Abstract
Backgroundinstitutionalisation following acute hospital admission is common and yet poorly described, with policy documents advising against this transition.Objectiveto characterise the individuals admitted to a care home on discharge from an acute hospital admission and to describe their assessment.Design and settinga retrospective cohort study of people admitted to a single large Scottish teaching hospital.Subjects100 individuals admitted to the acute hospital from home and discharged to a care home.Methodsa single researcher extracted data from ward-based case notes.Resultspeople discharged to care homes were predominantly female (62%), widowed (52%) older adults (mean 83.6 years) who lived alone (67%). About 95% had a diagnosed cognitive disorder or evidence of cognitive impairment. One-third of cases of delirium were unrecognised. Hospital stays were long (median 78.5 days; range 14–231 days) and transfers between settings were common. Family request, dementia, mobility, falls risk and behavioural concerns were the commonest reasons for the decision to admit to a care home. About 55% were in the acute hospital when the decision for a care home was made and 44% of that group were discharged directly from the acute hospital.Conclusionscare home admission from hospital is common and yet there are no established standards to support best practice. Decisions should involve the whole multidisciplinary team in partnership with patients and families. Documentation of assessment in the case notes is variable. We advocate the development of interdisciplinary standards to support the assessment of this vulnerable and complex group of patients.
Highlights
Care home admission, often termed institutionalisation, is a significant life event for an older person which is often portrayed with negativity [1]
The definition of care homes varies between countries: in the UK most places (e.g. 95% in Scotland) are occupied by long-stay residents, not expected to return to independent living in the community [3]
The processes involved in new institutionalisation following acute hospitalisation are poorly researched: we found no studies evaluating these
Summary
Often termed institutionalisation, is a significant life event for an older person which is often portrayed with negativity [1]. The definition of care homes varies between countries: in the UK most places (e.g. 95% in Scotland) are occupied by long-stay residents, not expected to return to independent living in the community [3]. This transition may have negative practical and emotional impacts on the individual [4], it is often necessary for some older adults, those with dementia [5]. Studies have documented the process and experiences of those with dementia moving to a care home from community settings [11,12,13]
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