Nursing home (NH) residents represent a population of particularly frail older adults
with multiple comorbid illnesses, high prevalence of physical disabilities, and/or
cognitive impairment.
1
When they develop acute exacerbations of their chronic conditions, which occurs commonly,
residents either receive treatments locally or are transferred to acute care hospitals,
usually to emergency departments (EDs). These transfers often become a source of potential
frustration. On the one hand, families and NH staff may feel helpless when residents
are transferred to the unfamiliar surroundings in acute care (especially for dementia
patients who are at increased risk of developing delirium after the environmental
translocation)
2
and subject to long wait times in busy EDs. On the other hand, ED and hospital staff
may feel challenged to manage these residents because hospitalization of NH residents
is associated with significant risks for adverse events, including functional decline,
delirium, and mortality.
3
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References
- How should we grade frailty in nursing home patients?.J Am Med Dir Assoc. 2007; 8: 595-603
- Delirium in older persons.N Engl J Med. 2006; 354: 1157-1165
- ACMEPLUS Project. A systematic literature review of factors affecting outcome in older medical patients admitted to hospital.Age Ageing. 2004; 33: 110-115
- Utilization of emergency room and hospitalization by Chinese nursing home residents: A cross-sectional study.J Am Med Dir Assoc. 2010; : 325-332
- An outreach geriatric medication advisory service in residential aged care: A randomised controlled trial of case conferencing.Age Ageing. 2004; 33: 612-617
- Appropriateness of patient transfer from a nursing home to an acute-care hospital: A study of emergency room visits and hospital admissions.J Am Geriatr Soc. 1991; 39: 1164-1168
- Ten tips for operating an effective acute care for elders unit (ACE).Can J Geriatr. 2008; 11: 181-185
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© 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.
