What becomes of people admitted to acute old age psychiatry wards? An exploration of factors affecting length of stay, delayed discharge and discharge destination.

摘要

Objectives: The study sought to identify the variables associated with increased length of stay (LoS) on old age psychiatry inpatient wards. It also explored the factors related to delayed discharge, and the likelihood of patients admitted from home returning there.Methods: Data were collected on the sociodemographic, clinical and service receipt characteristics of a six-month series of admissions to seven wards in England in 2010/11. The cohort was followed for a 9-11 month period. The relationship between patients’ status on admission and the specified outcome variables was explored. Results: Information was collected on 216 admissions, of whom 165 were discharged in the study period. Mean LoS was 64 days. Female gender, higher dependency, greater challenging behaviour and locality predicted extended stay. Forty per cent of cases experienced delayed discharge. Better physical health, more cognitive impairment, receipt of social care and locality were associated with delayed discharge. The vast majority of patients admitted from home returned there. Younger patients and patients with less dependency, cognitive impairment and challenging behaviour had a higher likelihood of returning home. Patients receiving social care or admitted because of carer stress, a risk of self-neglect, accidental self-harm or abuse/exploitation were less likely to return home.Conclusions: The study provides a useful starting point for identifying cases on which future efforts to improve inpatient outcomes might centre, and suggests local rather than national responses may be needed. It also highlights an urgent need for a national focus on the scope, purpose and effectiveness of acute inpatient care.