A survey of the delayed discharge of elderly people from hospitals in an inner-London health district

Abstract

Older people (aged 65+) are the main consumers for the services provided by the hospital sector in Britain. A concern often expressed by clinicians is the 'blocking' of acute beds by older people who cannot be discharged but who no longer need the facilities provided by an acute unit. To identify the number of beds blocked by the elderly in an inner London health district, a census of all wards was undertaken in the two district general hospitals within the health authority. Medical/nursing staff were first asked to identify all patients aged 65+ who they considered to be inappropriately placed on an acute unit. Standard demographic and medical data were collected as well as the reason why the patient could not be discharged. A total of 563 patients were enumerated, of whom 287 (51%) were aged 65+. According to medical/nursing staff 24% (68/287) of elderly patients were classed as inappropriately located. The definition of a 'bed blocker' was refined by relating to a length of stay of 1 month, which reduced the proportion of such elderly patients to 15%. Such patients were significantly more likely to be demented and incontinent. The study showed that comparatively few elderly patients were inappropriately occupying acute beds. The inappropriate use of acute beds is not a feature unique to elderly patients; younger clients may be similarly categorised. Furthermore bed blocking is not something patients actively choose to do; rather it reflects the failure of services to appropriately respond to the needs of such patients.