Health Care Courses of Elderly Hospitalized Patients for Inappropriate Reasons: Qualitative and Economic Analyzes

For almost 17 % of cases patients over 75 years are sent for inappropriate reasons to the emergency unit. They are described as inappropriate hospitalization because they don't require the use of technical platform or diagnostic neither therapeutic procedures under medical supervision. Those are inappropriate because the patient could have a paramedical and social care at home or in more efficient structures. The hospital remains the place of remedy for social and health situations whose resolution was not possible because of a lack of infrastructure available, of patient or his relative information, or a lack of coordination in medico-social establishment. These inappropriate hospitalizations involve an increase of length of stay that enhancing the fragility and vulnerability of the elderly. They have deleterious effects as decompensation, comorbidities and loss of autonomy. Moreover, the suffering of natural or informal caregivers is also an important public health question; Caregivers may have a serious disease resulting from caring their relative. That leads to increase their consumption of health care and medical goods. This comprehensive study will highlight the deficiencies of the actual health care through the analysis of the speech of the different parts involved (main study). Simultaneously, a comparative analysis of the costs of health care will be conducted (economic combined study).

Sex

All

Minimum age

75 Years

Inclusion Criteria:

* Patients 75 years old and older,
* Hospitalized in the emergency or geriatric units of the University Hospital of Besançon for inappropriate reasons according to Appropriate Assessment Protocol criteria,
* With a history of mild to moderate cognitive impairment according to the latest cognitive assessment (HAS 2009),
* Who have expressed no objection towards collecting and processing personal data (health care, health status, demographic and socio-economic characteristics) after information regarding the goals and course of the study.
* Adults under guardianship may be included

For the five patients followed:

* Able to speak French,
* Who have given their written consent to participate in the study after information about the objectives and course of the study (interviews, collection of personal data).

Exclusion Criteria:

\- Patients who have expressed their opposition to collecting and processing personal data.

For the five patients followed:

* Patients with a history of cognitive impairment preventing the semi-structured interview,
* Unable to speak French.