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Characteristics of Patients Described as Sub-acute in an Acute Care Hospital

Published online by Cambridge University Press:  31 May 2013

Heather Fillmore Elbourne ,
Kathryn Hominick ,
Laurie Mallery  and
Kenneth Rockwood
Heather Fillmore Elbourne
Affiliation:
School of Nursing, Dalhousie University
Kathryn Hominick
Affiliation:
Geriatric Medicine Research, Dalhousie University, and Queen Elizabeth II Health Sciences Centre
Laurie Mallery
Affiliation:
Geriatric Medicine Research, Dalhousie University, and Queen Elizabeth II Health Sciences Centre Division of Geriatric Medicine, Dalhousie University, and Queen Elizabeth II Health Sciences Centre
Kenneth Rockwood*
Affiliation:
Geriatric Medicine Research, Dalhousie University, and Queen Elizabeth II Health Sciences Centre Division of Geriatric Medicine, Dalhousie University, and Queen Elizabeth II Health Sciences Centre
*
*Correspondence and requests for offprints should be sent to / La correspondance et les demandes de tirés-à-part doivent être adressées à: Kenneth Rockwood, M.D. Geriatric Medicine Research Dalhousie University Queen Elizabeth II Health Sciences Centre 5955 Veterans’ Memorial Lane Halifax, NS B3H 2E1 (kenneth.rockwood@dal.ca)
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Abstract

Frail older patients suffer from multiple, complex needs that often go unmet in an acute care setting. Failure to recognize the geriatric giants in frail older adults is resulting in the misclassification of this population. This study investigated “sub-acute” frail, older-adult in-patients in a tertiary care teaching hospital. Although identified as being no longer acutely ill, all participants (n = 62) required active medical and/or nursing care. Frail older patients, often acutely ill, were being misclassified as sub-acute when the acuity of their illness went unrecognized which resulted in equally unrecognized disease presentations. The majority of participants wished to be cared for at or closer to home. The lack of post-acute-care service within our health care system and risk aversion on the part of hospital staff resulted in lengthy hospital stays and/or in patients being funneled into existing services (nursing homes) against their desire to go home.

Résumé

Les patients frêles et âgés souffrent de multiples besoins complexes qui souvent passent non-traitées dans un établissement de soins actifs. Ne pas reconnaître les géants gériatriques au sein de ces aînés frêles provoque des erreurs de classement de cette population. Cette étude a examiné des aînés malades “sub-aiguë” hospitalisés dans un hôpital de soins tertiaires. Bien qu’ils aient été identifiés comme n’étant plus gravement malades, tous les participants avaient besoin des soins medicaux actifs et/ou de soins infirmiers. Lorsque l’acuité de leur maladie est passée inaperçue, les patients âgés et fragiles ont été classés par erreur comme sub-aiguë. La majorité des participants ont souhaité être soignés chez eux ou à proximité. L’absence, dans notre système de soins de santé, des soins post-aigus, ainsi que l’aversion au risque de la part du personnel de l’hôpital, a abouti aux hospitalisations prolongées ou/et les patients étaient rélégués* dans les services existants (maisons de soins infirmiers) contre leur désir de rentrer chez eux.

Keywords

agingseniorsacute carehealth outcomesfunctional outcomesinterventionsimplementation strategiessocial and complexity theoryvieillissmentaînéssoins aigusrésultats sanitairesrésultats fonctionnelsstratégie de mise en oeuvrethéorie de la complexité sociale
Type
Policy and Practice Note / Note de politique et practique
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 32 , Issue 2 , June 2013 , pp. 203 - 208
Copyright
Copyright © Canadian Association on Gerontology 2013 

