After the hospital: return home or institutionalization? The general practitioner and the frail elderly patient

Context. One third of dependent elderly patients (EP) live in nursing homes. Entering a nursing home can be a traumatic and undesired event. The general practitioner (GP) plays a central role in the management of an EP's overall care. Aim. To evaluate factors determining entry into nursing homes after hospitalization and to assess the GP views on EPs who return home instead. Methods. Mixed method. Quantitative study, from April to June 2013, of EPs on the geriatric inpatient service. Qualitative study, from June to September 2013, of 16 GP via individual semi-structured interviews. Results. 94 inpatients were included (sex-ratio : 0.48, mean age : 84). 2/3 returned home, 1/4 against geriatricians' advice and 2/3 after refusing to enter a nursing home. 1/3 were institutionalized, 14% without their consent. Malnutrition (p=0.024), cognitive decline (p=0.007) and male gender (p=0.014) favored nursing home entry. 16 GPs were interviewed. Strong caregiver presence was essential for home care, while caregiver exhaustion favored nursing home entry. Multiple factors, including a GP's overall negative view of nursing homes, made nursing home entry more complex. An improvement in nursing home structures and quality of care was expected. Conclusion. Decision making for an EP's entry into a nursing home is complex. This process could be improved by improving the nursing homes and their reputations, better engaging the EP and family during this process, and strengthening the communication between the various actors