A prospective baseline study of frail older people before the introduction of an intermediate care service.
This paper describes the first part of a two-stage research project designed to investigate the clinical and service outcomes of a comprehensive intermediate care service. It is a baseline study of patients presenting to two elderly care departments as emergencies with the clinical syndromes of falls, incontinence, confusion or poor mobility before the introduction of a city-wide intermediate care service. The outcome measures were: mortality; disability (Barthel Index, BI); social activities (Nottingham Extended Activities of Daily Living); service use; and carer distress (General Health Questionnaire -28). These were measured at 3, 6 and 12 months after recruitment. Eight hundred and twenty-three patients were recruited (median age = 84 years; proportion of women = 70%; proportion with cognitive impairment = 45%; median BI score = 15). There was a high mortality rate (36%), evidence for incomplete recovery, a gradual decline in independence over 12 months and a high degree of carer stress. There was little use of rehabilitation services (< 5%), about 25% required readmission to hospital by each assessment point and there was a gradual increase in institutional care admissions. These findings support a needs-based argument for a more comprehensive community service for frail older people.
Young
John
J
Nuffield Institute for Health, Leeds University, Leeds, UK. john.young@bradfordhospitals.nhs.uk
Robinson
Michael
M
Chell
Sue
S
Sanderson
Diana
D
Chaplin
Stephen
S
Burns
Eileen
E
Fear
Jon
J
D000368:Aged; D000369:Aged, 80 and over; D003153:Community Health Services / Q000706:statistics & numerical data*; D004739:England; D016330:Frail Elderly; D015577:Geriatric Assessment; D006801:Humans; D007380:Intermediate Care Facilities; D011446:Prospective Studies