Conditions associated with the initiation of domiciliary care following a hospital admission: a cohort study in East London, England

Abstract

Objective Older people and people with complex needs often require both health and social care services, but there is limited insight into individual journeys across these services. To help inform joint health and social care planning, we aimed to assess the relationship between hospital admissions and domiciliary care receipt. Design Retrospective cohort study, using linked data on primary care activity, hospital admissions and social care records. Setting London Borough of Barking and Dagenham, England. Participants Adults aged 19 and over who lived in the area on 1 April 2018 and who were registered at a general practice in East London between 1 April 2018 and 31 March 2020 (n=140 987). Outcome measures The outcome was initiation of domiciliary care. We estimated the rate of hospital-associated care package initiation, and of care packages unrelated to hospital admission. We also described the characteristics of hospital admissions that preceded domiciliary care, including primary diagnosis codes. Results 2041/140 987 (1.4%) participants had a domiciliary care package during a median follow-up of 1.87 years. 32.6% of packages were initiated during a hospital stay or within 7 days of discharge. The rate of new domiciliary care packages was 120 times greater (95% CI 110 to 130) during or after a hospital stay than at other times, and this association was present for all age groups. Primary admission reasons accounting for the largest number of domiciliary care packages were hip fracture, pneumonia, stroke, urinary tract infection, septicaemia and exacerbations of long-term conditions (chronic obstructive pulmonary disease and heart failure). Admission reasons with the greatest likelihood of a subsequent domiciliary care package were fractures and strokes. Conclusion Hospitals are a major referral route into domiciliary care. While patients admitted due to new and acute illnesses account for many domiciliary care packages, exacerbations of long-term conditions and age-related and frailty-related conditions are also important drivers.

Nurses’ Roles in Caring for Older People in Domiciliary Settings: A Scoping Review Protocol

“…The vision of PHC is to be patient-centered, acknowledging the complex nature of health and well-being that encompasses physical, psychological, and social aspects [ 8 ]. Domiciliary care, also known as home care, is a key setting within the PHC framework that provides a range of caring activities to support individuals, particularly older adults, in their own homes [ 9 ].…”

“…These activities include education, monitoring, personal care, and assistance with routine household tasks, all of which are aimed at enhancing the health and well-being of individuals while maintaining their independence [ 9 ]. Currently, home care is considered the most favorable approach for supporting older people, with the aim of preserving their autonomy, as well as their connection to their personal history and identity, for as long as possible [ 10 ].…”