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References

Andrew, M. K., Freter, S. H., & Rockwood, K. (2005). Incomplete functional recovery after delirium in elderly people: A prospective cohort study. BMC Geriatrics, 5, 5.Google Scholar
Boyd, C. M., Landefeld, C. S., Counsell, S. R., Palmer, R. M., Fortinsky, R. H., Kresevic, D., et al. (2008). Recovery of activities of daily living in older adults after hospitalization for acute medical illness. Journal of the American Geriatrics Society, 56(12), 2171–2179.Google Scholar
Bridges, J., Flatley, M., & Meyer, J. (2009). Older people’s and relatives’ experiences in acute care settings: Systematic review and synthesis of qualitative studies. International Journal of Nursing Studies, 47(10), 89–107.Google Scholar
Cole, M. G., Ciampi, A., Belzile, E., & Zhong, L. (2009). Persistent delirium in older hospital patients: A systematic review of frequency and prognosis. Age and Ageing, 38(1), 19–26.Google Scholar
Covinsky, K. E., Eng, C., Lui, L. Y., Sands, L. P., & Yaffe, K. (2003). The last 2 years of life: Functional trajectories of frail older people. Journal of the American Geriatrics Society, 51(4), 492–498.Google Scholar
Evans, B., Potvin, C., Johnson, G., Henderson, N., Yuen, I., Smith, T., & Sniekers, D. (2011). Enhancing patient flow in an acute care hospital: Successful strategies at the Juravinski Hospital. Healthcare Quarterly, 14(3), 66–75.Google Scholar
Ferrucci, L., Guralnik, J. M., Pahor, M., Corti, M. C., & Havlik, R. J. (1997). Hospital diagnoses, Medicare charges, and nursing home admissions in the year when older persons become severely disabled. Journal of the American Medical Association, 277(9), 728–734.Google Scholar
Fried, L. P., Storer, D. J., King, D. E., & Lodder, F. (1991). Diagnosis of illness presentation in the elderly. Journal of the American Geriatrics Society, 39(2), 117–123.Google Scholar
Golden, A., Silverman, M., & Mintzer, M. (2012). Is geriatric medicine terminally ill? Annals of Internal Medicine, 156, 654–656.Google Scholar
Gomm, R., Needham, G. & Bullman, A. (2000). Evaluating research in health and social care. London: Sage.Google Scholar
Hubbard, R. E., Eeles, E. M., Rockwood, M. R., Fallah, N., Ross, E., Mitnitski, A. & Rockwood, K. (2011). Assessing balance and mobility to track illness and recovery in older inpatients. Journal of General Internal Medicine. 26(12), 1471–1478.Google Scholar
Inouye, S. K., Schlesinger, M. J. & Lydon, T. J. (1999). Delirium: A symptom of how hospital care is failing older persons and a window to improve quality of hospital care. American Journal of Medicine, 106(5), 565–573.Google Scholar
Jarrett, P. G., Rockwood, K., Carver, D., Stolee, P. & Cosway, S. (1995). Illness presentation in elderly patients. Archives of Internal Medicine, 155(10), 1060–1064.Google Scholar
Jones, D., Song, X., & Rockwood, K. (2005). Operationalizing a frailty index from a standardized comprehensive geriatric assessment. Journal of the American Geriatrics Society, 52(11), 1929–1933.Google Scholar
Kakuma, R., du Fort, , , G. G., Arsenault, L., Perrault, A., Platt, R. W., Monette, J., et al. (2003). Delirium in older emergency department patients discharged home: Effect on survival. Journal of the American Geriatrics Society, 51, 443–450.Google Scholar
Kansagara, D., Englander, H., Salanitro, A., Kagen, D., Theobald, C., Freeman, M., et al. (2011). Risk prediction models for hospital readmission: A systematic review. Journal of the American Medical Association, 306(15), 1688–1698.Google Scholar
Kovner, C., Mezey, M, & Harrington, C. (2002). Who cares for older adults? Workforce implications of an aging society. Health Affairs, 21(5), 78–89.Google Scholar
Mason, J., & Dale, A. (2011). Understanding social research. London: Sage.Google Scholar
McElhaney, J. E., Borycki, E., Biggs, M. C. E., Bisaillon, S., Upshua, R., & Rockwood, K. (2012). Perspectives on metanarratives as a way of factoring complexity into health research synthesis for transforming seniors care in Canada. Aging Health, 8(4), 351–365.Google Scholar
Moat, G., & Doble, S. (2006). Discharge planning with older adults: Towards a negotiated model of decision making. Canadian Journal of Occupational Therapy, 73(5), 303–311.Google Scholar
Parker, S. G., Fadayevatan, R. & Simon, D. L. (2006). Acute hospital care for frail older people. Age and Aging, 35, 551–552.Google Scholar
Rueben, D., & Tinetti, M. (2012). Goal-oriented patient care – An alternative health outcomes paradigm. The New England Journal of Medicine, 366, 777–779.Google Scholar
Russ, T. C., Shenkin, S. D., Reynish, E., Ryan, T., Anderson, D., & Maclullih, A. M. (2012). Dementia in acute hospital inpatients: The role of the geriatrician. Age and Aging, 41(3), 282–284.Google Scholar
Samaras, N., Chevalley, T., Samaras, D., & Gold, G. (2010). Older patients in the emergency department: A review. Annals of Emergency Medicine, 56(3), 261–269.Google Scholar
Theou, O., & Rockwood, K. (2012). Should frailty status always be considered when treating the elderly patient? Aging Health, 8(3), 261–271.Google Scholar
Wald, H., Huddleston, J., & Kramer, A. (2006). Is there a geriatrician in the house? Geriatric care approaches in hospitalist programs. Journal of Hospital Medicine, 1(1), 29–35.Google Scholar
Yin, R. K. (2003). Case study research: Design and methods (3rd ed.). Thousand Oaks, CA: Sage.Google Scholar