Studies of the elderly in hospitals and homes.

A cross-sectional study of all elderly (65 years and over) people in institutional care in Leicestershire in December of 1979 undertook an assessment of level of incapacity and suitability of placement. Comparisons were made with a similar study exactly three years previously. Follow-up of the earlier population yielded data on outcome at three years and was supplemented by a shorter follow-up of the 1979 population which gave information for that spell of care. Incapacity was greatest in geriatric hospitals and more recently admitted psychiatric hospital patients and least in homes for the elderly, although there the absolute numbers of highly incapacitated people were large. Misplacement was associated with high incapacity in homes for the elderly and low in geriatric and psychiatric hospitals. In acute wards greater age appeared to be more important in determining whether patients were judged as misplaced. More of the very elderly population were in residential homes and less in geriatric beds in 1979 compared to 1976. Higher proportions of all elderly age-groups were in acute beds and between the two study periods, additional acute beds were opened. Overall, levels of incapacity increased but in more recent admissions significant increases were only seen in geriatric hospital patients. Between 60 and 80% of continuously resident survivors remained unchanged whilst three to four times as many deteriorated as improved. Change and deterioration occurred with increasing age. After adjustment for differences in important variables, patients in geriatric and psychiatric hospitals deteriorated to a similar and significantly greater extent than their counterparts in residential homes. Increasing incapacity strongly and consistently affected survival adversely. With the exception of private nursing homes, after adjustment for differences in age and level of incapacity, survival for the populations in different types of care was similar. Policy implications, particularly the roles and relationships between different forms of institutional care are discussed.