[Current cooperation concerning admission to and discharge from geriatric hospitals]. / Nyt samarbejde om gamle menneskers sygehusindlaeggelse og -udskrivelse.

A method of building bridges--in terms of therapy and care--between the life of the elderly before, during, and after a stay in hospital is described in this randomized, controlled study from a Copenhagen suburb. A project nurse employed by the City called at the Hospital each day and followed the members of this group concerning the need to gather information from primary care, discuss discharge with the patient and the nursing staff, co-ordinate possible supportive measures in the home, and immediately after the discharge to make a home visit to ensure continuity of care and treatment.

[Cooperation concerning admission to and discharge of elderly people from the hospital. 1. The coordinated contributions of home care personnel]. / Samarbejde om gamle menneskers sygehusindlaeggelse og -udskrivelse. 1. Hjemmesygeplejerskens koordinerende indsats på sygehuset.

In cooperation between the home care system in the Municipality of Rødovre and four hospital departments in the County of Copenhagen, a controlled and randomized investigation was undertaken among the hospitalized patients of 65 years and over from the Municipality of Rødovre. A nurse employed by the Municipality particularly for this project visited the hospital daily and followed the 135 participants in the intervention group with the objects of obtaining information from the primary sector if necessary, discussing discharge with the patient and the hospital staff, coordinating possible supportive measures in the patient's home and visiting the patient in his home immediately after discharge from hospital in order to ensure continuity in care and treatment. The 138 participants in the control group underwent the usual procedures in connection with admission to hospital. In this article, the consequences of the contributions by the health visitor in the hospital are described in relation to the course of hospitalization. The intervention group had an average stay in hospital of 11.0 days as compared with 14.3 days in the control group (p greater than 0.05), and the total number of bed-days were 1,490 and 1,970, respectively. In addition, the two groups were compared as regards the number of diagnostic procedures during hospitalization, the number of deaths, the diagnoses on discharge and the functional capacity. No differences were observed in these respects between the two groups. Three patients from the control group were discharged to residential institutions as compared with none in the intervention group.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cooperation concerning admission to and discharge of elderly people from the hospital. 2. The course 1 year after discharge]. / Samarbejde om gamle menneskers sygehusindlaeggelse og -udskrivelse. 2. Forløbet 1 år efter udskrivelsen.

In connection with the health visitor's work in a hospital, a controlled and randomized investigation was undertaken among hospitalized patients of 65 years and over from the municipality of Rødovre. The efforts made in hospital were described in a previous article. Out of the intervention group of 135 patients, 125 were discharged alive. Of these, 114 were visited on one or more occasions immediately after discharge with the object of discussing the process of admission and review of the health and social circumstances to ensure adequate and relevant supportive measures. A total of 125 persons from a comparable control group were discharged alive after having received the usual offers of assistance during and after hospitalization. The two groups were followed for one year after discharge as regards the number of deaths and the utilization of hospital, waiting departments and the municipal residential institutions and home-help and home nursing services. No differences were found between the groups as regards the number of deaths, number of re-admissions and the duration of hospitalization. A total of three persons from the intervention group and 14 from the control group utilized wasting departments, nursing homes or residential places in day and night homes. Altogether these persons utilized 774 and 2,136 days, respectively, in institutions during the year after discharge. The intervention group employed more home-help hours and visits from home visitors. This attempt at co-ordination thus appears to the capable of reducing the needs for municipal residential places in patients with considerable loss of function.

[Cooperation concerning admission to and discharge of elderly people from the hospital. 3. Functional capacity, self-assessed health and quality of life]. / Samarbejde om gamle menneskers sygehusindlaeggelse og udskrivelse. 3. Funktionsevne, selvvurderet helbred og livskvalitet.

As part of a total project concerning description and effects of the coordinating efforts of home nurses in connection with admission to and discharge from hospital of persons over the age of 65 years, the functional capacity and the subjective parameters: quality of life, self-assessed health and loneliness were registered on discharge and two months later. In order to assess the effect of intervention, the intervention group was compared with a control group. No differences in the functional capacity could be demonstrated on discharge or after two months. No differences could be demonstrated in the subjective parameters either. The effect of the home nurses' efforts in the total project could be measured as a reduction in the number of institution-days in the intervention group. These results suggest that, in further attempts to reduce the risk of complications in recently discharged elderly patients, further assistance of the functional capacity should be added to the forms of intervention described.

Hospitalization of elderly people. A 3-year controlled trial.

