Geriatric Discharge

On my recent geriatric placement, as with most placements, a major role of physiotherapy was to organise and plan a safe discharge destination. For many of the patients on this ward, physical ability and functional status were not the only aspects that needed to be considered. One patient in particular I met as a readmission. She had been initially admitted to this rehab hospital with a history of small subdural bleeds with had affected her balance and motor control mildly. She was rehabilitated on her first visit and discharged home performing all functions independantly and ambulating nil aids upwards of 200m. Unfortunatly after a week of being home alone it became clear to her family that she was not coping and seemed very confused. She had begun doing things such as putting sheets in the fridge and forgetting where she had put her keys, locking herself in the house. Eventually the patient had a fall and was readmitted



On readmission I carried out her initial assessment, finding that she had very high function and her main impariments were decreased saving reactions when responding to external forces and decreased quads strength on the r) ( grade 4). After the inital assessment the patient was ambulating independantly on the ward and performing all ADL's independantly. Unfortunatly, in light of her failed discharge and possible perceptual problems, discharge home was not looking to be a feasible option and hostel discharge was the most likely outcome. Once this was decided, the issues was discussed with the patient, she was not enthusistic, however she did understand the situation. Unfortunatly, while awaiting placement the patient developed dual incontinence, secondary to bowel loading. While this was incredibly embarrasing for the patient, who is very independant, it also meant she was not suitable for discharge to hostel and instead would have to go to a nursing home.

I finished my placement before the patient was discharged and as such I do not know the outcome of this situation, however I feel that if this patient does end up in a nursing home then it is a very unfortunate ending. She is very independant and would feel very out of place in a nursing home. Unfortunately there is so many variables when it comes to discharging a patient and sometimes the safest option is not always the nicest option for the patient. I felt looking after this patient helped me develop and understanding of the sensitive issues we face when plannign discharges for our patienst and being aware of all aspects of their care.