Consequences of the Crisis in Social Care for Older Hospital Inpatients with Frailty

The social care system is currently under enormous pressure leading to delays in home care provision and unnecessarily prolonged hospital stays for frail, older people. This study examines the rate of hospital-associated complications (HAC) amongst older inpatients who are medically optimised but awaiting home care to facilitate discharge home.

Electronic records of patients =65 years with delayed transfer of care (DTOC) awaiting home care provision were examined for incidence of delirium, falls and infection (n=100). A smaller cohort of current inpatients (n=14) awaiting home care were interviewed with focus on quality-of-life (CASP-19), loneliness (UCLA Scale) and depressive symptoms (CES-D).

59% (57/97) (median 82 years) developed a HAC while medically optimised for discharge. For every additional day awaiting home care, the likelihood of HAC increased by 4% (Adjusted Odds Ratio 1.04 (1.00-1.08; p=0.027). Almost half of interview respondents reported quality-of-life had declined while discharge home was delayed (6/14, 43%), while over one third reported significant depressive symptoms (5/14, 36%).

Almost 60% of frail, older inpatients have a HAC while awaiting home care provision, with the likelihood increasing significantly for every additional day in hospital awaiting care. Interventions to address this deficit in home care are required urgently.