301 Role of comprehensive geriatric assessment in determining appropriateness of admission to long term care

Abstract

Abstract Background The benefit of comprehensive geriatric assessment (CGA) in supporting discharge to home from hospital for older people has been identified. When discharge to long term care (LTC) is considered by generalist teams, through determination of potential for further remediation and support, as well as vigilance for elder abuse and inappropriate third-party pressure, CGA supports continued living at home. Although European guidelines recommend, and Irish policy mandates, CGA prior to consideration of entry to LTC, it is not clear to what extent this is routinely undertaken. We aimed to determine the value of CGA in supported continued living at home when entry to LTC is proposed by referring clinical teams. Methods Review of electronic system of geriatric medicine consultations for assessment for LTC in a Level 4 teaching hospital. Information on discharge destination was retrieved from discharge summaries and electronic patient management systems. Results Of 740 consultations over 14 months between 2020 and 2021, 99 were for assessment for LTC. At review at 8 months, of 49 (49%) discharges to LTC, 42 (42%) were discharged as new residents, 4 (4%) were existing residents and 3 (3%) were discharged for end of life care. Of those for whom CGA recommended alternatives, 22 (22%) went directly home, 7 (7%) were discharged to offsite rehabilitation, 10 (10%) remained inpatients, and 8 (8%) died during admission. Conclusion This review highlights the importance and value of the role of CGA in planning discharge destination, a key if under-emphasised role for Irish geriatricians. Only 42% of the consults were discharged to LTC as a new permanent residence. This supports previous recommendations to routinely incorporate CGA when entry to LTC is considered, ensuring the most appropriate discharge destination for patients with significant multi-morbidity and complex care needs.