New institutionalisation following an acute hospital admission

Jenni Harrison is a Clinical Research Fellow in Geriatric Medicine funded by the Alzheimer Scotland Dementia Research Centre and the Centre for Cognitive Ageing and Cognitive Epidemiology at the University of Edinburgh. Here she discusses her recently published paper in Age and Ageing. She tweets @JenniKHarrison.

hospitalNew care home admission (also termed new institutionalisation) following an acute hospital admission occurs commonly in the UK. However, national policy documents argue the practice should generally be avoided. Furthermore it is known to be an area of six-fold variation in practice

However, research to understand new care home admission has been limited and little is known about those who experience this extremely important transition. Our interdisciplinary research study evaluated one hundred people admitted from home to a single hospital who were newly admitted to institutional care at the time of discharge. We sought to characterise the individuals, their hospital experience and assessments by means of comprehensive case note review. The limitations of this method are discussed at length in the paper.

We found evidence of significant variations in assessment and practice. While some findings were to be expected in terms of the age, gender and comorbidities among this population, other findings of note were identified. Only 73% had a state-supported package of care prior to hospital admission, interesting since personal care is free in Scotland to all those aged ≥65. Cognitive disorders were highly prevalent (95%) and delirium was unrecognised in a third of cases. Continence status changed significantly with 62% documented as fully continent on admission, dropping to 28% at time of discharge. This requires further investigation as a potential source of hospital-acquired harm. Family request was the commonest reason (35%) for care home admission, although for five individuals the main reason for care home admission was their preference.

I had the opportunity to present some of the data included in the paper at the BGS Spring Meeting in Liverpool and was encouraged by the level of interest and discussion provoked both on the day and subsequently on Twitter. Clearly there is widespread concern that variations in practice mean that decision-making is not always optimal. By researching the everyday experiences of patients in our care and examining our practice we can help to determine the effective components of the care and services we provide. Such evidence is required to identify areas for improvement, to help reduce unnecessary variations and to help justify the services we provide in this climate of austerity.

Gemma Logan (Research Nurse), one of the co-authors, has secured funding from the Edinburgh and Lothians Health Foundation to allow our group to look at this issue in greater depth. We will perform a qualitative study using case-study methodology to explore the perspectives of the key stakeholders in discharge decision-making around care homes, namely patients, their significant person(s) and members of the multidisciplinary team. Our aim is to help the multidisciplinary team support people admitted to the acute hospital make decisions about their future place of care.

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