Factors influencing admission or nonadmission of the aged to the hospital.

Abstract

A prospective study was carried out to determine which social, functional, or medical factors influenced the decision to admit or not to admit aged people to a general hospital in Israel. The study also focused on characteristics of patients admitted to the geriatric ward of the medical division as distinct from those sent to the internal medicine ward. Two hundred patients over the age of 65 were examined during ten consecutive intake days for the internal medicine ward over a period of five weeks. One hundred and sixty-seven were interviewed in the emergency departments, and the others after transfer from other departments by prearranged consultation. Thirty-five per cent were not admitted, 28 per cent were admitted to internal medicine, and 26 per cent were admitted to the geriatric department. Social factors played little part in the selecting process, the dominant need being acuteness and severity of illness. However, patients in the geriatric ward were found to be functionally much more disabled in regard to mobility, mental state, and incontinence. This was also reflected in a longer average stay of 15 days compared with nine in internal medicine, a higher mortality (19 per cent as against 7 per cent) and a higher degree of disability on discharge from hospital.