Brief hospitalizations of elderly patients: a retrospective, observational study

Abstract

BackgroundCrowded departments are a common problem in Danish hospitals, especially in departments of internal medicine, where a large proportion of the patients are elderly. We therefore chose to investigate the number and character of hospitalizations of elderly patients with a duration of less than 24 hours, as such short admissions could indicate that the patients had not been severely ill and that it might have been possible in these cases to avoid hospitalization.MethodsMedical records were examined to determine the number of patients aged 75 or more who passed through the emergency department over a period of two months, and the proportion of those patients who were discharged after less than 24 hours. The reasons for the hospitalization, the diagnoses and the treatment given were noted.ResultsThere was a total of 595 hospitalizations of patients aged 75 or above in the emergency department during the period. Twenty-four percent of the older patients were discharged after less than 24 hours. Of these, 40% were discharged from the emergency department. The most common problems leading to hospitalization were change in contact or level of consciousness, focal neurological change, red, swollen or painful leg conditions, dyspnea, suspected parenchyma surgical disease and problems with the urinary system or catheters. The most common diagnoses given at hospital were chronic cardiovascular disease, bacterial infection, symptoms deriving from bone, muscle or connective tissue, liquid or electrolyte derangement and observation for suspected stroke or transient cerebral ischemia. Eight percent of the patients required telemetry, 27% received intravenous liquids, 30% had diagnostic radiology procedures performed and 3% needed invasive procedures. Other types of treatment given included electrocardiography, laboratory examinations, oxygen supplements, urinary catheterization and medicine administered orally, subcutaneously, as an intramuscular injection or as an inhalation.ConclusionThere appears to be a group of patients who cannot be adequately handled with the resources of the primary health care sector, yet who do not belong at the emergency department. Further studies are needed to create a suitable service for these patients, and to improve the continuity of the treatment and the cooperation between hospitals and the primary health care sector.

Characteristics and predictors for hospitalizations of home-dwelling older persons receiving community care: a cohort study from Norway

“…This is harmonized with a common understanding that the most problematic expression of an ageing population is the clinical condition of frailty [ 26 ]. For this population, it is of vital importance to apply a systematic approach in community care, in order to reduce the use of inappropriate procedures, iatrogenic diseases and nosocomial infections, which are associated with hospitalization [ 29 , 48 ].…”

“…It is an ongoing discussion whether a proportion of the hospital admissions among older persons could have been prevented in primary treatment and care [ 7 , 27 , 28 ]. Studies from Scandinavia have found that older persons are hospitalized due to lack of an appropriate alternative in primary care [ 28 , 29 ], however a Norwegian study found no association between the volume of municipality general practitioners provided (in a universally accessible healthcare system) and unplanned hospitalizations of the entire elderly population (aged ≥65 years) [ 8 , 30 ]. The picture concerning the prevention of hospitalizations within this age group is thus not clear; heterogeneity in terms of health status and age-related conditions, as well as numerous contextual factors related to the health care system, represent a challenge for isolating factors concerning thematter.…”

Barriers and Facilitators to Implementing a Change Initiative in Long-Term Care Using the INTERACT® Quality Improvement Program

“…10,11,12 Unnecessary hospitalizations of NH residents have been shown to increase health care costs and contribute to various negative patient outcomes. 2 One solution is to introduce new programs that can assist staff in rapidly identifying and managing acute changes in the condition of NH residents and respecting advance care directives.…”

Health Care Personnel’s Perspective on Potential Electronic Health Interventions to Prevent Hospitalizations for Older Persons Receiving Community Care: Qualitative Study

“…The underlying assumption is that the use of digital technologies can potentially redesign care pathways in a way that will improve monitoring and treatment of degenerative and chronic diseases, encourage better self-management of health problems, and alert professional support if devices signal a problem [2,3,[6][7][8][9], ultimately reducing the disruptive impact of acute unscheduled hospital admissions, for example, for older persons [10]. Previous research has identified that emergency hospital admissions often occur when an older person has reached a point of crisis because of a combination of circumstances, such as an exacerbation of a chronic condition, change in social setting, or a cascade of symptoms because of multimorbidity and frailty [11][12][13][14][15][16][17]. The use of eHealth could thus be applied as a tool to prevent a severe state of illness that requires hospitalization by discovering and addressing the patients' symptoms at an early stage.…”