Age and Ageing (1979), 8, 149
MEDICAL AND NURSING NEEDS OF ELDERLY PATIENTS ADMITTED TO ACUTE MEDICAL BEDS COLIN T. CURRIE, ROGER G. SMITH AND J. WILLIAMSON
University Department of Geriatric Medicine, City Hospital, Greenbank Drive, Edinburgh EH10 5SB Summary The medical and nursing needs of elderly patients admitted to acute medical wards were examined. About one third of these patients received only care which could have been delivered at home.
The proportion of elderly patients in hospital is high and still rising. Unless present trends and practice change, the proportion of bed-days needed for the over-75 age group until 1991 will be as set out in Table I. These projections, particularly the 60% share of acute female bed-days foreseen for 1991, represent a very serious threat to the hospital service and all possible alternatives to hospital care must be considered. Table I. Bed usage—persons'aged 75 and over Actual
Projection
1964 M Percentage of admissions Percentage of bed-days
F
7.3 9. 2 17.7 27. 2
M
1973 F
8.,4 12.7 20..8 38.7
1981 M
1991 F
9.3 15.4 23.9 47.1
M
F
10. 4 18.4 27. 3 59.6
Various schemes for 'Hospital at Home' have been reported (Auckland Hospital Board 1967, Clarke 1976). Most have been concerned with the care of the chronic sick, but the possibility of providing such care for elderly patients with more acute conditions should now be explored. We set out to define the medical and nursing needs of acutely ill elderly people currently being admitted to medical wards. We decided to look at patients aged 70 and over admitted consecutively through the Emergency Bed Bureau to acute medical wards in Edinburgh hospitals (excluding geriatric units). A total of 103 patients was seen, each being visited by one of us in hospital approximately 48 hours after admission. Information from the general practitioner was recorded, the patient's condition was assessed and ward medical and nursing staff were consulted. Taking into account the nature and severity of the illness, investigations carried out and treatment given, we categorized patients as suitable or unsuitable, from the medical and nursing point of view, for home management, as in Fig. 1. In an attempt to eliminate the possible bias of geriatrician observers, a doctor from a general medical unit independently assessed 23 consecutive admissions. This 'doubleblind' exercise showed not unduly dissimilar results (Table II).
Colin T. Currie, Roger G. Smith and J. Williamson
150
46
% 40
_
30
.
20
-
10
.
30
13 9 5
Certainly Probably suitable for home care YES 41.7%
N.K.
Probably Certainly unsuitable for home care NO 53.4%
Fig. 1. Suitability of patients for home care: prospective study 1976. Table II. Independent assessments by a physician and by geriatricians compared, for 23 consecutive admissions Suitability for home care
Physician
Geriatricians
6 0 1 1 15
4 4 2 2 11
Certainly suitable Probably suitable Do not know Probably unsuitable Certainly unsuitable
As the 103 cases seen were admitted midsummer, a further exercise was undertaken to see if there was any important seasonal variation. Records of 73 consecutive patients aged 70 or more sent in as acute admissions in February 1976, together with 106 records randomly sampled from the year 1974, were scrutinized in detail. Using similar criteria, they were classified as in Fig. 2. It therefore seems that between 30 and 40% of elderly patients admitted to acute medical wards received a type of medical and nursing care that could have been provided at home. DISCUSSION
This simple study suggests that large numbers of elderly people who are admitted to acute beds may not be there for primarily medical or nursing reasons. In many cases a simple and reversible episode of respiratory or urinary tract infection, of cardiac failure
Medical and Nursing Needs of Elderly Patients
151 48
10 -
Certainly Probably Suitable for Home Care YES 45.8%
N.K.
Probably Certainly Unsuitable for Home Care f NO 52.5%
Fig. 2. Suitability of patients for home care: retrospective studies 1974/6. D 1974; • 1976. or transient cerebral ischaemia, the immediate medical management of which is entirely within the scope of the medical and nursing skills and resources available in the community, has led to hospital admission. The non-medical factors which precipitated admission were commonly 'social' in that family support for the acutely ill elderly person was either inadequate or absent, or appropriate nursing care was unavailable, or simply that a few nights' supervision could not be provided. It may also be that the traditional belief that such conditions are 'better treated in hospital' is a factor. If these non-medical needs of the acutely ill elderly could be met in the community, the disruptive, expensive and commonly complicated and prolonged admission of such cases to acute hospital beds would be avoided, with benefit to all. A much larger study of augmented home care for acutely ill elderly patients is in hand. ACKNOWLEDGEMENTS
We thank Dr David Ewing for seeing the cases in Table II and Dr Michael Garraway for the projections of bed usage to 1991. REFERENCES AUCKLAND HOSPITAL BOARD (1967) Handbook of Hospital, Domiciliary and Welfare Services. CLARKE,
12
F. (1976) Home care—an alternative to admission. Health Soc. Serv. J. 86, 44.
MEDICAL AND NURSING NEEDS OF ELDERLY PATIENTS ADMITTED TO ACUTE MEDICAL BEDS COLIN T. CURRIE, ROGER G. SMITH AND J. WILLIAMSON
University Department of Geriatric Medicine, City Hospital, Greenbank Drive, Edinburgh EH10 5SB Summary The medical and nursing needs of elderly patients admitted to acute medical wards were examined. About one third of these patients received only care which could have been delivered at home.
