WHILE’S WORDS
Admission and discharge of frail elderly people Alison While Alison While, Emeritus Professor of Community Nursing, King’s College London, Florence Nightingale Faculty of Nursing and Midwifery and Fellow of the QNI
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Health Service Journal/Serco (2014) Commission on Hospital Care for Frail Older People: Main Report. http://tinyurl.com/ pqftv35 (accessed 24 November 2014) Royal Voluntary Service (2014a) Going Home Alone: Counting the Cost to Older People and the NHS. RVS, Cardiff. http:// tinyurl.com/kdxk8gd (accessed 24 November 2014) Royal Voluntary Service (2014b) Society gone wrong: why 489 000 older people set to spend Christmas alone. RVS, Cardiff. http://tinyurl.com/k5svevp (accessed 24 November 2014)
622
‘Evidence suggests a relationship between the older person feeling unready for discharge and a readmission within 3 months.’
Alison While
© 2014 MA Healthcare Ltd
ardly a day passes without the challenges facing the NHS featuring in the media. It is sometimes difficult to know what solutions exist to ensure the delivery of the most efficient high-quality care for the population. However, several things are apparent: there is a legacy issue, with a reluctance to develop new modes of delivery and abandon outdated hospitals with limited potential; there is a persistent imbalance in funding between hospitals and primary care (where most care takes place); the quality of NHS care is variable across acute hospitals, mental health services and primary care according to the Care Quality Commission; and money is wasted through avoidable admissions and poor discharges. Admission of older people to hospitals seems to increase functional decline because it often reduces people’s mobility and activity levels. Elderly inpatients experience sensory deprivation and isolation. The lack of stimulation leads to reduced cognitive functioning (Health Service Journal (HSJ)/Serco, 2014). Unsurprisingly, older patients’ functional levels and confidence can be significantly reduced at discharge compared with their previous functional status. The HSJ/Serco Commission on Hospital Care for Frail Older People sets out the need to improve ‘the entry to, the journey through and exit from hospital care’ (HSJ/Serco, 2014: 12). The report notes that ‘improving acute care for frail older people will also mean that changing roles will be needed from staff in ambulance services and district nursing’ (HSJ/Serco, 2014: 7) if the current fragmented approach is to be changed. The Royal Voluntary Service’s (RVS’s) (2014a) report Going Home Alone also reminds us of the importance of timely and supported discharges if readmission to hospital is to be avoided. Their evidence suggests a relationship between the older person feeling unready for discharge and a readmission within 3 months. Similarly, those expressing a greater need for support at discharge and not receiving that support were more likely to be readmitted within 3 months. Interestingly, many of those readmitted had support at home from family, friends and others, which indicates that the relationship between readmission to hospital and support at home is complex. For example, those needing support may be more vulnerable. However, it is noteworthy that non-receipt of services was associated with greater readmission rates, suggesting the need for comprehensive support at home over longer periods. RVS ‘Home from Hospital’ schemes offer additional resources over a 6–10-week period and appear to be highly valued by older people, also generating cost savings through the avoidance of hospital costs. Sadly, at this time of year, the RVS (2014b) has estimated that nearly half a million people over 75 years of age will spend Christmas Day on their own. Has something gone wrong with society? BJCN
British Journal of Community Nursing January 2015 Vol 20, No 1
h Journal of Community Nursing. Downloaded from magonlinelibrary.com by 193.061.135.112 on November 3, 2015. For personal use only. No other uses without permission. . All rights res
Admission and discharge of frail elderly people Alison While Alison While, Emeritus Professor of Community Nursing, King’s College London, Florence Nightingale Faculty of Nursing and Midwifery and Fellow of the QNI
H
Health Service Journal/Serco (2014) Commission on Hospital Care for Frail Older People: Main Report. http://tinyurl.com/ pqftv35 (accessed 24 November 2014) Royal Voluntary Service (2014a) Going Home Alone: Counting the Cost to Older People and the NHS. RVS, Cardiff. http:// tinyurl.com/kdxk8gd (accessed 24 November 2014) Royal Voluntary Service (2014b) Society gone wrong: why 489 000 older people set to spend Christmas alone. RVS, Cardiff. http://tinyurl.com/k5svevp (accessed 24 November 2014)
622
‘Evidence suggests a relationship between the older person feeling unready for discharge and a readmission within 3 months.’
Alison While
© 2014 MA Healthcare Ltd
ardly a day passes without the challenges facing the NHS featuring in the media. It is sometimes difficult to know what solutions exist to ensure the delivery of the most efficient high-quality care for the population. However, several things are apparent: there is a legacy issue, with a reluctance to develop new modes of delivery and abandon outdated hospitals with limited potential; there is a persistent imbalance in funding between hospitals and primary care (where most care takes place); the quality of NHS care is variable across acute hospitals, mental health services and primary care according to the Care Quality Commission; and money is wasted through avoidable admissions and poor discharges. Admission of older people to hospitals seems to increase functional decline because it often reduces people’s mobility and activity levels. Elderly inpatients experience sensory deprivation and isolation. The lack of stimulation leads to reduced cognitive functioning (Health Service Journal (HSJ)/Serco, 2014). Unsurprisingly, older patients’ functional levels and confidence can be significantly reduced at discharge compared with their previous functional status. The HSJ/Serco Commission on Hospital Care for Frail Older People sets out the need to improve ‘the entry to, the journey through and exit from hospital care’ (HSJ/Serco, 2014: 12). The report notes that ‘improving acute care for frail older people will also mean that changing roles will be needed from staff in ambulance services and district nursing’ (HSJ/Serco, 2014: 7) if the current fragmented approach is to be changed. The Royal Voluntary Service’s (RVS’s) (2014a) report Going Home Alone also reminds us of the importance of timely and supported discharges if readmission to hospital is to be avoided. Their evidence suggests a relationship between the older person feeling unready for discharge and a readmission within 3 months. Similarly, those expressing a greater need for support at discharge and not receiving that support were more likely to be readmitted within 3 months. Interestingly, many of those readmitted had support at home from family, friends and others, which indicates that the relationship between readmission to hospital and support at home is complex. For example, those needing support may be more vulnerable. However, it is noteworthy that non-receipt of services was associated with greater readmission rates, suggesting the need for comprehensive support at home over longer periods. RVS ‘Home from Hospital’ schemes offer additional resources over a 6–10-week period and appear to be highly valued by older people, also generating cost savings through the avoidance of hospital costs. Sadly, at this time of year, the RVS (2014b) has estimated that nearly half a million people over 75 years of age will spend Christmas Day on their own. Has something gone wrong with society? BJCN
British Journal of Community Nursing January 2015 Vol 20, No 1
h Journal of Community Nursing. Downloaded from magonlinelibrary.com by 193.061.135.112 on November 3, 2015. For personal use only. No other uses without permission. . All rights res
