Early supported discharge for elderly trauma patients: a report on a preliminary study

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Abstract
To cope with increasing numbers of elderly patients in acute orthopaedic units, various schemes have been introduced to expedite early rehabilitation and discharge. This paper reports a study undertaken in a large Scottish teaching hospital in order to assess the potential and requirements for a local scheme of early supported discharge for elderly trauma patients. Over a four-month period, data were collected from and about elderly patients (70+) admitted from home to the orthopaedic unit (overall sample of 282, detailed subsample of 100). Existing arrangements were shown to allow the apparently satisfactory direct discharge home of a substantial proportion (45%) of these patients in spite of their age (mean 80.2 years) and the fact that previous frailty was common and many (59%) lived alone. Findings of the study suggested that the number of discharges directly home could be increased with improved early rehabilitation, better pain control, systematic discharge planning, occupational therapy input and stronger links between the orthopaedic ward and the community services. Early clinical predictions of individual potential for direct discharge were unreliable. In a Scheme of Early Supported Discharge now in operation following the preliminary study, all patients admitted directly from home are considered.

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