Geriatric versus general medical wards: comparison of patients' behaviours following discharge from an acute care hospital

Abstract

The objective of this study was to explore, from a nursing perspective, the effectiveness of geriatric wards in preparing elderly patients for discharge from an acute care hospital. A convenience sample of 40 patients aged 70 years or older was obtained from three geriatric medical wards and two general medical wards of a large British teaching hospital. Data were collected immediately prior to discharge, and after 6 and 13 weeks following discharge. No meaningful differences were found between the two patient-groups in their ability to cope with activities of daily living following discharge. The majority of deaths and/or hospital readmissions occurred within 6 weeks of discharge. A major concern identified in both groups was patients' lack of knowledge about medications and their side-effects. A need for more effective teaching programmes for elderly patients was identified.

Discharge planning: issues and challenges for gerontological nursing. A critique of the literature

“…Of interest are the reports on the effect of patient medication education prior to discharge. Such education was found to be a major influence in decreasing the numbers of hospital readmissions (Markey & Igou 1987, Naylor 1990 Jackson 1989, Naylor 1990). Both individual and team approaches to discharge planning report positive outcomes, i.e.…”

“…Medication education by nurses is found to be as important to a successful outcome as arranging for a homemaker or a home care nurse (Felsenthal ef al. 1986, MacGuire et al 1987, Jackson 1989.…”

“…One reason is that poor patient outcomes are not always due to poor discharge planning. Readmissions may be due to several factors, including patient fragility and/or families' decreased ability to adapt to the constant physical and emotional stress of caregiving (Hunt 1980, Johnson & Fethke 1985, Andrews 1986, Berkman et al 1987, Jackson 1989. New and unforeseeable problems, or problems from the presence of chronic diseases with associated functional decline may occur.…”

Helping ‘new carers' of the frail elderly patient: the challenge for nurses in acute care settings

“…Such comprehensive assessment and support for the new carer may well be happening in many areas, yet recent evidence would suggest that this is not the norm. Discharge planning rarely takes a priority and individuals are returned to the community with little consultation or prior notice, often without important information (Waters, 1987a,b;Victor & Vetter, 1988;Jackson, 1989). Despite the aforementioned policy guidance on discharge planning a recent influential report reached the conclusion that the situation has not improved, with planning being patchy, too late and poorly documented (Audit Commission, 1991).…”

Commentary on Dobrzanska L & Newell R (2006) Readmissions: a primary care examination of reasons for readmission of older people and possible readmission risk factors. Journal of Clinical Nursing 15, 599–606

“…One problem is that the authors chose to look at admissions occurring within 28 days, presumably because reduction in this figure forms a component of government targets for the health service and data are therefore maintained on these readmissions. The literature on readmissions of older people is very variable in relation to the time period covered, ranging for example from 42 days (Jackson 1989) to one year (Rubenstein et al 1984), but with many studies using 90 days (Smith et al 1985, Victor & Vetter 1985, Phillips et al 1987. Unfortunately, whilst this means that the relevance of this study to current policy can be clearly determined, it is less easy to relate to existing literature.…”