Prevalence, determinants and practical implications of inappropriate hospitalizations in older subjects: A prospective observational study

Post-discharge care needs of the older people with hospital-associated disability: A longitudinal study

AIMS

To investigate the change and associated factors of care needs within 6 months post-discharge in older people with hospital-associated disability, and the relationship between time-varying care needs and physical function.

BACKGROUND

Older people with hospital-associated disability will have various care needs post-discharge. Understanding their care needs will help to improve their health. However, studies on this population are still limited.

DESIGN

A longitudinal study.

METHODS

The older people who met the inclusion and exclusion criteria were selected in 2 tertiary hospitals in Zhejiang Province, China. The questionnaire survey method was used to collect data about socio-demographic characteristics, physical function and care needs. The data of 375 older people who completed follow-up were analysed using logistic regression analysis, generalised estimating equations and generalised additive mixed model. We followed STROBE checklist for reporting the study.

RESULTS

The care needs of the older people with hospital-associated disability declined unevenly, it decreased rapidly in the first three months, and then flattening out. The percentage of people with care needs in each dimension decreased over time, but daily care and rehabilitation needs were consistently more important. Socio-demographic factors and physical function had different effects on need at different time points, the physical function was the main factor among them. There were non-linear relationships between the physical function and different care needs with different inflection points.

CONCLUSION

This research revealed change patterns of the care needs of older people with hospital-associated disability post-discharge and the non-linear relationship between physical function and care needs. These findings may help healthcare professionals and caregivers to provide accurate care.

RELEVANCE TO CLINICAL PRACTICE

The findings can be used to identify effective approaches to address the care needs of older people with hospital-associated disability based on the time of discharge, in conjunction with age, education, and especially physical function, which will promote the justify allocation of nursing resources. What does this paper contribute to the wider global clinical community?

Discharge Delay: How Can We Help Ourselves, Patients, and Families

PURPOSE/OBJECTIVES

Discharge delays are frustrating to patients, staff, and families. Case managers need a better understanding of what type of patient may experience a discharge delay so they can better prepare patients and families or avoid the discharge delay before it happens.

PRIMARY PRACTICE SETTINGS

Hospital.

FINDINGS/CONCLUSIONS

Discharge delays are exasperating to all involved, as they take up precious time and resources of case managers and make patients and families feel like there is an unclear plan. There are actions a case manager can take to lessen the burden of a discharge delay. Actions such as having a rapid discharge plan once the home environment is deemed inappropriate and making sure families and patients are communicated with frequently about their plan of care can decrease or avoid a discharge delay.

IMPLICATIONS FOR CASE MANAGEMENT PRACTICE

Case managers need to know how to identify a patient who might experience a delay in their discharge early, so they can assist the patient and family to ease their stress by explaining limitations and realistic timelines. By identifying a patient who will be experiencing a delay in their discharge due to postacute lack of staffing, care managers can alert families that finding other options for discharge might be more satisfactory. By screening a patient and identifying their needs early, a discharge delay can be shortened or avoided.