Subjective perception of additional support requirements of elderly patients discharged from accident and emergency departments

Fifty per cent of elderly patients discharged from accident and emergency (A&E) departments experience functional deterioration and increased dependence; 5.6% require readmission within 14 days. Discharge is often to inadequate community support. Functional assessment by A&E department staff may identify patients at greatest risk. The predictive ability of 25 patients aged 75 years or over to identify their additional support requirements following discharge from the A&E department was evaluated retrospectively using interview questionnaires 10-20 days after discharge. A total of 23 patients, of mean age 79.3 years, were interviewed. Six patients expressed concern both about coping at home and about needing extra support; four of the nine patients who recruited additional help were in this group (P = 0.239; n.s.). There was no correlation between additional support needed and patients living alone (P = 0.302; n.s.), dependent relative (P = 0.325; n.s.) or existing domiciliary support (P = 0.197; n.s.). All patients were satisfied with their management, and of the six who expressed concern about being able to cope at home, none informed A&E staff. Patients' perception is an unreliable indicator of their need for additional help and their ability to manage at home after discharge from A&E departments. Additional support requirements appear to be unrelated to domestic circumstances.