Data indicate that discharge against medical advice (DAMA) is associated with greater risk of hospital readmission, increased costs, and higher rates of morbidity and mortality. However, there is a lack of national data on DAMA in the rapidly increasing elderly inpatient population in the US.
For a study published in the Journal of the American Geriatrics Society, Jashvant Poeran, MD, PhD, Rosanne Leipzig, MD, PhD, and colleagues analyzed data from The National Inpatient Sample to describe trends and assess factors associated with DAMA in elderly patients.
“Most of the research in this area has been performed in patients younger than 65 and specific patient subgroups such as those with mental health problems,” says Dr. Leipzig.
Study results indicated that from 2003 to 2013, rates increased in individuals aged 18 to 64 (1.44% to 1.78%) and in those aged 65 and older (0.37% to 0.42%). Factors associated with higher adjusted odds of DAMA were generally similar between age groups
“However, the risk of discharge against medical advice was much more pronounced among African American and Hispanic elderly patients compared with minority patients aged 18-64,” says Leipzig. “This could stem from communication-related issues, especially since studies have demonstrated that these are likelier to occur in minority patients. The same goes for elderly patients, who rate physician–patient communication lower than younger patients). Communication is even more important in elderly patients as cognitive issues, multiple chronic diseases, mobility, housing and family circumstances are even more pronounced.”