Monday, January 26, 2009

hospital discharge of seniors

I must admit that I felt much frustration in the years my mother fought cancer, and my father fought his brain tumour.

More often than not, they were discharged with little home care, and home care that was entirely unsuited to them. They were not Alternate Level of Care (ALC) patients (so-called bed blockers) who need a chronic care facility more than their own home or a long-term care facility. (Nursing homes, as they used to be called, no longer exist!)

More often than not, a senior will go to hospital in an emergency situation. If not, there should be pre-admission screening* to assess functional impairment, medical complexity, psychological functioning, and social supports.

Before a senior goes home, they really need to have a number of protocols in place.
Theoretically, a Comprehensive Geriatric Assessment, by a Rehabilitation Team, which should weed out those whose physical or medical instability precludes them from more appropriate care such as palliative care, or placement in a long-term care setting.

For those who qualify, supports can and should be done in these areas: assessment of physical, psychological, cognitive and social needs. My parents were often discharged and told to 'get neighbours to help' with ADL or IADLs.

They were not provided with rehabilitation that would help improve their daily lives, and ameliorate the comorbidities that attacked their bodies. In one study, they found that evaluation, diagnostic,, and therapeutic interventions could restore functional ability or enhance functional capability in frail seniors with diabling impairments (Boston Working Group, 1997).

It is appalling to see our frail seniors sent home, with a high risk for return to the hospital. They are entitled to appropriate treatment plans, especially after diagnoses that devastate a family, or with risky treatment. This was the case in my family. Mom's cancer was irreversible. Dad's brain tumour similarly so. Yet they both had to face a quality of life that forever changed the entire family. This treatment plan was a secret, hidden from the rest of us, as Mom faced her cancer and made decisions based on little understanding, no research, during a time when she was incapable of making logical decisions.

An in-hospital stay increases infection risks, and/or falls. In 2002, more than 20% of elders in one study looked at thseo with a hip fracture, pneumonia, delirium, dementia, heart failure, psychiatric disorder or stroke either died in hospital or were readmitted to hospital within 28 days*.


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*Organization Design for Geriatrics: An evidence based approach
RGP of Ontario, July, 2008

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