Study Supports Hospital-at-Home Care for Elderly
Patients with Chronic Heart Failure
Hospitals, the standard for providing acute medical
care, may be hazardous for senior citizens with complications, other
adverse events
Sept. 28, 2009 - Hospital-at-home care may be a
practical alternative to traditional hospital inpatient care for elderly
patients with acutely decompensated (suddenly worsening) chronic heart
failure, according to a report in the September 28 issue of Archives
of Internal Medicine, one of the JAMA/Archives journals.
Nearly 7 million Europeans and 5 million North
Americans are affected by chronic heart failure, a progressive and
disabling syndrome, according to background information in the article.
Hospitalization for chronic heart failure for older
patients has increased and occurs in two percent to three percent of
patients over age 85 every year.
In the United States, decompensation (worsening) of
chronic heart failure leads to more than 1 million hospital admissions
per year and a 50 percent risk of subsequent hospitalization within six
months of discharge.
"Although the hospital is the standard venue for
providing acute medical care, it may be hazardous for older persons, who
commonly experience iatrogenic illness (complications due to treatment),
functional decline and other adverse events," According to the report.
The effectiveness of a physician-led
hospital-at-home service for elderly patients with acute decompensation
of chronic heart failure was compared with traditional hospital
inpatient care by Vittoria Tibaldi, M.D., Ph.D., and colleagues at the
University of Torino, San Giovanni Battista Hospital, Torino, Italy.
Patients age 75 or older with decompensation of
chronic heart failure were randomly assigned to either a general medical
ward (53 patients) or to the Geriatric Home Hospitalization Service (48
patients) between April 2004 and April 2005.
The Geriatric Home Hospitalization Service provided
diagnostic and therapeutic treatments by hospital health care
professionals in the home of the patient.
At six months, 15 percent of all patients had died,
with no significant differences between the two groups.
"The number of subsequent hospital admissions was
not statistically different in the two groups, but the mean (average)
time to first additional admission was longer for the Geriatric Home
Hospitalization Service patients (84.3 days vs. 69.8 days). Only the
Geriatric Home Hospitalization Service patients experienced improvements
in depression, nutritional status and quality-of-life scores," the
authors write.
"Recent trends in health care favor alternatives to
traditional acute care in hospitals. These trends include advancement in
telehealth technologies and increased demand for treatment at home," the
authors conclude.
"Further development of hospital-at-home care will
require additional research and dedicated resources to support
dissemination."
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boomers
Sept. 28, 2009 - Hospital-at-home care may be a
practical alternative to traditional hospital inpatient care for elderly
patients with acutely decompensated (suddenly worsening) chronic heart
failure, according to a report in the September 28 issue of Archives
of Internal Medicine, one of the JAMA/Archives journals. 