Social Connectedness and Successful Nursing Home Discharge After Heart Failure Hospitalization

Abstract

Objectives: Social connectedness is associated with positive health outcomes. Patients discharged to skilled nursing facilities (SNFs) after heart failure (HF) hospitalization face a high risk of hospital readmission, but the association between social connectedness and successful discharge from postacute SNF care is unknown. This study aimed to quantify the association between social connectedness and successful discharge from postacute SNF care among veterans with HF.

Design: This retrospective cohort study's primary outcome was successful discharge, defined as discharge to the community within 90 days of admission to the SNF, and survival 30 days after discharge without hospitalization or institutionalization. Social connectedness was measured by the Social Connectedness Index [SCI, range 0-5: binarized into low (SCI = 0-4) or high social connectedness (SCI = 5)].

Setting and participants: Veterans admitted to a Department of Veterans Affairs Medical Center for HF and subsequently discharged to a SNFs between January 2011 and June 2019.

Methods: We estimated the association of high SCI with successful discharge using a modified Poisson regression with robust error variance.

Results: A total of 29,725 veterans were included. Veterans with high social connectedness (SCI = 5) in SNF settings were more likely to have successful discharge than those with lower social connectedness [adjusted relative risk (95% CI): 1.21 (1.13-1.31)]. This association was seen in patients with Alzheimer disease or Alzheimer disease and related dementias (AD/ADRD) [1.32 (1.16-1.49)] and without ADRD [1.14 (1.04-1.25)] cohorts.

Conclusions and implications: Veterans with HF who were more socially connected in the SNF setting had higher rates of successful discharge than those with lower social connectedness. Low social connectedness may be an indicator of care needs that make discharge from SNF to home more challenging. Clinical social isolation measurement may be a useful tool in identifying successful discharge candidates.

Keywords: Social connectedness; heart failure; successful discharge.