Year: 2016
Type: article
Abstract: To the Editor: Transitions between acute and outpatient care pose serious health risks for older adults, leading to hospital readmissions and adverse drug events.1 Language barriers compound this risk of adverse events,2, 3 but few studies have examined care transition outcomes for older adults with language barriers. The purpose of this study was to compare outcomes of care transitions for Spanish–English bilingual veterans with those of English-speaking veterans, with the hypothesis that older bilingual veterans would be at risk of poorer posthospital outcomes. This study was a secondary analysis of data from a controlled trial of an inpatient medication reconciliation intervention for veterans upon hospital admission. The institutional review board at the James J. Peters Veterans Affairs (VA) Medical Center approved the study. Veterans with medical records indicating use of both VA and non-VA services who were admitted to medical–surgical or psychiatric hospital inpatient units were enrolled. Usual postdischarge transitional care was provided over the telephone and in clinic visits for all subjects. Participants were defined as bilingual if Spanish was recorded in the medical record as the preferred language or the individual replied “Spanish” to any of the following interview items at study enrollment: What language do you mainly speak at home? What is your primary language? In which language do you feel most comfortable communicating? Three domains of post-hospital care transition quality were assessed: patient communication, postdischarge medication problems, and hospital readmission. Patient communication was assessed using the Care Transitions Measure (CTM) in a telephone interview in English 30 days after discharge.4 Postdischarge medication problems, defined as endorsement that any of their symptoms were related to taking a medication, were also ascertained over the telephone 30 days after discharge.5 Thirty-day hospital readmission was ascertained by reviewing medical records. Bivariate comparisons were used to compare bilingual with English-speaking individuals, using chi-square tests for categorical variables and t-tests for continuous variables. Bilingual participants were also categorized according to magnitude of language preference (defined as how many interview items they indicated a Spanish preference for; range 1–4), and CTM scores were calculated in each group using SAS version 9 (SAS Institute, Inc., Cary, NC). There were 99 veterans aged 65 and older in the study, of whom 16 (16.2%) were bilingual, accounting for 117 and 22 admissions, respectively. Bilingual veterans were more likely to be married and be Medicaid beneficiaries and less likely to live alone than English-speaking veterans (Table 1). Bilingual veterans had significantly lower CTM scores (62.4) than English-speaking veterans (71.8) (P = .04), indicating poorer quality of communication (Table 1). This association remained significant after controlling for the difference between groups in percentage living alone, which could influence quality of communication if the participant's caregiver was involved in transitional care coordination. Veterans with a stronger Spanish language preference were likely to have lower CTM scores (1 interview item, average CTM score 69.4; 2 items, average CTM score 66.7; 3 or 4 items, average CTM score 57.1). There was no difference in postdischarge medication-related symptoms (15.4% vs 14.3%; P = .92) or 30-day hospital readmission (13.6% vs 19.0%; P = .56) between bilingual and English speakers. Older Spanish–English bilingual veterans reported poorer communication quality related to care transitions than English-speaking veterans, as indicated by lower CTM scores, even though medication problems and hospital readmission were no different. These findings underscore the importance of ascertaining language preference even in individuals with some English proficiency, because the communication barrier may not be as evident to providers coordinating posthospital care. These findings indicate that components of transitional care may need to be customized for older adults whose preferred language is Spanish, even if they can communicate in English. It may also be necessary to involve professional language translators or caregivers fluent in English to close a communication gap. Limitations include the sampling of Spanish-speaking veterans at a single tertiary care center, which may limit generalizability. In addition, there may be residual confounding because the sample size precludes multivariable adjustment. Spanish- and English-language proficiency was not directly assessed in study participants who indicated a Spanish-language preference. Although the U.S. military has used language tests in all service branches to ensure that all applicants can follow English commands,8 the standards of English proficiency to follow commands may be substantially different from those needed for adequate understanding of managing one's health during care transitions. Quality of care transitions communication was lower for bilingual than for English-speaking older adults. Bilingual individuals without help at home may be at particular risk and should be targeted for enhanced language-sensitive transitional care. We gratefully acknowledge the contributions of Courtney Dunn, MSW. Presented in part at the American Geriatrics Society Annual Scientific Meeting, Seattle, Washington, May 2–5, 2012. Conflict of Interest: The authors have no conflicts of interest to disclose. Author Contributions: O'Kula, Boockvar: concept and design, acquisition of data, analysis and interpretation of data, drafting the article. Gottesman, Jones: acquisition of data. Signor: acquisition of data, analysis and interpretation of data. Hung: concept and design, analysis and interpretation of data, drafting the article. All authors revised the manuscript critically for important intellectual content and approved the final version. Sponsor’s Role: None.
DOI: 10.1111/jgs.14116
Language: English
Subfield: General Health Professions
Field: Health Professions
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2406669920