Assessment of the decision-making capacity of hospital discharge

Romdhani, Mouna; Koskas, P.; Kohler, Samuel; Drunat, O.

doi:10.1017/s1041610219000759

Cited by 3 publications

(5 citation statements)

References 4 publications

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“…The lack of agreement was further salient given that the physicians were each basing their determinations on the same videotaped interviews, whereas agreement among independent interviewers might be even lower. Similar results have subsequently been found by other researchers (Kim et al, 2011;Sessums et al, 2011).…”

supporting

confidence: 92%

“…Achieving a balance between these two ethical imperatives is a profoundly important yet complex task. This issue comes up frequently for many mental health care providers, as a number of cognitive and other neuropsychiatric conditions may elevate the risk of impairment in decision-making capacity in one or more domains of independent functioning (Biella et al, 2020;Oshima et al, 2020;Parmigiani et al, 2021;Romdhani et al, 2020).…”

mentioning

confidence: 99%

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Improving knowledge of capacity assessment

Palmer

2021

Int. Psychogeriatr.

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confidence: 92%

mentioning

confidence: 99%

Improving knowledge of capacity assessment

Palmer

2021

Int. Psychogeriatr.

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“…But these studies do not focus on the social situation of the patients [e.g. [18][19][20]. There exists a broad range of studies as well as meta-analyses on the question of social predictors of nursing home admissions or institutionalisations in the general population [9,11,[21][22][23][24].…”

Section: Literature Review: Social Predictors Of Nursing Home Admission After Hospital Dischargementioning

confidence: 99%

Social and Regional Factors Predict the Likelihood of Admission to a Nursing Home After Acute Hospital Stay in Elderly People with Chronic Health Conditions: A Multilevel Analysis Using Routinely Collected Hospital and Census Data in Switzerland.

Bachmann

Zumbrunn

Bayer-Oglesby

2021

Preprint

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Background: If hospitalisation becomes inevitable in the course of a chronic disease, discharge from acute hospital care in elderly individuals is often associated with temporary or persistent frailty, functional limitations and the need for help with daily activities. Thus, acute hospitalisation represents a particularly vulnerable phase of transient dependency on social support and health care. This study examines how social and regional inequality affect the decision for an institutionalisation after acute hospital discharge in Switzerland. Methods: The current analysis uses routinely collected inpatient data from all Swiss acute hospitals that was linked on the individual level with Swiss census data. The study sample included N=60,209 patients 75 years old and older living still at a private home and being hospitalised due to a chronic health condition in N=199 hospitals between 2010 and 2016. Random intercept multilevel logistic regression was used to assess the impact of social and regional factors on the odds of a nursing home admission after hospital discharge. Results: Results show that 7.8% of all patients were admitted directly to a nursing home after hospital discharge. We found significant effects of education level, insurance class, living alone and language regions on the odds of nursing home admission in a model adjusted for age, gender, nationality, health status, year of hospitalisation and hospital-level variance. The language regions moderated the effect of education and insurance class but not of living alone.Conclusion: Acute hospital discharge in elderly is a critical moment of transient dependency. Social and health care should work closely and coordinated together for a well-supported hospital discharge to avoid unnecessary institutionalisations of socially disadvantaged patients.

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“…Hospital discharge decision-making is described as a complex process involving stakeholders with a range of expertise, experience and perspectives. The older patient's voice is often not included enough in this process, especially under the time pressure of shortened length of stay ( 11 , 12 ). Being transferred directly from acute hospital into long-term care is a common pathway, but is seen critical ( 13 ).…”

Section: Introductionmentioning

confidence: 99%

“…Several studies analyze the decision-making process from a hospital's perspective showing the relevance of hospital-level factors like quality of the discharge management. But these studies do not focus on the social situation of the patients [e.g., ( 12 , 23 , 24 )]. There exists a broad range of studies as well as meta-analyses on the question of social predictors of nursing home admissions or institutionalizations in the general population ( 10 , 14 , 25 – 28 ).…”

Section: Introductionmentioning

confidence: 99%

Social and Regional Factors Predict the Likelihood of Admission to a Nursing Home After Acute Hospital Stay in Older People With Chronic Health Conditions: A Multilevel Analysis Using Routinely Collected Hospital and Census Data in Switzerland

Bachmann

Zumbrunn

Bayer-Oglesby

2022

Front. Public Health

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If hospitalization becomes inevitable in the course of a chronic disease, discharge from acute hospital care in older persons is often associated with temporary or persistent frailty, functional limitations and the need for help with daily activities. Thus, acute hospitalization represents a particularly vulnerable phase of transient dependency on social support and health care. This study examines how social and regional inequality affect the decision for an institutionalization after acute hospital discharge in Switzerland. The current analysis uses routinely collected inpatient data from all Swiss acute hospitals that was linked on the individual level with Swiss census data. The study sample included 60,209 patients 75 years old and older living still at a private home and being hospitalized due to a chronic health condition in 199 hospitals between 2010 and 2016. Random intercept multilevel logistic regression was used to assess the impact of social and regional factors on the odds of a nursing home admission after hospital discharge. Results show that 7.8% of all patients were admitted directly to a nursing home after hospital discharge. We found significant effects of education level (compulsory vs. tertiary education OR = 1.16 (95% CI: 1.03–1.30), insurance class (compulsory vs. private insurance OR = 1.24 (95% CI: 1.09–1.41), living alone vs. living with others (OR = 1.64; 95% CI: 1.53–1.76) and language regions (French vs. German speaking part: OR = 0.54; 95% CI: 0.37–0.80) on the odds of nursing home admission in a model adjusted for age, gender, nationality, health status, year of hospitalization and hospital-level variance. The language regions moderated the effect of education and insurance class but not of living alone. This study shows that acute hospital discharge in older age is a critical moment of transient dependency especially for socially disadvantaged patients. Social and health care should work coordinated together to avoid unnecessary institutionalizations.

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Assessment of the decision-making capacity of hospital discharge

Cited by 3 publications

References 4 publications

Improving knowledge of capacity assessment

Improving knowledge of capacity assessment

Social and Regional Factors Predict the Likelihood of Admission to a Nursing Home After Acute Hospital Stay in Elderly People with Chronic Health Conditions: A Multilevel Analysis Using Routinely Collected Hospital and Census Data in Switzerland.

Social and Regional Factors Predict the Likelihood of Admission to a Nursing Home After Acute Hospital Stay in Older People With Chronic Health Conditions: A Multilevel Analysis Using Routinely Collected Hospital and Census Data in Switzerland

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