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Characteristics of Patients Described as Sub-acute in an Acute Care Hospital

Published online by Cambridge University Press:  31 May 2013

Heather Fillmore Elbourne
Affiliation:
School of Nursing, Dalhousie University
Kathryn Hominick
Affiliation:
Geriatric Medicine Research, Dalhousie University, and Queen Elizabeth II Health Sciences Centre
Laurie Mallery
Affiliation:
Geriatric Medicine Research, Dalhousie University, and Queen Elizabeth II Health Sciences Centre Division of Geriatric Medicine, Dalhousie University, and Queen Elizabeth II Health Sciences Centre
Kenneth Rockwood*
Affiliation:
Geriatric Medicine Research, Dalhousie University, and Queen Elizabeth II Health Sciences Centre Division of Geriatric Medicine, Dalhousie University, and Queen Elizabeth II Health Sciences Centre
*
*Correspondence and requests for offprints should be sent to / La correspondance et les demandes de tirés-à-part doivent être adressées à: Kenneth Rockwood, M.D. Geriatric Medicine Research Dalhousie University Queen Elizabeth II Health Sciences Centre 5955 Veterans’ Memorial Lane Halifax, NS B3H 2E1 (kenneth.rockwood@dal.ca)

Abstract

Frail older patients suffer from multiple, complex needs that often go unmet in an acute care setting. Failure to recognize the geriatric giants in frail older adults is resulting in the misclassification of this population. This study investigated “sub-acute” frail, older-adult in-patients in a tertiary care teaching hospital. Although identified as being no longer acutely ill, all participants (n = 62) required active medical and/or nursing care. Frail older patients, often acutely ill, were being misclassified as sub-acute when the acuity of their illness went unrecognized which resulted in equally unrecognized disease presentations. The majority of participants wished to be cared for at or closer to home. The lack of post-acute-care service within our health care system and risk aversion on the part of hospital staff resulted in lengthy hospital stays and/or in patients being funneled into existing services (nursing homes) against their desire to go home.

Résumé

Les patients frêles et âgés souffrent de multiples besoins complexes qui souvent passent non-traitées dans un établissement de soins actifs. Ne pas reconnaître les géants gériatriques au sein de ces aînés frêles provoque des erreurs de classement de cette population. Cette étude a examiné des aînés malades “sub-aiguë” hospitalisés dans un hôpital de soins tertiaires. Bien qu’ils aient été identifiés comme n’étant plus gravement malades, tous les participants avaient besoin des soins medicaux actifs et/ou de soins infirmiers. Lorsque l’acuité de leur maladie est passée inaperçue, les patients âgés et fragiles ont été classés par erreur comme sub-aiguë. La majorité des participants ont souhaité être soignés chez eux ou à proximité. L’absence, dans notre système de soins de santé, des soins post-aigus, ainsi que l’aversion au risque de la part du personnel de l’hôpital, a abouti aux hospitalisations prolongées ou/et les patients étaient rélégués* dans les services existants (maisons de soins infirmiers) contre leur désir de rentrer chez eux.

Type
Policy and Practice Note / Note de politique et practique
Copyright
Copyright © Canadian Association on Gerontology 2013 

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