title: Home or Residential Care? The Role of Behavioral and Psychosocial Factors in Determining Discharge Outcomes for Inpatients with Huntington's Disease.
abstract: BACKGROUND
  The progressive nature of Huntington's disease (HD) means that families often struggle to cope with increasing care needs of their affected family member. As a result, individuals with HD are likely to be at risk of hospitalization and subsequent early placement into residential care facilities.
  
  
  OBJECTIVE
  To explore which factors were associated with early residential care placement in a group of hospitalized patients with HD.
  
  
  METHODS
  A retrospective, systematic medical file audit of a neurological inpatient unit was conducted. Fifty-nine patients with HD were admitted from the community between January 2008 and December 2011; of these, 31 patients were discharged home while 28 patients required discharge to a residential care facility. These two groups were compared on a range of demographic, clinical and psychosocial variables identified as precipitating the hospital admission. Group comparisons were performed using t-tests and chi-square tests with Bonferroni correction for multiple comparisons.
  
  
  RESULTS
  A higher proportion of men were placed in residential care than were able to return home (p = 0.045); and the group placed in residential care had longer inpatient hospital stays (p < 0.001). Groups did not differ in age, medications or disease duration. We found that psychosocial difficulties (p < 0.001) and behavioral problems (p = 0.001), but not physical, cognitive, or psychiatric factors, significantly differentiated the groups.
  
  
  CONCLUSIONS
  Patients with HD discharged to residential care were more likely to have psychosocial and behavioral problems, and lengthy hospital stays. These findings indicate the need for community-based psychosocial and behavior management interventions aimed at preventing residential care admissions for persons with HD.
authors: Calvary Health Care Bethlehem, Caulfield, VIC, Australia.  fisher.fiona@gmail.com
authors: Fiona
authors: F
authors: Fisher
authors: Calvary Health Care Bethlehem, Caulfield, VIC, Australia.
authors: Sophie
authors: S
authors: Andrews
authors: Calvary Health Care Bethlehem, Caulfield, VIC, Australia.
authors: Andrew
authors: A
authors: Churchyard
authors: Calvary Health Care Bethlehem, Caulfield, VIC, Australia.
authors: Susan
authors: S
authors: Mathers
mesh_terms: D001315:Australia / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D006816:Huntington Disease / Q000453:epidemiology* / Q000628:therapy*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008485:Medical Audit; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010360:Patient Transfer / Q000706:statistics & numerical data; D011584:Psychology; D012112:Residential Facilities / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D017678:Sex Distribution; D012944:Social Support
keywords: Huntington's disease; behavior; hospitalization; institutionalization; residential facilities; social support