The proportion of elderly patients in hospital is high and still rising. Unless present trends and practice change, the proportion of bed-days needed for the over-75 age group until 1991 will be as set out in Table I. These projections, particularly the 60% share of acute female bed-days foreseen for 1991, represent a very serious threat to the hospital service and all possible alternatives to hospital care must be considered. Table I. Bed usage—persons'aged 75 and over Actual
Projection
1964 M Percentage of admissions Percentage of bed-days
F
7.3 9. 2 17.7 27. 2
M
1973 F
8.,4 12.7 20..8 38.7
1981 M
1991 F
9.3 15.4 23.9 47.1
M
F
10. 4 18.4 27. 3 59.6
Various schemes for 'Hospital at Home' have been reported (Auckland Hospital Board 1967, Clarke 1976). Most have been concerned with the care of the chronic sick, but the possibility of providing such care for elderly patients with more acute conditions should now be explored. We set out to define the medical and nursing needs of acutely ill elderly people currently being admitted to medical wards. We decided to look at patients aged 70 and over admitted consecutively through the Emergency Bed Bureau to acute medical wards in Edinburgh hospitals (excluding geriatric units). A total of 103 patients was seen, each being visited by one of us in hospital approximately 48 hours after admission. Information from the general practitioner was recorded, the patient's condition was assessed and ward medical and nursing staff were consulted. Taking into account the nature and severity of the illness, investigations carried out and treatment given, we categorized patients as suitable or unsuitable, from the medical and nursing point of view, for home management, as in Fig. 1. In an attempt to eliminate the possible bias of geriatrician observers, a doctor from a general medical unit independently assessed 23 consecutive admissions. This 'doubleblind' exercise showed not unduly dissimilar results (Table II).
Colin T. Currie, Roger G. Smith and J. Williamson
150
46
% 40
_
30
.
20
-
10
.
30
13 9 5
Certainly Probably suitable for home care YES 41.7%
N.K.
Probably Certainly unsuitable for home care NO 53.4%
Fig. 1. Suitability of patients for home care: prospective study 1976. Table II. Independent assessments by a physician and by geriatricians compared, for 23 consecutive admissions Suitability for home care
Physician
Geriatricians
6 0 1 1 15
4 4 2 2 11
Certainly suitable Probably suitable Do not know Probably unsuitable Certainly unsuitable
As the 103 cases seen were admitted midsummer, a further exercise was undertaken to see if there was any important seasonal variation. Records of 73 consecutive patients aged 70 or more sent in as acute admissions in February 1976, together with 106 records randomly sampled from the year 1974, were scrutinized in detail. Using similar criteria, they were classified as in Fig. 2. It therefore seems that between 30 and 40% of elderly patients admitted to acute medical wards received a type of medical and nursing care that could have been provided at home. DISCUSSION
This simple study suggests that large numbers of elderly people who are admitted to acute beds may not be there for primarily medical or nursing reasons. In many cases a simple and reversible episode of respiratory or urinary tract infection, of cardiac failure
Medical and Nursing Needs of Elderly Patients
151 48
10 -
Certainly Probably Suitable for Home Care YES 45.8%
N.K.
Probably Certainly Unsuitable for Home Care f NO 52.5%
Fig. 2. Suitability of patients for home care: retrospective studies 1974/6. D 1974; • 1976. or transient cerebral ischaemia, the immediate medical management of which is entirely within the scope of the medical and nursing skills and resources available in the community, has led to hospital admission. The non-medical factors which precipitated admission were commonly 'social' in that family support for the acutely ill elderly person was either inadequate or absent, or appropriate nursing care was unavailable, or simply that a few nights' supervision could not be provided. It may also be that the traditional belief that such conditions are 'better treated in hospital' is a factor. If these non-medical needs of the acutely ill elderly could be met in the community, the disruptive, expensive and commonly complicated and prolonged admission of such cases to acute hospital beds would be avoided, with benefit to all. A much larger study of augmented home care for acutely ill elderly patients is in hand. ACKNOWLEDGEMENTS
We thank Dr David Ewing for seeing the cases in Table II and Dr Michael Garraway for the projections of bed usage to 1991. REFERENCES AUCKLAND HOSPITAL BOARD (1967) Handbook of Hospital, Domiciliary and Welfare Services. CLARKE,
12
F. (1976) Home care—an alternative to admission. Health Soc. Serv. J. 86, 44.
