Williams Susan, Whiston Aoife, Morrissey Ann-Marie, O'Riordan Clíona, O'Connor Margaret, Hartigan Deirdre, Devlin Collette, Galvin Rose
School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland.
Department of Psychology, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.
Clin Interv Aging. 2024 Dec 3;19:2013-2030. doi: 10.2147/CIA.S465393. eCollection 2024.
Early supported discharge (ESD) facilitates early discharge from acute hospitals with continued rehabilitation in the home environment from a multi-disciplinary team at the same intensity as would be received in the inpatient setting. Emerging evidence suggests it can have a positive impact on the care of older adults on discharge from the acute hospital setting to home. This study aims to characterize an inreach model of ESD for older adults discharged from four hospitals in the Mid-West of Ireland and describe its impact on clinical and process outcomes at 30 and 180 days.
Consecutive older adults referred for ESD from four hospitals were recruited over six-months. Baseline assessments were carried out on initial review, and patients were followed up at 30 and 180 days by an independent outcome assessor. Outcomes measured include functional status, frailty, health related quality of life, mortality, and healthcare utilization.
One hundred and thirty older adults (mean age 76.62 years, SD 9.81 years) were recruited, 44 for surgical complaints and 86 for medical complaints. The ESD service was provided over a median of 31 (medical) - 44 (surgical) days, primarily by physiotherapy and occupational therapy. The incidence of functional decline was 16.41% at 30 days and 27.5% at 180 days. There was a significant improvement in the self-reported function from index visit 72.94 (19.50) mean standard deviation (SD) to 30 days 84.05 (21.08) mean (SD) which was maintained at 180 days 80.53 (30.93) mean (SD). Frailty was independently associated with incidence of functional decline at 30 days (OR 2.06, 95% CI 1.39 to 3.06) and 180 days (OR 1.7, 95% CI 1.29 to 2.24).
An ESD model of care can have significant effects on patient outcomes for older adults admitted to hospital at 30 and 180 days, without increasing the risk of unscheduled Emergency Department re-presentation. Future research should explore the impact of an ESD model of care on specific older adult cohorts.
早期支持出院（ESD）有助于急性医院的患者尽早出院，并在家庭环境中接受多学科团队提供的与住院环境相同强度的持续康复治疗。新出现的证据表明，它对老年患者从急性医院出院回家后的护理可能产生积极影响。本研究旨在描述一种针对从爱尔兰中西部四家医院出院的老年人的ESD院内服务模式，并描述其在30天和180天时对临床和流程结果的影响。
在六个月的时间里，招募了从四家医院转介接受ESD的连续老年患者。在初次评估时进行基线评估，并由独立的结果评估人员在30天和180天时对患者进行随访。测量的结果包括功能状态、虚弱程度、健康相关生活质量、死亡率和医疗保健利用率。
共招募了130名老年人（平均年龄76.62岁，标准差9.81岁），其中44名因外科疾病就诊，86名因内科疾病就诊。ESD服务的提供时间中位数为31天（内科）至44天（外科），主要由物理治疗和职业治疗提供。30天时功能下降的发生率为16.41%，180天时为27.5%。自我报告的功能从初次就诊时的72.94（标准差19.50）显著改善到30天时的84.05（标准差21.08），并在180天时维持在80.53（标准差30.93）。虚弱与30天时（比值比2.06，95%置信区间1.39至3.06）和180天时（比值比1.7，95%置信区间1.29至2.24）功能下降的发生率独立相关。
ESD护理模式对入院的老年患者在30天和180天时的患者结果有显著影响，且不会增加非计划重返急诊科的风险。未来的研究应探讨ESD护理模式对特定老年人群体的影响。
