From the Guidelines
The lack of transportation for the 77-year-old female patient upon discharge is considered a social determinant of health. Social determinants of health are the non-medical factors that influence health outcomes, including conditions in which people are born, grow, work, live, and age 1. Transportation is a key social determinant that affects a person's ability to access healthcare services, medications, and follow-up appointments. In this case, the patient's inability to secure transportation could potentially impact her recovery from pneumonia and lead to complications or readmission if she cannot attend follow-up appointments or obtain prescribed medications.
This differs from ADLs (Activities of Daily Living), which refer to basic self-care tasks like bathing, dressing, and eating, and from disability, which involves impairments that substantially limit major life activities. According to the American Heart Association, social determinants of health, including transportation, can have a significant impact on health outcomes, particularly for patients with chronic conditions like heart failure 1.
Key points to consider in this scenario include:
- The patient's lack of transportation is a social determinant of health that can affect her ability to access healthcare services and recover from pneumonia
- Healthcare facilities should address this transportation barrier before discharge by connecting the patient with community resources, medical transportation services, or social work consultation to ensure continuity of care and prevent adverse outcomes related to this social determinant 1
- The World Health Organization defines social determinants of health as the circumstances in which people are born, grow, live, work, and age, and the systems put in place to offer healthcare and services to a community 1
- Upstream and downstream social determinants of health can have a significant impact on health outcomes, and addressing these factors is crucial to improving patient care and preventing adverse outcomes 1.
From the Research
Lack of Transportation for a 77-year-old Female Living Alone
The lack of transportation for a 77-year-old female living alone after hospital discharge for pneumonia can be considered a social determinant of health.
- This is because reliable transportation is essential for accessing healthcare services, including follow-up appointments and medication management, as noted in the study 2.
- The absence of transportation can exacerbate health disparities and hinder recovery, particularly for older adults living alone.
- Social determinants of health, such as transportation, play a crucial role in shaping health outcomes and should be addressed in discharge planning, as highlighted in the study 3.
Activities of Daily Living (ADL) Limitation and Disability
While the lack of transportation may contribute to ADL limitations and disability, it is not directly considered an ADL limitation or disability.
- ADL limitations refer to difficulties in performing daily tasks, such as bathing, dressing, and eating, which may be affected by the underlying health condition, such as pneumonia, as discussed in the study 4.
- Disability, on the other hand, refers to a restriction in participation in societal roles and activities, which may be influenced by various factors, including transportation, as noted in the study 2.
Implications for Healthcare
The lack of transportation for older adults, particularly those living alone, highlights the need for comprehensive discharge planning and social support.
- Healthcare providers should consider the social determinants of health, including transportation, when developing discharge plans, as emphasized in the study 3.
- Telehealth services, as discussed in the studies 5 and 6, may help mitigate some of the challenges associated with transportation, but they may not entirely replace the need for in-person healthcare services.