Objective: To examine the effectiveness of Integrated Care and Discharge Support for elderly patients in reducing accident and emergency department attendance, acute hospital admissions, and hospital bed days after discharge. Factors that compromise its effectiveness were investigated and cost analysis was performed.Design: Cohort prospective study. Results: A total of 1090 older patients were studied. The Integrated Care and Discharge Support for elderly patients programme reduced accident and emergency department attendance by 40% (P<0.001), acute hospital admissions by 47% (P<0.001), and hospital bed days by 31% (P<0.001) at 6 months after implementation. Improvements in Barthel Index 20 (P<0.001) and Modified Functional Ambulation Category scale (P<0.001) were observed. Of the patients, 85 (7.8%) died within 6 months of initiation of the programme. Only 26 (2.4%) older patients required institutionalisation in residential care homes within 6 months after the programme. Increasing age (P=0.025) and high Charlson Comorbidity Index score (P=0.001) were positive predictors for accident and emergency department attendance. A high albumin level (P=0.001) and living alone (P=0.033) were negative predictors for Effectiveness of a discharge planning and community support programme in preventing readmission of high-risk older patients New knowledge added by this study • Integrated Care and Discharge Support for elderly patients (ICDS) reduced accident and emergency department (AED) attendances, acute hospital admissions, and hospital bed days. Setting• ICDS service was potentially cost-saving and might minimise institutionalisation.• Age, Charlson Comorbidity Index, albumin level, and living alone were associated with AED attendance.• Age, number of medications, and haemoglobin levels were associated with no reduction in bed days. Implications for clinical practice or policy • ICDS programme should be continued in Hong Kong to face the challenges of an increasing older population.• Further studies are suggested to examine whether AED attendance, acute hospital admissions, and hospital bed days among high-risk older patients can be further reduced by modifying some of the predictive factors identified in this study.• A more detailed auditing is warranted to show its value in reducing health care costs.
Objective. To evaluate the safety and effectiveness of the careful hand feeding (CHF) programme in a geriatric step-down hospital.Methods. Medical records of patients aged ≥65 years who received CHF in Fung Yiu King Hospital between February 2017 and November 2021 were retrospectively reviewed.Results. 446 patients (178 men and 268 women) aged 66 to 109 (mean, 91) years were included for analysis. 88% of patients were severely frail or very severely frail. 70% of patients had advanced dementia. 81.3% of patients had dysphagia. 44% of patients were in imminent death status (who were highly likely to die within a week) before starting CHF. Food intake during CHF was poor or very poor in 51% of patients and satisfactory or good in 49% of patients. 90% of patients required clinically assisted hydration. The mean length of hospital stay was 19.3±16 days, and the mean duration of CHF was 14±13.5 days. 39% of patients died during the index admission; most of the remaining 61% of patients were discharged to their original placement. 27 (6%) patients had pneumonia. Independent predictors for pneumonia were the length of hospital stay (odds ratio=1.024, p=0.014) and poor/very poor intake (odds ratio=1.82, p=0.017). Conclusion.CHF is safe in a geriatric step-down hospital and avoids use of a nasogastric feeding tube in patients in their last phase of life. It fosters comfort and dignity for dying patients. Most patients can return to their original placement for CHF after discharge.
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