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Patient Outcomes after Discharge from a Geriatric Day Hospital

Published online by Cambridge University Press:  31 March 2010

Richard G. Crilly ,
Sonya Lylwynec ,
Marita Kloseck ,
Jan M. Smith ,
Tyler Olsen ,
Bill Gold  and
Shelley Masse
Richard G. Crilly*
Affiliation:
Division of Geriatric Medicine, University of Western Ontario
Sonya Lylwynec
Affiliation:
Geriatric Day Hospital, St. Joseph's Health Care London
Marita Kloseck
Affiliation:
Faculty of Health Sciences, University of Western Ontario
Jan M. Smith
Affiliation:
Division of Geriatric Medicine, University of Western Ontario
Tyler Olsen
Affiliation:
Geriatric Day Hospital, St. Joseph's Health Care London
Bill Gold
Affiliation:
Geriatric Day Hospital, St. Joseph's Health Care London
Shelley Masse
Affiliation:
Geriatric Day Hospital, St. Joseph's Health Care London
*
Requests for offprints should be sent to: / Les demandes de tirés-à-part doivent être adressées à : Richard G. Crilly, M.D., Division of Geriatric Medicine, St. Joseph's Health Care London – Parkwood Site, 801 Commissioners Road East, London, ON N6C 5J1. ([email protected])
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Abstract

Evidence suggests that frailer older patients benefit from a continuum of care rather than the admit/discharge model of our health system. This study examined patient outcomes after discharge from a geriatric day hospital (GDH) to determine what proportion continues to do well, what proportion declines, how the two groups differ, and if factors predictive of deterioration can be identified. Using telephone survey and Goal Attainment Scaling methodologies, the goals of 151 patients discharged from a GDH between 6 and 18 months previously were examined to determine whether GDH achievements were maintained or lost. All but 5 patients improved between GDH admission and discharge; after discharge, 39 per cent deteriorated. The need for more support in the community was predictive of deterioration, probably reflecting patient frailty. Number of medical diagnoses or medications were not predictive. Frailer older patients tend not to maintain goals achieved in a GDH after discharge and may benefit from ongoing maintenance.

Résumé

Les données révèlent que les personnes âgées fragiles profitent de tout un spectre de soins plutôt que du modèle admission/sortie d/hôpital de notre système de santé. Cette étude se concentre sur l/évolution de l/état de santé des patients après leur sortie d/un hôpital gériatrique de jour (HGJ) afin de déterminer quelle proportion de ces gens continue de bien aller et quelle proportion connaît un déclin, quelles sont les différences entre ces deux groupes et si l/on peut déceler des facteurs qui permettraient de prédire la détérioration de l/état de santé. Au moyen d/un sondage téléphonique et de méthodes d/évaluation de l/atteinte des objectifs, les objectifs de 151 patients ayant obtenu leur sortie d/un HGJ il y a plus de six mois et moins de 18 mois ont été étudiés afin de déterminer si les objectifs atteints à l/HGJ se sont maintenus ou non. Tous les patients sauf cinq ont vu une amélioration de leur état entre leur admission et leur sortie de l/HGJ; après leur sortie, 39 p. 100 des patients ont vu leur état se détériorer. Le besoin d/un soutien accru au sein de la communauté constituait un élément permettant de prédire la détérioration, ce qui témoignait probablement de la fragilité du patient. Bon nombre de diagnostics médicaux et de traitements ne constituaient pas des éléments de prédiction. Les personnes âgées fragiles tendent à ne pas conserver les niveaux atteints dans un HGJ après leur sortie et elles pourraient tirer profit de services continus.

Keywords

geriatricday hospitalGoal Attainment Scalingoutcomesaginggériatrie, hôpital de jourévaluation de l/atteinte des objectifsrésultats
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 24 , Issue 3 , Fall/Automne 2005 , pp. 305 - 309
Copyright
Copyright © Canadian Association on Gerontology 2005

