Study to examine the impact of hospital transfers on older adults
When someone is ill or injured in a rural or island community, they are often transferred to a larger medical center for more specialized care, sometimes many hours away. These transfers can be necessary for patients of all ages. Still, emergency medicine physician Dr. Kathy Li notes that transfers of older adults may carry additional risks that are not always fully considered.
Older adults often face complications that younger patients rarely encounter. Even short disruptions to routine can increase the risk of delirium, in-hospital falls, and functional decline. Many also rely on neighbors or friends for help with transportation or daily needs, and that support becomes much harder to coordinate when a patient is sent far from home.
Not every transfer is necessary, either. While many are medically justified and ultimately beneficial, some older adults travel long distances only to find that no hospitalization or specialty procedure is needed. After seeing these challenges firsthand, Li is launching a new study supported by the National Institute on Aging (NIA) to understand how often these transfers lead to unrecognized complications.
“Once that patient is stable and ready to be discharged, they now have to figure out their own way home,” explained Li. “If they don’t have someone to help navigate this situation, or who can pick them up right away, we may have to admit the patient to the hospital. And that is where the problems can start.”
If an older adult ends up needing rehabilitation or nursing home care, the closest available spot may be near the receiving hospital, not back in their own community. That can keep them away from their usual support system and make it take longer to get home.
“Had the patient been able to stay at their own hospital, they would be more likely to go to a nursing home closer to home,” said Li. “We don’t yet know what effect that distance from home has — but understanding those consequences is what I want to find out.”
Li’s study will use Washington state data and patient interviews to understand what older adults experience before, during, and after a transfer. Her team will examine hospital and emergency department records to compare outcomes for older adults who were transferred with those who were not. They will focus on delirium, in-hospital falls, hospital length of stay, and the frequency of patients requiring rehabilitation or nursing home care.
The team will also speak directly with older adults who were transferred, their caregivers, rural physicians who initiate transfers, and the specialists who receive them. These conversations will help capture the emotional, logistical, and financial challenges that patients and families face throughout the process.
Li hopes the findings will support better shared decision-making around transfers. One potential future approach could be a telehealth consultation before transfer, which would help patients and their families understand their options more clearly.
“Patients deserve to know the risks and benefits so they can decide for themselves whether a transfer makes sense,” said Li.
The project will unfold over the next two years, with early insights expected within the first year.
