Psychosocial Profile of Elderly Patients Discharged from a Community Hospital

Abstract

Social workers have historically been an advocate for vulnerable groups. One such vulnerable group is elderly patients who have been shown to have multiple, chronic health problems. The current fiscal environment favors shortened lengths of stay, potentially leaving these vulnerable patients at risk for adverse outcomes upon discharge, especially Hospital (Ontario, Canada). The objectives were to (1) estimate the number of elderly people who indicate biopsychosocial risk for adverse outcomes, (2) determine the specific risks and their severity, and (3) estimate the number of readmissions to hospital within three months after discharge. Standardized, self-reported scales were used to measure risks in elderly patients at discharge from acute care medical and surgical units. The sample included 62 patients with a mean age of 79 years. At discharge almost 40% of the patients were considered at risk for adverse outcomes, 11% indicated depression, 45% indicated psychological distress, 13% showed cognitive impairment, and 62.5% (35/56) had at least one nutritional concern. Over the three-month follow-up period, there were 23 readmissions, 8 ED visits (not mutually exclusive), and 7 outpatient visits. The mortality rate over the three-month period was 5% (3/62). Many elderly patients who were discharged from hospital to home experienced several challenges medically, psychologically and some also experienced social adversities. The implication is that these patients may benefit from a more comprehensive discharge plan than is currently practiced that addresses their challenges.

Including psychosocial factors in screening for surgery: A preliminary literature review from a social work perspective (Preprint)

“…While it has been noted that without effective intervention, surgery patients may have substantial unmet psychosocial needs [29], from the current review, the outcomes reported from such interventions were mixed. One study found that "preoperative patient teaching" had no significant effect, and had minimal impact on the patient's ability to cope with anxiety [35].…”

“…In summary and acknowledging the ranked quality and relevance of articles, four of the highly ranked articles emphasised the link between psychosocial issues, poorer treatment outcomes and longer hospital stays [5,14,27,29]. This underscored the importance of these connections.…”

“…The review noted that screening might incorporate some key dimensions. These include, age of the patient, co-morbidities, cognitive functioning, locus of control, mental health issues such as depression and anxiety [26,29], as well as coping skills, perceived medical symptoms, general life history, and healthcare history [16,[28][29][30].…”

“…Screening is required as a basis for addressing length of stay [28], it can inform discharge planning and community follow up [16,29], and it is a hallmark of a quality service [5]. It was noted that psychosocial screening should follow social work principles and seek to facilitate empathetic listening [16,29,32].…”

“…In light of fiscal constraints on services, and pressure to reduce length of stay [29,32], a greater focus on screening may be warranted.…”