title: Acute medical admissions for older people from residential care facilities: are they appropriate?
abstract: OBJECTIVE
  Acute medical admissions are increasing and potentially avoidable admissions (PAA) from residential care facilities (RCF) have been blamed. Estimates for the proportion of PAA from RCFs vary enormously in the literature. This study aimed to prospectively determine the level of PAA to a New Zealand hospital.
  
  
  METHODS
  Two cohorts of consecutive acute medical admissions of older (65 years and older) people from RCFs were reviewed (one retrospective and one prospective). Discharge domicile and survival at 6 months were determined for all patients. PAAs were determined by the treating general physician/geriatrician in the prospective cohort.
  
  
  RESULTS
  Admissions from RCF are a very heterogeneous group with a wide range of diagnoses, levels of dependency and outcomes. Most admissions (88%) from lower level care (LLC) were appropriate and most returned to their usual RCF on discharge. Patients from higher level care (HLC) patients had poorer outcomes (5/8 died in the acute hospital and only 1/8 alive at 6 months). Twenty percent of all RCF admissions were potentially avoidable and could have been managed in a different setting
  
  
  CONCLUSIONS
  Most admissions from RCF were appropriate. However for a minority of admissions, other models of care within RCFs and community care are needed to provide alternative options of care. These may reduce some acute hospital admissions.
authors.affiliation: Older Persons Health Specialist Service, The Princess Margaret Hospital, Christchurch, New Zealand. carl.hanger@cdhb.govt.nz
authors.forename: H Carl
authors.initials: HC
authors.lastname: Hanger
authors.forename: Valerie
authors.initials: V
authors.lastname: Fletcher
authors.forename: Andrew
authors.initials: A
authors.lastname: Sidwell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006300:Health Services Misuse; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D009520:New Zealand / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data*; D010351:Patient Discharge; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D012112:Residential Facilities; D012189:Retrospective Studies