Discharge of elderly people from an accident and emergency department: evaluation of health visitor follow-up.

Elderly people discharged directly home from an accident and emergency department are known to be a vulnerable group. The value of health visitor follow-up in patients aged 75 years and over was assessed in a random controlled trail; 222 intervention patients were seen at home by a research health visitor shortly after discharge and screened for new dependency and support needs, appropriate community services then being offered. These patients, and 192 controls for whom no special arrangements were made, were followed up four weeks later by a research occupational therapist. New dependency, most commonly trauma-related, was found in approximately 50%, and in the majority proved transient. Advice and/or referral to a wide range of services was offered to 92% of the intervention group. Service refusal rates were high in both groups. Compared to controls, intervention patients received more services and were significantly more independent at four weeks. Health visitor assessment was seen as helpful. In order to identify elderly accident and emergency department patients at risk following discharge, study data were used to derive a short questionnaire. In follow-up visits to 48 patients the use of this questionnaire was piloted, and its validity demonstrated. A number of study limitations and areas for development of discharge planning are discussed.