Postsurgical Discharge Research Articles

Listenability as a Tool for Advancing Health Literacy

Health literacy research and practice has focused mainly on the readability of written documents. Yet oral communication plays at least as important a role in the interpersonal ecology in which people make real decisions about their health. Moreover, the single-minded quest for short sentences and simple vocabulary inherent in the readability paradigm can subvert the effort to engage in patient- or consumer-centered communication. Listenability is the quality of discourse that eases the cognitive burden that aural processing imposes. Listenability is a function of oral-based language plus “considerate” rhetorical structures. The Listenability Style Guide presented in this article offers evidence-based recommendations for producing listenable discourse. A study testing the applicability of the Listenability Style Guide to postsurgical discharge instructions was conducted. College students either heard or read discharge instructions composed in either high or moderate listenability. Comprehension was higher for this population in reading than in listening. Across modalities, the high listenability version was easiest to comprehend. Incorporating listenability concerns in research and practice is consistent with emerging, broad conceptions of health literacy and with the dictates of the National Action Plan to Improve Health Literacy.

Diabetes and Health Outcomes Among Older Taiwanese with Hip Fracture

Hip fracture tremendously impacts functional abilities for the elderly with high morbidity and mortality; recovery is compromised by co-morbidities. Diabetes mellitus is a common co-morbidity for the aging population, but little is known about the influence of diabetes on outcomes of the Asian elderly with hip fracture. This study was a secondary analysis of data on 242 community-dwelling elders with hip fracture from three previous longitudinal studies. Sixty-one cases (25.2%) had diabetes. Outcomes were measured by the Chinese Barthel Index, Medical Outcomes Study Short Form-36 Taiwan version, and analyzed by the generalized estimating equation approach to examine how diabetes influenced hip-fractured elders' mortality, service utilization, mobility, daily activities, and health-related quality of life during the first 12 months after postsurgical discharge in Taiwan. Hip-fractured elderly with diabetes had a significantly higher mortality rate (22.6% vs. 10.3%, p=0.03) during the first year following discharge, and significantly higher readmission rate (10.0% vs. 2.5%, p=0.04) from the first to third month following discharge than those without diabetes. After controlling for covariates, elderly participants without diabetes had an overall 2.2 times (confidence interval [CI]=1.15-4.21) greater odds of recovery in walking ability and better reported general health (β=9.33; p=0.01) and physical functioning (β=7.26; p=0.02) than those with diabetes during the first year after discharge. Diabetes negatively influenced outcomes of elderly patients with hip fracture. The results may provide a reference for developing interventions for hip-fractured elders with diabetes.