Debulking the Myth of the ‘Social’ Admission – A Retrospective Review of Acutely Admitted Medical Patients in Wexford General Hospital

Abstract Background “Acopia”, “social admission” and other synonymous terms are frequently provided reasons requiring admission to acute hospitals and represent a common encounter for the Geriatric clinician. These cases are usually so called when the patient’s social circumstances are felt to need urgent attention, yet their medical health has not acutely deteriorated. Such non-diagnostic labels often mask underlying complex medical issues which can have detrimental health outcomes if not addressed appropriately. Despite this, they persist in the vernacular of modern medicine with almost half of doctors, junior and senior, finding the term useful (43.5%) and acceptable as a diagnosis (30.9%)1. We sought to examine what percentage of adult medical patients admitted to an acute hospital did not have an appreciable medical cause for their presentation. Methods We conducted a retrospective review of 191 patients admitted under medical teams in Wexford General Hospital across a 13-day period. Inclusion criteria included adult patients admitted under a medical team from the Emergency Department. Exclusion criteria applied to any patient admitted from OPD or by non-medical specialities. Results 191 cases were analysed. The average age was 65.8, median age was 70 and majority were male (n=105, 55%). There were only 2 patients (1%) who had no acute medical concerns following medical review. In one, the patient’s home oxygen supply had run out and the intended delivery of oxygen had been delayed. Another patient required increased home care supports however their medical status had not changed. Conclusion Our findings suggest that most patients presenting to acute hospitals following a robust medical review will evidence an acute medical issue. Dismissive phrases such as “acopia” and “social admission” need to be challenged for the superficial assessment that they are, and this reductive approach must be expunged from clinical practice to avoid misdiagnosis and malpractice in the care of the older adult.