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Feasibility and impact of a post–discharge geriatric evaluation and management service for patients from residential care: the Residential Care Intervention Program in the Elderly (RECIPE)

Harvey, Penelope, Storer, Meg, Berlowitz, David John, Jackson, Bruce, Hutchinson, Anastasia and Lim, Wen Kwang 2014, Feasibility and impact of a post–discharge geriatric evaluation and management service for patients from residential care: the Residential Care Intervention Program in the Elderly (RECIPE), BMC Geriatrics, vol. 14, pp. 1-9, doi: 10.1186/1471-2318-14-48.

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Title Feasibility and impact of a post–discharge geriatric evaluation and management service for patients from residential care: the Residential Care Intervention Program in the Elderly (RECIPE)
Author(s) Harvey, Penelope
Storer, Meg
Berlowitz, David John
Jackson, Bruce
Hutchinson, AnastasiaORCID iD for Hutchinson, Anastasia orcid.org/0000-0002-0014-689X
Lim, Wen Kwang
Journal name BMC Geriatrics
Volume number 14
Article ID 48
Start page 1
End page 9
Total pages 9
Publisher BioMed Central
Place of publication London, England
Publication date 2014-04-16
ISSN 1471-2318
Keyword(s) residential aged care facilities
geriatric assessment
advanced care plans
advanced directives
acute health care utilisation
aged care nursing
Summary Background
Geriatric evaluation and management has become standard care for community dwelling older adults following an acute admission to hospital. It is unclear whether this approach is beneficial for the frailest older adults living in permanent residential care. This study was undertaken to evaluate (1) the feasibility and consumer satisfaction with a geriatrician-led supported discharge service for older adults living in residential care facilities (RCF) and (2) its impact on the uptake of Advanced Care Planning (ACP) and acute health care service utilisation.

Methods

In 2002–4 a randomised controlled trial was conducted in Melbourne, Australia comparing the geriatrician–led outreach service to usual care for RCF residents. Patients were recruited during their acute hospital stay and followed up at the RCF for six months. The intervention group received a post-discharge home visit within 96 hours, at which a comprehensive geriatric assessment was performed and a care plan developed. Participants and their families were also offered further meetings to discuss ACPs and document Advanced Directives (AD). Additional reviews were made available for assessment and management of intercurrent illness within the RCF. Consumer satisfaction was surveyed using a postal questionnaire.

Results
The study included 116 participants (57 intervention and 59 controls) with comparable baseline characteristics. The service was well received by consumers demonstrated by higher satisfaction with care in the intervention group compared to controls (95% versus 58%, p = 0.006).

AD were completed by 67% of participants/proxy decision makers in the intervention group compared to 13% of RCF residents prior to service commencement. At six months there was a significant reduction in outpatient visits (intervention 21 (37%) versus controls 45 (76%), (p < 0.001), but no difference in readmissions rates (39% intervention versus 34% control, p = 0.6). There was a trend towards reduced hospital bed-day utilisation (intervention 271 versus controls 372 days).

Conclusion
It is feasible to provide a supported discharge service that includes geriatrician assessment and care planning within a RCF. By expanding the service there is the potential for acute health care cost savings by decreasing the demand for outpatient consultation and further reducing acute care bed-days.
Language eng
DOI 10.1186/1471-2318-14-48
Field of Research 111001 Aged Care Nursing
110308 Geriatrics and Gerontology
110399 Clinical Sciences not elsewhere classified
Socio Economic Objective 920502 Health Related to Ageing
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2014, The Authors
Free to Read? Yes
Use Rights Creative Commons Attribution licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30062504

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Created: Thu, 17 Apr 2014, 11:38:30 EST by Ana Hutchinson

Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.