Psychological Impact of Hospital Discharge on the Older Person: A Systematic Review.

Abstract

Introduction: Hospitalisation and prolonged length of stay is associated with deconditioning that risks adverse outcomes after discharge. Less is known about the psychological impact on older people after hospital discharge. The purpose of this systematic review was to elucidate factors contributing to psychological stress in older patients post-discharge to inform better discharge planning. Methods: A systematic search for studies reporting poor discharge outcomes in older people between 2010 and 2022 was performed in Medline, CINAHL, and PsycINFO. Search terms were 'older patients > 65 year', 'post-discharge', 'psychological distress', 'loneliness', 'anxiety', 'depression', and 'length of hospital stay'. Exclusion criteria included COVID-19 disease, dementia (±severe cognitive impairment), individuals aged <65, and those under palliative care services. Results: A total of 1666 records were identified, of which 878 were excluded as they were outside of our date limits or were not written in the English language, 681 were excluded after application of exclusion criteria, and 699 were excluded because of insufficient details. A total of 31 duplicates were removed, leaving 38 articles that were assessed for eligibility; 7 of these reports were found suitable, comprising 1131 patients. Three highly relevant themes identified relating to post-discharge outcomes were social isolation, lack of support, depression and anxiety. Older patients with a tendency toward depressive symptoms had an increased likelihood of death. Conclusions: It appears that the discharge process from hospital fails to address psychological factors that permit a successful transition from hospital. Pre-discharge screening of psychological symptoms and coping ability may assist in identifying older patients who are at risk of mental as well as subsequent physical deterioration. Better knowledge of positive and negative predictors of a successful transition from hospital to home would enable more holistic, effective, and inclusive discharge planning processes for older adults.