[When should nursing home residents be transferred to hospital?]

Abstract

Background: Nursing home residents are old persons with chronic diseases, functional impairment and often dementia. Acute illness is common and nursing home staff often has to consider transfer to hospital.

Material and methods: The aim was to find why nursing home residents are transferred to hospital and to discuss when such transfers are appropriate. The results are taken from the literature.

Results: No studies are reporting the reasons why nursing home residents in Norway are transferred to hospital. Hip fracture, pneumonia, stroke, chest pain, cardiac failure and anaemia are the most common causes of hospital admissions among the very oldest, in our experience also from nursing homes. Hospital transfer can be appropriate for: 1) diagnostic work up, 2) medical treatment to avoid death and functional impairment, and 3) palliative care. Admission for hip fracture and serious anaemia will improve survival and function if the patient is not dying from other diseases. Admission for pneumonia, stroke and acute coronary syndrome may improve survival and function for patients without advanced dementia and with some life expectancy. Transfer for palliative care will benefit the patient only if nursing home care is insufficient. Medical services and knowledge about palliative care should be increased; guidelines for hospitalisation and end-of-life decisions are recommended.