Content provided in partnership with

Health Care Industry

The impact of a comprehensive multi-dimensional geriatric assessment programme on duration of stay in a French acute medical ward

Age and Ageing, May, 1994 by B. Ledesert, P. Lombrail, P. Yeni, C. Carbon, M. Brodin

The impact of a multi-dimensional geriatric assessment (MDGA) programme on the reorientation of the elderly person at discharge is described. One hundred and six elderly persons from a hospital catchment area identified for its poor level of social services, poor living conditions and high prevalence of dependency were allocated to either an experimental or control group. The experimental group was given the multi-dimensional assessment in the first three days of admission while the control group was subject to the usual hospital procedures. The study shows that the provision to the medical staff of easily obtained information relating to the individual's level of dependency and living conditions, in conjunction with recommendations for possible post-discharge placement, significantly reduced prolongation of stay due to non-medical reasons, albeit without a measurable impact on the whole duration of hospital stay.

Most Popular Articles in Health: Fuel your workout: exercisers who eat before they work out have more energy ...; Soothe a dry, itchy scalp: 5 easy expert solutions; Cocktails and calories: Beer, wine and liquor calories can really add up. ...; The sour truth about apple cider vinegar - evaluation of therapeutic use; The, six best supplements you've never heard of: these secret weapons can ...; More »

Introduction

In France, as in other Western countries, the proportion of elderly persons in the general population has been steadily increasing, rising from 13.9% of the population over 65 in 1982 (7 528 708 persons) to 14.7% in 1990 (8 347 959 persons) and estimated to increase to 15.7% (9 113 321 persons) by the year 2000. It is also well documented that the health of persons over 65 is significantly poorer than that of the general population with an especially high prevalence of sensory defects, locomotor difficulties, arterial hypertension, cardiac illness and cognitive deterioration (1)(2)(3). Owing to the cumulative effects of illnesses over a lifetime, the elderly person becomes more fragile and vulnerable with multiple pathologies. Not surprisingly the rate of hospitalization in elderly populations is high; in the Paris region for example, persons over 65 constitute 23.4% of patients and 33% of days spent in hospital although representing only 11.1% of the population (4).

In addition to problems of health and an increasing risk of hospitalization, the elderly population is frequently exposed to financial hardship and poor living conditions. Data from the national census of 1982 show, for example, that, in the Paris region 11.4% of homes occupied by elderly persons did not have hot water, 12.1% did not have a toilet and 45.5% of persons lived alone. These factors, in conjunction with the increased prevalence of disability amongst older people, mean that the discharge of an elderly person from acute hospital care is often not the happy return to the community experienced by younger persons, but rather a point of crisis. Illness and hospitalization with their adverse effects on both physical and mental strength serve further to reduce the elderly person's capacity to deal with inappropriate living conditions. Social services are rallied at the moment of intended discharge to confront this unanticipated crisis situation resulting in the prolongation of stay of the elderly person for non-medical reasons. A study conducted in Aquitaine in 1983 (5) has shown that only one third of persons over 75 admitted to acute care were able to return home and that 10% of acute-care hospital days were due to prolongation of care for non-medical reasons. On the other hand, in a great number of cases, there is no discussion between the medical staff and the elderly patient to prepare for discharge (6).

This situation is not only costly in that acute hospital beds are used as temporary sheltered accommodation, but the situation of 'crisis management' which is thereby engendered is stressful both for hospital personnel and care-givers. Moreover the outcome, in terms of longerterm housing for the elderly persons, risks being inappropriate due to the rapidity with which a solution must be sought.

The present study aimed to develop and evaluate an intervention strategy designed to ameliorate the management of this potential crisis situation. The principal working hypothesis is that the introduction of multidimensional-geriatric assessment (MDGA) in the first three days of admission will permit the prediction of individual medico-social needs at discharge, allow recommendations for possible post-discharge placement and thus reduce the extent to which acute-ward stay is extended for non-medical reasons.

Methods

The study was carried out at the Bichat Hospital, Paris, whose catchment area has a high proportion of elderly persons (19.0%) in comparison with the national average (13.9%). This group is also at high risk of post-admission difficulties in community re-integration having particularly poor living conditions (21.5% without toilets and 19.5% without hot water), insufficient domiciliary aid services and poor social network. The study took place in two internal medicine wards over a period of 7 months. Two groups were constituted from amongst all persons over 65 years hospitalized for the first time in the ward; an experimental group of 52 persons who were the subject of the post-admission geriatric assessment procedure and a control group of 54 persons. It was calculated that in order to demonstrate a 20% reduction in duration of stay, taking into account average length of stay in the ward, at least 40 subjects would be required in each group. Thus although the sample is small, statistically it should be sufficiently large to show any significant differences resulting from the experimental condition.

Health Care Industry

The impact of a comprehensive multi-dimensional geriatric assessment programme on duration of stay in a French acute medical ward

Age and Ageing, May, 1994 by B. Ledesert, P. Lombrail, P. Yeni, C. Carbon, M. Brodin

Find Research Guides for:

Find Featured Titles for: News

Most Popular Articles in Health

Most Popular Publications in Health