The domiciliary assessment visit in hospital geriatric practice: pressures and dicisions on needs for admission

In a sample of 230 cases, requests for admission to a hospital geriatric unit were assessed, in the patients' homes, by a physician and his associate. The physician recorded his opinion of the strength of 14 factors influencing his decisions and also of total admission pressure. Each case was affected by an average of five different factors. Medical factors were most commonly noted: chronic physical illness in 94% of patients, chronic mental illness in 70%; but acute physical illness in only 34%. Difficult nursing was recorded in 76% of cases: other social factors were noted less frequently and related mainly to problems of support. The analysis suggested the importance of the chronic physical illness, difficult nursing, an short-term advantage factors in their contribution to a decision on the need for admission. The chronic mental factor appeared to affect the decision independently of the other factors. It was considered that half the patients were very strongly in need of admission; but a third gave no, or weak, admission pressure, were too ill to be moved, or refused to leave home.