We agree with Manthorpe’s (2009) commentary on Bauer et al. (2009) that hospital discharge of frail older people is an area that urgently requires attention. Improvements in discharge planning can make a significant difference to the outcomes for frail older people and their family carers as they pass through the health care system and/or return to their own homes. It is well known that the complexity of health care increases as people age. In Australia, 99% of persons aged 65 and over report one or more long-term medical conditions (Australian Bureau of Statistics 2006).
We use the term ‘frail’ to refer to older people who are no longer able, fully and adequately, to care for themselves because of either normal age-related changes in the body, which impair functional ability, or one or more medical conditions which, similarly, can impede activities of daily living. We acknowledge that such restrictions in activity levels can of course also occur with a disability at any age (Australian Institute of Health and Welfare 2004), and a focus on hospital discharge practices as they relate to younger people with disabilities and their carers is an area that warrants future exploration.
Competent discharge planning is more important now than it has ever been. The increase in the ageing population will have an impact on the demand for hospital care and the need for improved levels of service provision for frail older people and their family carers. Older people are the biggest users of hospital health care for acute episodic care, and the length of stay in hospital increases with age. A census snapshot conducted at the night of 30 June 2004 found that 53% of people in hospital were 65 years of age and over (Australian Institute of Health and Welfare 2007). The extended period of recovery required by older people has led to the label of ‘bed blocker’ to describe the impact on hospital bed turnover.
We know that the burden of supporting frail older people is primarily borne by the ‘family’, typically a spouse or child, but friends sometimes also assume this role (Australian Institute of Health and Welfare 2004). Traditionally, family carers have been women, and it is noteworthy that approximately 20% are over the age of 65 themselves with one in 10 also suffering from a significant restriction in self-care ability, communication or mobility (Australian Institute of Health and Welfare 2004). Caring for someone with dementia is even more burdensome and challenging than caring for someone with chronic medical conditions or other disabilities (Access Economics 2009). For the person with dementia, the supportive role that the family carer plays is pivotal in the maintenance of quality of life.
An increase in the rate of divorce and separation among the ageing baby boomer generation, step children and older same sex couples may well recast traditional family carer roles in a totally new light and provide health care professionals with new challenges when it comes to working with ‘families’.
Poor discharge outcomes add to family carers’ stress. Hospitals need to give discharge policies, processes and procedures greater attention. In times of fiscal restraint, this will be challenging, and research on the exploration of innovative strategies, including new family care models for discharge planning, is the recommended one we intend to pursue. Changes to discharge planning practices need to centre on hospital systems, ways of better engaging with the family carer and the education and training of hospital health care professionals to be more responsive to the needs of family carers.