JMIR Publications

ABSTRACT

Background:

Post-acute care services are important to ensure functional recovery and provide adequate care for geriatric inpatients in acute care. The choice between different post-acute care options can be challenging and predictors for the most appropriate among diverse discharge options are warranted.

Objective:

We conducted a scoping review to identify predictors of appropriate discharge destinations for older adults (≥65 years) in acute care transitioning to different post-acute care settings.

Methods:

Databases of Medline, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, CINAHL, and Emcare were systematically searched for English or German literature published until February 25th, 2022. Three researchers screened, extracted and categorized data according to domains, discharge destinations, mean age and health care systems origin. The Jaccard index was calculated to compare the similarity between different possible domain combinations and existing literature.

Results:

Out of 22,382 records screened, 171 quantitative and 10 qualitative studies were included. Examined discharge destinations included nursing home, skilled nursing facility, inpatient rehabilitation, home with or without support, assisted living, early inpatient rehabilitation. Age was the most frequently reported predictor, geriatric syndromes were found more often in the ≥80y old and non-US studies. Top reported predictors for discharge to nursing homes were diagnosed dementia and deficits in instrumental activities of daily living, for discharge to rehabilitation longer length of stay and existent cardiopulmonary disease, and back home without support good activities of daily living and mobility assessments. Among 20 predictor domains eight were most concordant with the literature: Cognitive impairment, ADL, demographics, social support, hospitalization data, multimorbidity, mobility, and primary diagnosis.

Conclusions:

This scoping review provides a comprehensive overview of predictors for appropriate discharge decisions in older adults in acute care, stratified by destination, age, and study origin and the predictor domains most concordant with the literature. Results will be valuable to inform the choice of features for clinical decision support systems including the training of machine learning algorithms.