A collaborative trial is needed
At a time when there is a widely held perception that older people, and particularly nursing home residents, are occupying acute care hospital beds at the expense of others,1 the article by Finn et al2 in this issue of the Journal is very pertinent. It describes the presentation, over a 6-month period, of a cohort of 541 patients from aged care facilities (nursing homes and hostels) to the emergency department of a large tertiary hospital, and notes that the substantial majority (87%) of these presentations were considered to be appropriate. These patients were acutely unwell (most having been so for less than 2 days) and required the investigations and expertise available in the emergency department for diagnosis and management. Sixty per cent of these patients required hospital admission and most (90%) survived to be discharged back to their aged care facility.
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- Rehabilitation and Aged Care, Hornsby Ku-ring-gai Hospital, Sydney, NSW.
- 1. Frankum B. Honesty a first step to better health care. Sydney Morning Herald 2006 Feb 1; Comment: 15.
- 2. Finn JC, Flicker L, Mackenzie E, et al. Interface between residential aged care facilities and a teaching hospital emergency department in Western Australia. Med J Aust 2006; 184: 432-435.<eMJA full text>
- 3. Australian Government Department of Health and Ageing. Aged Care Service lists. Available at: http://www.health.gov.au/internet/wcms/publishing.nsf/content/ageing-rescare-servlist-download.htm (accessed Feb 2006).
- 4. Creditor M. Hazards of hospitalization of the elderly. Ann Intern Med 1993; 118: 219-223.
- 5. Cartledge S. Hospital in the nursing home. Hospital & Healthcare 2004; Aug: 52-53.
- 6. Kane RL, Homyak P, Bershadsky B, et al. Patterns of utilization for the Minnesota senior health options program. J Am Geriatr Soc 2004; 52: 2039-2044.
- 7. Saliba D, Kington R, Buchanan J, et al. Appropriateness of the decision to transfer nursing facility residents to the hospital. J Am Geriatr Soc 2000; 48: 154-163.
- 8. NSW Health. Using advance care directives: New South Wales. Sydney: NSW Health, 2004. Available at: http://www.health.nsw.gov.au/pubs/2004/pdf/adcare_directive.pdf (accessed Apr 2006).