Emergency hospital admissions from care-homes: who, why and what happens? A cross-sectional study

Abstract

Background: An increasing number of adults are resident in care-homes. Poor prognosis is often assumed; however, outcomes in this group are not well described. We hypothesised that the clinical characteristics of emergency admissions from care-homes are no different from those of age-matched, community-dwelling elders.

Objectives: To determine the clinical characteristics of unscheduled hospital admissions from care-homes in terms of severity of illness, admission diagnosis and outcome. To put these data into context, we compare them with data from age-matched, non-care-home resident, emergency admissions.

Methods: The definition of care-home was a residential facility providing full-time care. We prospectively studied consecutive, unscheduled hospital admissions from care-homes to all receiving wards (medical, surgical and orthopaedic) in a central, urban, teaching hospital. Controls matched by age (± 1 year), gender, ward and admission date were independently collated. Basic descriptive statistics were employed for the analysis of clinical and demographic variables. Data were non-parametric and comparative analyses were based on χ² or Mann-Whitney tests as appropriate.

Results: Over a 3-month period, there were 114 care-home admissions representing 80 patients (82 medical ward, 17 orthopaedic and 15 surgical). Demographics, co-morbidities and medication number were equivalent for cases and controls, as was the severity of the presenting illness (Modified Early Warning System scoring, serum albumin and C-reactive protein). Presenting diagnoses were heterogeneous with the majority of care-home admissions being secondary to sepsis (24; 29%) and falls (16; 19%). Care-home admissions and controls had similar inpatient mortality (14 vs. 15%; p = 0.84) and duration of stay (5 vs. 5 days; p = 0.73). There were a greater number of readmissions of patients from care-homes compared to the controls (26 vs. 3%; p < 0.0001).

Conclusion: Care-home residents admitted for unscheduled hospital care have similar outcomes to age-matched, community dwelling admissions; however, their risk of readmission is substantially higher.