Abstract
BackgroundGeriatric evaluation and management has become standard care for community dwelling older adults following an acute admission to hospital. It is unclear whether this approach is beneficial for the frailest older adults living in permanent residential care. This study was undertaken to evaluate (1) the feasibility and consumer satisfaction with a geriatrician-led supported discharge service for older adults living in residential care facilities (RCF) and (2) its impact on the uptake of Advanced Care Planning (ACP) and acute health care service utilisation.MethodsIn 2002–4 a randomised controlled trial was conducted in Melbourne, Australia comparing the geriatrician–led outreach service to usual care for RCF residents. Patients were recruited during their acute hospital stay and followed up at the RCF for six months. The intervention group received a post-discharge home visit within 96 hours, at which a comprehensive geriatric assessment was performed and a care plan developed. Participants and their families were also offered further meetings to discuss ACPs and document Advanced Directives (AD). Additional reviews were made available for assessment and management of intercurrent illness within the RCF. Consumer satisfaction was surveyed using a postal questionnaire.ResultsThe study included 116 participants (57 intervention and 59 controls) with comparable baseline characteristics. The service was well received by consumers demonstrated by higher satisfaction with care in the intervention group compared to controls (95% versus 58%, p = 0.006).AD were completed by 67% of participants/proxy decision makers in the intervention group compared to 13% of RCF residents prior to service commencement. At six months there was a significant reduction in outpatient visits (intervention 21 (37%) versus controls 45 (76%), (p < 0.001), but no difference in readmissions rates (39% intervention versus 34% control, p = 0.6). There was a trend towards reduced hospital bed-day utilisation (intervention 271 versus controls 372 days).ConclusionIt is feasible to provide a supported discharge service that includes geriatrician assessment and care planning within a RCF. By expanding the service there is the potential for acute health care cost savings by decreasing the demand for outpatient consultation and further reducing acute care bed-days.
Highlights
Geriatric evaluation and management has become standard care for community dwelling older adults following an acute admission to hospital
We found that a proactive program that promoted and facilitated Advanced Care Planning (ACP) discussions and documentation of Advanced Directives (AD) in residential care facilities (RCF) was well accepted by patients, and their proxies/families
This study has demonstrated that it is feasible and acceptable to provide a post-discharge outreach service to frail older people living in RCFs
Summary
Geriatric evaluation and management has become standard care for community dwelling older adults following an acute admission to hospital. It is unclear whether this approach is beneficial for the frailest older adults living in permanent residential care. Services that provide comprehensive geriatric assessment and subsequent care in the community are one alternative to sending older adults to hospital [9]. This approach has been demonstrated to be highly effective for communitydwelling older adults [9], there is less evidence surrounding its effectiveness for those in long-term residential care facilities (RCF)
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