C D Brymer | PubMed Health

PubMed1995

Do geriatric programs decrease long-term use of acute care beds?

OBJECTIVE: To determine whether the introduction of coordinated geriatric and discharge planning services at teaching and community hospitals in Toronto has changed the number of beds occupied by patients awaiting transfer to long-term care institutions. DESIGN: Retrospective review of social work records for the period 1985-1992. SETTING: Two tertiary and four primary acute care hospitals in Metropolitan Toronto. PARTICIPANTS: Hospitals were matched for location, acuity, and teaching affiliation. MAIN OUTCOME MEASURES: The numbers of beds occupied by patients awaiting transfer to nursing homes or chronic care hospitals were noted. RESULTS: In those teaching and community hospitals that had introduced coordinated geriatric and discharge planning services, there was a reduction in the percentage of beds occupied by patients awaiting long-term care placement (average-51%), whereas in hospitals without geriatric services, the percentage of beds occupied by patients awaiting long-term care placement increased (average + 25%) (P = .05 by Fisher's exact method, 95% confidence limit odds ratio 0, .9999). CONCLUSION: The introduction of coordinated geriatric and discharge planning services was associated with a decrease in the percentage of beds occupied by patients awaiting long-term care in both teaching and community hospitals.

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Characteristics of patients who made gains at a geriatric day hospital.

The charts of patients who attended a geriatric day hospital (DH) over a 16-month period were reviewed retrospectively (n = 112). Home visits were conducted on consenting patients who made gains (either functional, psychosocial or medical) according to the chart review; they (and/or their caregivers) were questioned about what gains were made at the DH and whether these gains were still present. Initial gains (n = 77, or 69%) were gains identified by chart review, and confirmed by patients at the home visit (when a home visit was possible). Patients who had home visits performed (n = 58) were further classified as to if they had persistent gains or not. Measurements of mood, function, cognition, mobility, balance, and medications were also collected. Patients were defined as having had persistent gains if they relayed gains were still present and, when a gain was measurable (e.g., mobility), there had to be objective evidence of persistent improvement. Backwards elimination modeling using logistic regression analyses was conducted to look for characteristics of patients who made initial gains and had persistent gains. In gender-adjusted analyses, people with cardiac conditions (p = 0.006) or depression (p = 0.047) were most likely to make initial gains whereas those with dementia were less likely to make initial gains (p = 0.005). There were no statistically significant associations (p < 0.05) found between any of the variables examined and the likelihood of having persistent gains. This study suggests that certain types of patients may be more likely to benefit, at least initially, from a DH program.

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