An Early Supported Discharge Model of Care for Older Adults Admitted to Hospital: A Descriptive Cohort Study

Abstract Background Early supported discharge (ESD) facilitates an early discharge from hospital with continued rehabilitation in the home environment from a multi-disciplinary team at the same intensity as would be received in the inpatient setting. Evidence suggests it can have a positive impact on older adults discharging from the acute setting to home. This study aims to characterise an inreach model of ESD for older adults discharged from four hospitals in the Mid-West of Ireland and describe its impact on clinical and process outcomes at 30 days and 180 days. Methods Consecutive older adults referred for ESD from four hospitals in the Mid-West of Ireland were recruited over a six-month period. Baseline assessments were carried out on initial review and patients were followed up at 30 days and 180 days by an independent outcome assessor. Outcomes measured include functional status, frailty, health related quality of life, mortality, and healthcare utilisation. Results 130 older adults (mean age 76.623 years, SD 9.812 years) were recruited over six months, 44 due to surgical and 86 for medical complaints. The ESD service was provided over a median of 31 (medical) - 44 (surgical) days. The incidence of functional decline was 16.406% at 30 days and 27.5% at 180 days. There was a significant improvement in self-reported function from index visit 72.939 (19.502) mean (SD) to 30 days 84.046 (21.078) mean (SD) which was maintained at 180 days 80.534 (30.930) mean (SD). Frailty was independently associated with incidence of functional decline at 30 days (OR 2.061, 95%CI 1.386 to 3.062) and 180 days (OR 1.7, 95%CI 1.292 to 2.236). Conclusion An ESD model of care can have significant effects on patient outcomes for older adults admitted to hospital at 30 and 180 days. Future research should explore the impact of an ESD model of care on specific cohorts, using RCT methodology.