Nicoletta Aimonino Ricauda

Substitutive “Hospital at Home” Versus Inpatient Care for Elderly Patients with Exacerbations of Chronic Obstructive Pulmonary Disease: A Prospective Randomized, Controlled Trial

OBJECTIVES: To evaluate hospital readmission rates and mortality at 6‐month follow‐up in selected elderly patients with acute exacerbation of chronic obstructive pulmonary disease (COPD).

Hospital at Home for Elderly Patients With Acute Decompensation of Chronic Heart Failure A Prospective Randomized Controlled Trial

BACKGROUND Although the hospital is the standard venue for short-term medical care, it may be hazardous for older persons. This study was performed to evaluate the feasibility and effectiveness of a physician-led hospital-at-home service for selected elderly patients with acute decompensation of chronic heart failure (CHF). METHODS Prospective, single-blind, randomized controlled trial with 6-month follow-up for patients 75 years or older admitted to the hospital from April 1, 2004, through April 31, 2005, for acute decompensation of CHF. Patients were randomly assigned to the general medical ward (n = 53) or to the Geriatric Home Hospitalization Service (GHHS; n = 48). The GHHS provides diagnostic and therapeutic treatments by hospital health care professionals in the home of the patient. RESULTS Patient mortality at 6 months was 15% in the total sample, without significant differences between the 2 settings of care. The number of subsequent hospital admissions was not statistically different in the 2 groups, but the mean (SD) time to first additional admission was longer for the GHHS patients (84.3 [22.2] days vs 69.8 [36.2] days, P = .02). Only the GHHS patients experienced improvements in depression, nutritional status, and quality-of-life scores. CONCLUSIONS Substitutive hospital-at-home care is a viable alternative to traditional hospital inpatient care for elderly patients with acutely decompensated CHF. This type of care demonstrated clinical feasibility and efficacy in comparison with its alternative. Trial Registration clinicaltrials.gov Identifier: NCT00623571.

Home hospitalization service for acute uncomplicated first ischemic stroke in elderly patients: a randomized trial.

Objectives: To evaluate whether home treatment of elderly patients with acute uncomplicated first ischemic stroke is associated with different mortality rates and clinical outcomes from those of patients treated on a general medical ward (GMW).

Risk factors of functional decline during hospitalization in the oldest old

Background and aims: The number of hospital admissions of the elderly is increasing and hospitalization often leads to functional decline. The aim of this study was to identify major risk factors for functional decline in the hospitalized oldest old. Methods: Prospective, observational, non-randomized study of patients aged ≥80 years, admitted for at least two days to the University Department of Geriatric Medicine of Torino, Italy, between November 2003 and November 2004. For detection of functional decline, the ADL scale was used, referring to the number of dependent ADL. Results: At discharge, ADL mean scores were significantly higher than on admission (2.5±2 vs 2.3±1.9, p<0.001). 23.9% of the sample lost at least one ADL function during hospitalization, and 19.2% were transferred to long-term care, compared with 5.4% of those with no functional decline. Length of hospitalization, neoplasm, low level of albumin and high number of drugs prescribed were associated with functional decline. At multivariate analysis, only in-hospital stay was an independent risk factor for functional decline (RR 1.1 per day of hospitalization, CI 1.03–1.14). Conclusions: Hospitalization of the oldest old increases the risk of functional decline, especially if prolonged. It is important to identify patients at high risk for functional decline after hospital admission.

The RAD-HOME Project: A Pilot Study of Home Delivery of Radiology Services

of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Searles. Acquisition of data: Shapiro. Analysis and interpretation of data: Edwards and Searles. Drafting of the manuscript: Edwards. Critical revision of the manuscript for important intellectual content: Searles and Shapiro. Statistical analysis: Edwards. Financial Disclosure: None reported.

Home management of hematological patients requiring hospital admission

The hospital-at-home service (HHS) could be considered as an alternative to the traditional ward for elderly patients. We aimed at evaluating the home management of elderly people requiring transfusions. The ever-increasing demand on acute hospital services requires alternative methods of delivering all aspects of health care. HHS demonstrated to be as efficacious as a traditional ward for elderly and functionally compromised patients. The method was a retrospective descriptive study enrolling patients needing an hospital admission from 1st January 2007 to 31st December 2007 and reporting an hematological discharges diagnosis as primary or secondary diagnosis. A total of 54 patients were evaluated in this study. Of them, 34 (62.9%) needed a hemocomponent transfusion for a total volume of 112 blood units and 49 platelet pools. Patients requiring at least one blood or platelet transfusion were more functionally compromised and presented a higher level of acute physiology and chronic health evaluation, compared to the non-transfused ones. The conclusion was that hematological subjects mainly the frail ones and functionally highly compromised with acute illnesses could be treated at home as an alternative of the traditional medical ward. This could be the starting point for future studies that will be able to increase the power of hospital-at-home service for this type of patients.

Prevalence, Clinical Correlates, and Use of Glucose-Lowering Drugs among Older Patients with Type 2 Diabetes Living in Long-Term Care Facilities.

Prevalence, clinical correlates, and use of glucose-lowering drugs were comprehensively evaluated among 863 nursing home older patients with diabetes (mean age 82.9 ± 2.1 years): functional dependence and cognitive impairment were present in 84.1% and 68% of patients, respectively, and 66.3% of patients had 2–4 comorbidities. HbA1c values < 7.0% were documented in 54.9% of diabetic; significantly lower HbA1c levels were observed in demented patients than in nondemented subjects. Documented hypoglycemic episodes were reported for 57 patients (6.6%), without significant association with age, functional dependence, cognitive impairment, or HbA1c levels. About one-fifth of older long-term facilities residents have diabetes, with concomitant poor health conditions and high prevalence of cognitive impairment and functional dependence. Roughly three-fourths of these older and frail diabetic patients have HbA1c values lower than optimal, suggesting a potential for hypoglycemic harm especially among patients with severe cognitive impairment.

L'innovazione tecnologica e l'ospedalizzazione a domicilio

Riassunto. I progressi nella riduzione delle dimensioni e nella leggerezza delle tecnologie diagnostiche, l’informa tizzazione, il monitoraggio remoto e le cure a distanza han no migliorato la fattibilita delle cure domiciliari, anche per pazienti in condizioni di salute gravi. Progetti di telemedicina e teleradiologia sono in corso presso l’Ospedalizzazio ne a Domicilio di Torino. Parole chiave. Ospedalizzazione a domicilio, tecnologie domiciliari, telemedicina. Technological advances and hospital-at-home care. Summary. Advances in the miniaturization and portability of diagnostic technologies, information technologies, re mote monitoring, and long-distance care have increased the viability of home-based care, even for patients with se rious conditions. Telemedicine and teleradiology projects are active at the Hospital at Home Service of Torino.

Non-pharmacological prevention of delirium

NISAR AHMED1,∗, SHEILA PAYNE2, SAM H. AHMEDZAI3 1Research Associate, Academic Unit of Supportive Care, School of Medicine and Biomedical Sciences, University of Sheffield, Sykes House, Little Common Lane, Sheffield S11 9NE, UK Email: n.ahmed@sheffield.ac.uk 2Help the Hospices Chair in Hospice Studies, International Observatory on End of Life Care, Institute for Health Research, Lancaster University, Lancaster LA1 4YT, UK Email: s.a.payne@lancaster.ac.uk 3Professor of Palliative Medicine, Academic Unit of Supportive Care, School of Medicine and Biomedical Sciences, University of Sheffield, K Floor, Beech Hill Road, Sheffield S10 2RX, UK Email: pallmed@sheffield.ac.uk ∗To whom correspondence should be addressed