3661 Using data linkage to identify predictors of care home entry after psychiatric hospital discharge: a retrospective cohort study

Abstract Background Pathways into care homes represent a critical yet under-researched aspect of decision-making for individuals, families, and professionals. Prior research links recent psychiatric hospital discharge to higher risk of care home entry from hospital. This retrospective cohort study used linked health and care home data to identify predictors of care home admission following psychiatric hospital discharge within the previous six months. Methods We included adults moving-in to care homes between 1/4/13 and 31/3/16, recorded in the Scottish Care Home Census. Data were linked to inpatient stays, community prescribing, and mortality records to identify diagnoses, comorbidities, polypharmacy, frailty, healthcare use, and deaths. Regression models identified predictors of care home entry following recent (within six months) psychiatric hospital discharge compared to those without. Results Following adjustment, individuals entering a care home after a recent psychiatric hospital discharge were more likely to be male (OR 1.60, 95%CI 1.43–1.78), and of a younger age. A hospital diagnosis of any fracture within the past three years (OR 1.90, 95%CI 1.48–2.44), or dementia within the past six months (OR 1.31, 95%CI 1.11–1.55) were significant predictors of moving-in after psychiatric hospital discharge. Furthermore, combined psychiatry and hospital diagnoses three years before moving-in of delirium (OR 1.75, 95%CI 1.38–2.21), dementia (OR 9.05, 95%CI 7.51–10.91), depression (OR 3.97, 95%CI 3.29–4.79), or mental and behavioural disorders due to alcohol (OR 2.10, 95%CI 1.71–2.58) were significant predictors of moving-in to a care home after a psychiatric hospital discharge. Conclusions This study identifies important differences in the individuals entering care homes after a psychiatric hospital discharge compared to those with non-psychiatric backgrounds. These provide useful insights to a complex clinical population which can guide more supportive practices. Further exploration involving staff, carers, and patients could help shape more informed pathways from psychiatric settings into care homes.