The discharge plan promotes continued improvement in a person’s mental health through psychological intervention, medication, physical activity, social connection, and regular contact with the patient’s GP.
A discharge plan must address issues such as the risk of self-harm and self-neglect, non-compliance with diet and medication instructions1, low social supports and limitations in daily activities.2
Discharge planning should involve educating the older person, family and carers and identifying strategies to enhance recovery. Provide patients and families or carers with information about depression and staying well.
In addition to referring to the patient’s GP, consider the following referrals:
- Aged Care Assessment Service for follow up in the community
- planned activity groups and local councils, neighbourhood houses, libraries, churches and men’s sheds to enhance opportunities for social connection based on patient's interests
- community supports such as Home and Community Care (HACC) and Meals on Wheels
- psychologist, psychiatrist, old age psychiatrist or aged psychiatric team.
If the patient is at risk of developing depression post discharge, monitoring (via the GP) is important.
1. Albrecht, J.S., et al., Hospital discharge instructions: Comprehension and compliance among older adults. J Gen Intern Med, 2014. 29(11): pp. 1491-1498.
2. Ciro, C.A., et al., Patterns and correlates of depression in hospitalized older adults. Arch Gerontol Geriatr, 2012. 54(1): pp. 202-205.
Reviewed 05 October 2015