Getting back home after a hospital admission
When older people are admitted to hospital as an emergency there is often a fear that they will not return home. This fear is borne out by findings from a recent research study (reference 1). It showed that people who were confused (whether due to dementia or delirium or both) were three times as likely to no longer be living in their own home 30 days after discharge as those without confusion. Delirium is a rapid change in an individual’s mental function that can often be associated with an acute illness such as a urinary tract infection or a chest infection.
As part of a larger study of 5570 hospital admissions in Scotland led by Professor Emma Reynish, University of Stirling, researchers looked at where people were living 30 days after discharge. It took account of other important factors including their age, other medical conditions, prescribed medications and ability to perform everyday tasks.
An analysis of the data showed that people with any form of confusion had more than twice the risk of not living in their own home 30 days after being discharged compared to those who were not confused (18% versus 7%). Furthermore they showed that the risk is more than four times as great for those with dementia who developed delirium at the time of hospital admission (31% versus 7%). These findings suggest three out of every ten people with dementia aged 65 years and over, who are admitted to hospital with delirium, will not be living in their own home 30 days after discharge. Those who were no longer living at home had either died, been admitted to a care home or had been r e-admitted to hospital.
The finding that having confusion (or a cognitive spectrum disorder) was associated with a statistically significant lower likelihood of living at home 30 days after discharge from hospital, points to the vulnerability of people who have confusion in hospital, whether it be due to delirium or dementia or both conditions. The reasons for this finding are not clear but they highlight the need for a review and rethink of the treatment and care in hospital for anyone with confusion. In many cases a patient’s confusion, or even their diagnosis of dementia, can go unrecognised and, therefore, undiagnosed.
Without this recognition of an underlying problem, the hospitals ability to deliver the specialist care needed is hampered and this may be impacting on the chances of the person returning home. Much work is being done. The Alzheimer’s Society published a report “Fix Dementia care” suggesting that all hospitals should publish an annual statement on dementia care (reference 2); the Scottish Government improvement programme “Focus on Dementia” aims to improve the care of people with dementia in hospital by delivering on 10 care actions (reference 3).
To complement this, additional work is needed to standardise recognition and treatment for all people with confusion in hospital. Research is required to understand whether it is their confusion alone that brings about these poor outcomes, or whether it is the presence of multiple chronic medical conditions and frailty in older people which makes them more vulnerable. With this increased understanding we can then to pull together a comprehensive management plan for people who are confused in hospital.
Reference 1 - J.K. Burton et al, BMC Medicine (2018) 16:231, Living at home after emergency hospital admission:prospective cohort study in older adults with and without cognitive spectrum disorder
Reference 2 - Alzheimer's Society (2016), Fix Dementia Care Hospitals
Reference 3 - Healthcare Improvement Scotland ihub