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References

Cohen, J. (1986). Statistical power analysis for the behavioural sciences (2nd ed.). Hillside, NJ: Lawrence Erlbaum.Google Scholar
Eagle, D.J., Guyatt, G.H., Patterson, C., Turpie, I., Sackett, B., & Singer, J. (1991). Effectiveness of a geriatric day hospital. Canadian Medical Association Journal, 144(6), 699–704.Google ScholarPubMed
Eldar, R. (2000). Integrated institution-community rehabilitation in developed countries: A proposal. Disability and Rehabilitation, 22(6), 266–274.CrossRefGoogle ScholarPubMed
Enderby, P., & Wade, D.T. (2001). Community rehabilitation in the United Kingdom. Clinical Rehabilitation, 15, 577–581.CrossRefGoogle ScholarPubMed
Forster, A., Young, J., & Langhorne, P. (1999). Systematic review of day hospital care for elderly people. British Medical Journal, 318, 837–841.CrossRefGoogle ScholarPubMed
Fried, L.P., Tangen, C.M., Walston, J., Newman, A.B., Hirsch, C., Gottdiener, J., Seeman, T., Tracy, R., Kop, W.J., Burke, G., & McBurnie, M.A. (2001). Frailty in older adults: Evidence for a phenotype. Journals of Gerontology, 56A(3), M146–M156.Google Scholar
Gill, T.M., Baker, D.I., Gottschalk, M., Peduzzi, P.N., Allore, H., & Byers, A. (2002). A program to prevent functional decline in physically frail, elderly persons who live at home. New England Journal of Medicine, 347(14), 1068–1074.CrossRefGoogle ScholarPubMed
Gillick, M. (2001). Pinning down frailty. Journals of Gerontology, 56A(3), M134–M135.Google Scholar
Hartman, D., Borrie, M.J., Davison, M., & Stolee, P. (1997). Use of goal attainment scaling in a dementia special care unit. American Journal of Alzheimer's Disease, May/June, 111–116.CrossRefGoogle Scholar
Indredavik, B., Fjaertoft, H., Ekeberg, G., Loge, A.D., & Borch, B. (2000). Benefit of an extended stroke unit service with early supported discharge: A randomized controlled trial. Stroke, 31, 2989–2994.CrossRefGoogle ScholarPubMed
Jones, G.R., Miller, T.A., & Petrella, R.J. (2002). An evaluation of rehabilitation outcomes in older hip fracture patients. American Journal of Physical Medicine and Rehabiliation, 81(7), 489–497.CrossRefGoogle Scholar
Kazis, L.E., Anderson, J.J., & Meenan, R.F. (1989). Effect sizes for interpreting changes in health status. Medical Care, 27, S178–S189.CrossRefGoogle ScholarPubMed
Kiresuk, T.J., Smith, A., & Cardillo, J.E. (1994). Goal attainment scaling: Applications, theory and measurement. New Jersey: Lawrence Erlbaum.Google Scholar
Lewis, D.L., Turpe, I.D., MacLeod, J.C., & Cowan, D.D. (2000). A prospective evaluation of a geriatric day hospital. Annals of the Royal College of Physicians and Surgeons of Canada, 33(6), 348–352.Google Scholar
Mahoney, F.I., & Barthel, D.W. (1965). Functional evaluation: The Barthel Index. Maryland State Medical Journal, 14, 61–65.Google ScholarPubMed
Melin, A.L., & Bygren, L.O. (1992). Efficacy of the rehabilitation of elderly primary health care patients after short-stay hospital treatment. Medical Care, 30(11), 1004–1015.CrossRefGoogle ScholarPubMed
Melin, A.L., Hakansson, S., & Bygren, L.O. (1993). The cost-effectiveness of rehabilitation in the home: A study of Swedish elderly. American Journal of Public Health, 83(3), 356–362.CrossRefGoogle Scholar
Nikolaus, T., Specht-Leible, N., Back, M., Oster, P., & Schlierf, G. (1995). A randomized trial of comprehensive geriatric assessment and home intervention in the care of hospitalized patients. Age and Ageing, 28(6), 543–550.CrossRefGoogle Scholar
Stolee, P., Stadnyk, K., Myers, A.M., & Rockwood, K. (1999). An individualized approach to outcome measurement in geriatric rehabilitation. Journal of Gerontology, 54A(12), M641–M647.Google Scholar
Stuck, A.E., Egger, M., Hammer, A., Minder, C.E., & Beck, J.C. (2002). Home visits to prevent nursing home admission and functional decline in elderly people: A systematic review and meta-regression analysis. Journal of the American Medical Association, 287(8), 1022–1028.Google ScholarPubMed
Stuck, A.E., Siu, A.L., Wieland, G.D., Adams, J., & Rubenstein, L.Z. (1993). Comprehensive geriatric assessment: A meta-analysis of controlled trials. Lancet, 342, 1032–1036.CrossRefGoogle ScholarPubMed
Tinetti, M.E., Baker, D.I., Gottschalk, M., Williams, C.S., Pollack, D., Garrett, P., Gill, T.M., Marottoli, R.A., & Acampora, D. (1999). Home-based multicomponent rehabilitation program for older persons after hip fracture: A randomized trial. Archives of Physical Medicine and Rehabilitation, 80(8), 916–922.CrossRefGoogle ScholarPubMed
Tucker, M.A., Davison, J.G., & Jogle, S. (1984). Day hospital rehabilitation-effectiveness and cost in the elderly: A randomized controlled trial. British Medical Journal, 289, 1209–1212.CrossRefGoogle Scholar