New institutionalisation following acute hospital admission: a retrospective cohort study

Age and Ageing, Volume 46, Issue 2, 1 March 2017, Pages 238–244,

Published: 15 October 2016



following acute hospital admission is common and yet poorly described,
with policy documents advising against this transition.


characterise the individuals admitted to a care home on discharge from
an acute hospital admission and to describe their assessment.

Design and setting

a retrospective cohort study of people admitted to a single large Scottish teaching hospital.


100 individuals admitted to the acute hospital from home and discharged to a care home.


a single researcher extracted data from ward-based case notes.


discharged to care homes were predominantly female (62%), widowed (52%)
older adults (mean 83.6 years) who lived alone (67%). About 95% had a
diagnosed cognitive disorder or evidence of cognitive impairment.
One-third of cases of delirium were unrecognised. Hospital stays were
long (median 78.5 days; range 14–231 days) and transfers between
settings were common. Family request, dementia, mobility, falls risk and
behavioural concerns were the commonest reasons for the decision to
admit to a care home. About 55% were in the acute hospital when the
decision for a care home was made and 44% of that group were discharged
directly from the acute hospital.


home admission from hospital is common and yet there are no established
standards to support best practice. Decisions should involve the whole
multidisciplinary team in partnership with patients and families.
Documentation of assessment in the case notes is variable. We advocate
the development of interdisciplinary standards to support the assessment
of this vulnerable and complex group of patients.


Jennifer Kirsty Harrison  Azucena Garcia Garrido Sarah J. Rhynas

Gemma Logan  Alasdair M. J. MacLullich

Juliet MacArthur Susan Shenkin

Published by Residential Forum

The Residential Forum is to promote the achievement of high standards of care and support for children and adults living in residential care and nursing homes, supported housing, residential schools and colleges, hospices and hostels. It contributes to improving the quality of service to the public. Members of the Forum are people of standing and experience drawn from the public, private and voluntary sectors, as well as some who can speak for service users and carers.

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