[Hospital Discharge Arrangements for Very Elderly Patients with Chronic Subdural Hematoma]

Area of Science:

• Neurosurgery
• Geriatric Medicine
• Public Health

Background:

• Chronic subdural hematoma (CSDH) is increasingly diagnosed in elderly populations due to longer life expectancies.
• Delayed disease onset in older adults complicates hospital discharge planning.
• This study specifically examines surgical outcomes and discharge for patients aged 90 years and above with CSDH.

Purpose of the Study:

• To investigate the feasibility and outcomes of surgical intervention for chronic subdural hematoma in patients aged 90 years and older.
• To analyze hospital discharge arrangements and identify factors influencing them in this elderly cohort.
• To compare outcomes between patients aged ≥90 years and younger patients undergoing CSDH surgery.

Main Methods:

• Retrospective analysis of 53 patients (63 sides) with CSDH treated between April 2018 and March 2019.
• Patients were categorized into an 'elderly' group (≥90 years) and an 'others' group (<90 years).
• Standardized 8-day hospitalization protocol including burr hole surgery, subdural drain, and rehabilitation was applied.

Main Results:

• The elderly group (≥90 years) had a mean hospitalization of 7.6 days.
• 100% of elderly patients received intervention from a Medical Consultation Team (discharge support nurse/medical social worker), compared to 65% in the other group.
• All patients were successfully discharged to planned living arrangements with multidisciplinary team assistance and rehabilitation.

Conclusions:

• Surgical treatment for CSDH is viable for patients over 90 years old.
• Multidisciplinary intervention, including a Medical Consultation Team and rehabilitation, is crucial for facilitating smooth hospital discharge in elderly CSDH patients.
• Potential challenges in elderly patients include dementia exacerbation and disuse syndrome, which can be mitigated by timely surgical and supportive care.