In a controlled epidemiologic intervention study, preventive home visits to elderly people aged 75 or older were made very third month over 3 years. Two hundred eighty-five (62% women) elderly participated in the intervention group and 287 (62% women) in the control group. Information about the number of admissions to hospitals, the number of bed days, the main reason for hospitalization, the diagnoses on discharge, and the residence after discharge was collected. Two hundred nineteen admissions (4,884 bed days) were registered for the intervention group compared with 271 (6,442 bed days) for the control group. During the second half of the study, a significant reduction in the number of admissions--especially readmissions--to hospitals was seen in the intervention group. The mean risk per person of being hospitalized was 24%, 20%, and 20% in years 1, 2, and 3, respectively, for the intervention group, and 22%, 25%, and 28% for the controls. The mean number of bed days per admission did not differ between the two groups. Using the results to make a general epidemiologic and longitudinal assessment of the admissions of elderly aged 75 or older, the following can be concluded: 4% of the participants used 42% of the bed days, and most of these people awaited alternative residential accommodation; 62% stayed less than 2 weeks in the hospital. The main reason for hospitalization was fall episodes among women (20%) and dyspnea among men (18%). Approximately three-fourths were discharged to their own homes or to the family, while 18% died. Preventive home visits seem to be one of the tools to improve the future lives of the elderly in their own homes.

Is growing old a disease? A study of the attitudes of elderly people to physical symptoms.

In a survey of people living at home, aged 77 years and over, a total of 126 women and 77 men were interviewed concerning their attitudes to their physical symptoms. For each organ system the subjects indicated whether their symptoms were considered to be a normal condition for elderly people or a manifestation of a disease. To a large extent symptoms were accepted as a normal condition, however, a highly significant difference in their attitudes to symptoms stemming from different systems was found (p less than 0.001). Generally, compared with severe symptoms, mild symptoms were accepted more readily as a normal condition in old age. Although most of the elderly people had seen a doctor because of their symptoms, a highly significant difference was found in consultation rates among elderly persons with symptoms from different organ systems (p less than 0.001). The attitudes to symptoms influenced the tendency of the subjects to consult a doctor (p less than 0.05). The need for education of elderly people and health professionals is discussed.

Use of social and health services by elderly people during the terminal 18 months of life.

In a randomised and controlled intervention study elderly people aged 75 or more were visited regularly in their own homes over a period of three years. An age and sex matched control group was not contacted until the conclusion of the study period. In the present study, the use of social and health services during the terminal 18 months of life was computed for each individual member of the study group. The categories of services included the bed usage in hospitals, the stays in nursing homes, the provisions of home help and home nursing care as well as contacts with general practitioners. No differences in the use of social and health services were found between the visited elderly (n = 25) and the control group (n = 46). About 50% of the elderly had a considerable use of public services during the months prior to death, and only 14% received no public support, disregarding the terminal phase. Among those elderly people belonging to the study group, and who died within the study period, an increased use of the above mentioned services was seen during all 18 months. However, an increased use of hospital beds was only computed during the terminal 6 months of life. 58% of the bed days were used for patients who died during the next few months.

Consequences of assessment and intervention among elderly people: a three year randomised controlled trial.

Over three years 285 randomly selected subjects aged 75 years or more and living in a suburb of Copenhagen were visited every three months in their own homes (the intervention group) to assess whether scheduled medically and socially preventive intervention would influence the number of admissions to hospitals or nursing homes, the number of contacts with general practice, or mortality. A randomly selected group of 287 people of the same age and sex were visited during the final three months of the study (the control group). Two hundred and nineteen admissions to hospitals (4884 bed days) were registered for the intervention group compared with 271 (6442 bed days) for the control group. Especially during the second half of the study, a significant reduction in the number of admissions to hospitals was seen in the intervention group. Twenty people in the intervention group and 29 in the control group moved into nursing homes (p greater than 0.05). The corresponding numbers of deaths were 56 and 75 (p less than 0.05). No difference was seen in the number of contacts with general practice. Significantly fewer emergency medical calls, however, were registered for the intervention group. Subjects in the intervention group benefited from the regular visits and the increased distribution of aids and modifications to their homes to which these led. The regular visits probably also produced an important increase in confidence.

Intake of drugs among elderly people in a Danish municipality, Rødovre.

Drug intake has been studied among a random group of persons, aged 75 or over, in Rødovre Municipality. Two hundred and eight-three elderly persons living in their own homes have been visited and interviewed about their daily intake of prescribed and nonprescribed drugs (including so-called natural drugs). Similar information was gathered from 146 elderly persons living in nursing homes. Thirty-one per cent of the elderly living in their own homes and 3% of those living in nursing homes did not use prescribed drugs daily. The median daily amount of different types of drugs used was 1.8 (range 0-10) for elderly persons living in their own homes and 4.5 (range 0-11) (p less than 0.001) for those living in nursing homes. Women living at home had a higher intake of drugs than men, especially diuretics. The most frequently used drugs were diuretics, sedatives/hypnotics, analgesics, digitalis and electrolytes. For all types of drugs a higher consumption, especially of phenothiazines, was found among elderly persons living in nursing homes. Drug consumption was independent of age and social stratification in both groups. The use of non-prescribed drugs ranges from 0 to 9 different types in the group living in their own homes, and from 0 to 5 in the group living in nursing homes--laxatives being the type most frequently used.