Abstract
The Psychological Impact of Hospital Discharge on the Older Person
Hussein Y 1, Edwards S 2, Patel HP 2,3,4
1 Undergraduate Medicine, Faculty of Medicine, University of Southampton, UK;
2 Department of Medicine for Older People, University Hospital Southampton NHS Foundation Trust, UK; 3Academic Geriatric Medicine, University of Southampton, UK; 4NIHR Southampton Biomedical Research Centre, University of Southampton & University Hospital Southampton NHS Foundation Trust, UK
Background
The number of older people at risk of health-related morbidity is growing at an unprecedented rate. Older people often require hospitalisation but prolonged length of stay and deconditioning in the acute setting is associated with multiple adverse outcomes. On average, 35% of older people do not recover functionally after hospital discharge. Less is known on the psychological impact and coping mechanisms after hospital discharge for vulnerable older people. Our aim was to explore factors signalling psychological vulnerability in older patients post-discharge to inform better discharge planning.
Methods
A systematic search for studies reporting poor discharge outcomes in older people were performed in the databases Medline, CINAHL, PsycInfo between 2010-2022. The search terms were ’older patients >65 year’, ‘post-discharge’, ’psychological distress’, ’loneliness’, ‘anxiety’, ‘depression’, and ‘length of hospital stay’. Exclusion criteria included COVID-19 disease, dementia (+/- severe cognitive impairment), individuals aged <65 and those under palliative care services.
Results
1,666 records were identified of which 878 were excluded as they were outside of our date limits or were not in English Language. 681 were excluded after application of exclusion criteria and 699 were excluded because of insufficient details. 31 duplicates were removed leaving 38 articles that were assessed for eligibility. 7 of these reports were found suitable, comprising of 1,131 patients. Three highly relevant themes identified relating to post-discharge outcomes across all studies were social isolation, lack of support, depression, apathy and fear, which led to further psychological distress. Older patients with tendency toward depressive symptoms had an increase likelihood of death.
Conclusion
It appears discharge processes fail to address psychological factors that permit successful transition from hospital. Pre-discharge screening of psychological symptoms and coping ability may assist in identifying older patients who are at risk of mental as well as subsequent physical deterioration. Better knowledge of positive and negative predictors of a successful transition from hospital to home would enable more holistic, effective, and inclusive discharge planning processes for older people.