[Long-term solutions for the continuous post-acute care of the frail elderly in internal medicine]

Long-term care is a hospital unit, designed for frail elderly people, with ongoing physical challenges and in difficult social situations who have been suffering from multiple not-yet-stabilized pathologies. These subjects need medical-nursing and continuing care and/or treatments of rehabilitation which cannot be performed in extra-hospital situations. The aim of our study was to estimate a geriatric assessment of an old population hospitalized in a long-term care unit, using psychometric scales, paying attention to clinical, cognitive, functional, nutritional and social status. Two-hundred and ninety-seven patients of both sexes (middle age 81.3 +/- 8.6 years) divided into two groups of age (> or = 80 and < 80 years) were evaluated. The most important result of our study is a high index of disability (about five daily living activities were lost). These "functional deficits" were related to age, comorbidity, dementia, institutionalization and mortality. The study group showed a multiple pathology with various pharmacology therapy and, in 23.9% of cases, pressure ulcers were found and were related to mortality, as statistically noted. A serious cognitive impairment was found in 41.4% of the group (dementia was related to aging). As for residential destination, the most significant result is that almost half of the discharged patients went back to their home with a caregiver, who often was a woman. We finally underline the importance of increasing long-term care unit and the need for a higher integration in the territorial social-sanitary system, in order to guarantee care continuity for the frail and elderly.