprenorphine for opioid use disorder for many years) but hospitalized for an acute medical problem. These include a higher demand for SUD care in settings that have traditionally not seen high rates of patients with SUDs, including post-acute and long-term care settings
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