Delayed discharges in older adults with mental illness and/or dementia in hospital: a scoping review

Delayed discharge among older adults is rising in hospitals across many countries, placing increased strain on healthcare systems and negatively affecting patients’ emotional and physical well-being due to prolonged hospital stays and uncertainty. Despite this growing issue, limited research has explored the specific impact of delayed discharge on older adults living with a mental illness and/or dementia. This scoping review aims to examine what is currently known about older adults (aged 65 and over) with a diagnosis of dementia and/or mental illness who experience delayed discharge from hospital settings. This scoping review followed the five-stage framework outlined by Arksey and O’Malley. Comprehensive literature searches were conducted in Medline, Embase, Emcare, PsycINFO, Web of Science, and CINAHL. Studies were included if they focused on hospitalized older adults (65+) with delayed discharge and a diagnosis of dementia and/or mental illness, including the perspectives of patients, family care partners and healthcare providers. Eleven articles and one grey literature report met the inclusion criteria. Data synthesis was guided by Grembowski’s Conceptual Model of Complexity. Delayed discharge is a prevalent problem in this population. Patient characteristics, including ages 79 years and older, diagnosis of dementia, cognitive impairment, high levels of care dependency and lack of continuity of care with a primary care physician in the community, were identified as key risk factors for delayed discharge. The most commonly reported cause of delay was the unavailability of appropriate discharge destinations, primarily long-term care homes or adequate support services in the home. Delayed discharge carries significant risks of adverse events for older adults and is distressing to care partners. Upstream approaches to service provisions, such as continuity of care in primary care settings likely helps to reduce delayed discharges. Care practices within the hospital setting, including early family and patient involvement in discharge planning, education and training in dementia and mental health care, and improved collaboration between inpatient and community services are important considerations to address delayed discharge. Further research is needed to address knowledge gaps and inform system-level interventions tailored to this population experiencing vulnerabilities during hospitalization.