title: New institutionalisation following acute hospital admission: a retrospective cohort study.
abstract: institutionalisation following acute hospital admission is common and yet poorly described, with policy documents advising against this transition.
  
  
  
  to characterise the individuals admitted to a care home on discharge from an acute hospital admission and to describe their assessment.
  
  
  
  a retrospective cohort study of people admitted to a single large Scottish teaching hospital.
  
  
  
  100 individuals admitted to the acute hospital from home and discharged to a care home.
  
  
  
  a single researcher extracted data from ward-based case notes.
  
  
  
  people discharged to care homes were predominantly female (62%), widowed (52%) older adults (mean 83.6 years) who lived alone (67%). About 95% had a diagnosed cognitive disorder or evidence of cognitive impairment. One-third of cases of delirium were unrecognised. Hospital stays were long (median 78.5 days; range 14-231 days) and transfers between settings were common. Family request, dementia, mobility, falls risk and behavioural concerns were the commonest reasons for the decision to admit to a care home. About 55% were in the acute hospital when the decision for a care home was made and 44% of that group were discharged directly from the acute hospital.
  
  
  
  care home admission from hospital is common and yet there are no established standards to support best practice. Decisions should involve the whole multidisciplinary team in partnership with patients and families. Documentation of assessment in the case notes is variable. We advocate the development of interdisciplinary standards to support the assessment of this vulnerable and complex group of patients.
authors.affiliation: Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK.|Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.
authors.forename: Jennifer Kirsty
authors.initials: JK
authors.lastname: Harrison
authors.affiliation: NHS Lothian, Edinburgh, UK.
authors.forename: Azucena Garcia
authors.initials: AG
authors.lastname: Garrido
authors.affiliation: Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK.|Nursing Studies, University of Edinburgh, Edinburgh, UK.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Rhynas
authors.affiliation: NHS Lothian, Edinburgh, UK.
authors.forename: Gemma
authors.initials: G
authors.lastname: Logan
authors.affiliation: Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.|Department of Clinical and Surgical Sciences, Geriatric Medicine,  University of Edinburgh, Edinburgh, UK.
authors.forename: Alasdair M J
authors.initials: AM
authors.lastname: MacLullich
authors.affiliation: Nursing Studies, University of Edinburgh, Edinburgh, UK.|Corporate Nursing, NHS Lothian,  Edinburgh, UK.
authors.forename: Juliet
authors.initials: J
authors.lastname: MacArthur
authors.affiliation: Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.|Department of Clinical and Surgical Sciences, Geriatric Medicine,  University of Edinburgh, Edinburgh, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Shenkin
mesh_terms: D000058:Accidental Falls; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000066491:Clinical Decision-Making; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis / Q000523:psychology; D003704:Dementia / Q000175:diagnosis / Q000523:psychology; D005260:Female; D015577:Geriatric Assessment; D006707:Homes for the Aged; D006784:Hospitals, Teaching; D006801:Humans; D007326:Institutionalization; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D051346:Mobility Limitation; D009735:Nursing Homes; D010343:Patient Admission; D010348:Patient Care Team; D010351:Patient Discharge; D010817:Physician-Patient Relations; D012189:Retrospective Studies; D012307:Risk Factors; D012606:Scotland
keywords: Institutionalisation; care home; cognition; interdisciplinary; older people; standards