Elderly people referred for institutional care--is prior assessment necessary?

To determine whether requests for placement of an elderly person into rest home or hospital care accurately predicted the final outcome and to identify factors influencing a move to institutional care.

Three month audit of all referrals to an assessment and rehabilitation unit for the elderly requesting rest home or hospital placement. Requests for medical advice or rehabilitation were excluded.

Two hundred patients were studied (24.6% of all referrals). Placement was requested in a rest home in 132 and hospital in 68. Seventy-one (54%) patients referred for rest home placement were able to return to their own home and 64 remained there at six month follow-up. Hospital level care was assessed as appropriate in 62% of requests for this initially and at six month follow up. Age and diagnosis were not significant predictors of patients requiring placement. Overall, of 158 patients living at home referred for rest home or hospital care, 67 (42%) were managing at home six months later.

Accurate assessment and treatment/management of elderly patients is necessary before recommending higher levels of care. Patients can be maintained in their current environment for longer than perceived by the referring doctor. This has important social and financial benefits.