New institutionalisation following acute hospital admission: a retrospective cohort study

Harrison, J. K. , Garrido, A. G., Rhynas, S. J., Logan, G., MacLullich, A. M.J., MacArthur, J. and Shenkin, S. (2017) New institutionalisation following acute hospital admission: a retrospective cohort study. Age and Ageing, 46(2), pp. 238-244. (doi: 10.1093/ageing/afw188) (PMID:27744305) (PMCID:PMC5860512)

168187.pdf - Published Version
Available under License Creative Commons Attribution.



Background: institutionalisation following acute hospital admission is common and yet poorly described, with policy documents advising against this transition. Objective: to characterise the individuals admitted to a care home on discharge from an acute hospital admission and to describe their assessment. Design and setting: a retrospective cohort study of people admitted to a single large Scottish teaching hospital. Subjects: 100 individuals admitted to the acute hospital from home and discharged to a care home. Methods: a single researcher extracted data from ward-based case notes. Results: people 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. Conclusions: care 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.

Item Type:Articles
Additional Information:The project was funded by a grant from The Alex and Elizabeth Gibson Trust: Scottish Charity Number SC043311. J.K.H. is supported by a clinical research fellowship from Alzheimer Scotland and The University of Edinburgh Centre for Cognitive Ageing and Cognitive Epidemiology, part of the cross council Lifelong Health and Wellbeing Initiative (MR/L501530/1). Funding from the Biotechnology and Biological Sciences Research Council (BBSRC) and Medical Research Council (MRC) is gratefully acknowledged. S.J.R. is supported by an Alzheimer Scotland post doctoral fellowship as part of a Dementia Clinical Academic Research Career Scheme, funded by NHS Lothian and The University of Edinburgh, Alzheimer Scotland Dementia Research Centre.
Glasgow Author(s) Enlighten ID:Burton, Dr Jenni
Authors: Harrison, J. K., Garrido, A. G., Rhynas, S. J., Logan, G., MacLullich, A. M.J., MacArthur, J., and Shenkin, S.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:Age and Ageing
Publisher:Oxford University Press
ISSN (Online):1468-2834
Published Online:15 October 2016
Copyright Holders:Copyright © 2016 The Authors
First Published:First published in Age and Ageing 46(2):238-244
Publisher Policy:Reproduced under a Creative Commons License

University Staff: Request a correction | Enlighten Editors: Update this record