Dementia, Cognition disorders, Central Nervous System Diseases, Aged, Home Care Services
Conditions
Interventions
After informed consent is obtained, the participant completes two brief cognitive tests and participant and caregiver complete the baseline assessment. Subsequently, randomization takes place to eithe
translocation of care from the hospital to a participants’ home or (b) Control
usual hospital care. In case of nonparticipation, reasons for declination, date of birth, sex and the presence of a caregiver are reported, if possible.
Participants allocated to Hospital at Home w
Sponsors
University of Groningen, University Medical Center Groningen, University Center for Geriatric Medicine, Groningen, The Netherlands
Eligibility
Inclusion criteria
Inclusion criteria: 1. Age ≥ 65 years 2. Cognitive impairment; dementia, delirium or other cause of cognitive impairment, either previously diagnosed, documented in medical record or;Identified by the ED-clinician (e.g. with the IQCODE-sf, 4AT-test and/or Short Blessed Test or another screening test of choice) 3. Presentation at the ED with a defined acute illness 4. Felt to require hospital admission by attending ED physician, but not expected to require emergency interventions o Modified Early Warning Score (MEWS) ≤ 2 points 5. Living in hospital’s catchment area (< 25 km) 6. Informal caregiver is present and able to understand and perform instructions and consented to participate in the trial 7. Home suitable for hospital at home care (available informal caregiver, running water, adequate heating, safety)
Exclusion criteria
Exclusion criteria: 1. Previously enrolled 2. Hospitalized within 7 days preceding ED presentation 3. Nursing home residents or awaiting a nursing home place on an active waiting list (excluding so called sleeping waiting list candidates) 4. Need for surgical assessment 5. Suspected acute coronary syndrome or cardiac arrythmia 6. Dialysis dependent patients 7. Expected terminal events or in need of palliative care due to oncological illness 8. Acute illness requiring hospital admission independent of the target diagnosis of presentation
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Participation rates, reasons for non-participation and data on characteristics of non-participants will be collected. Quality of care will be measured by collecting data on mortality, institutionalization (e.g. to hospital or nursing home), ADL-functioning, prevalence of hospital-associated geriatric syndromes, the length of stay in hospital or in Hospital at Home care program and the contact with health care professionals. | — |
Secondary
| Measure | Time frame |
|---|---|
| Advantages and disadvantages of the Hospital at Home care program will be assessed. Additional data will be collected on the time spent at home (home-time); total number of days alive and out of the hospital or a skilled nursing facility in the 6 months after the randomization at the emergency department, the number of transfers (home ↔ hospital) and the number of health care professionals involved. Data on costs will be collected as described by Drummond et al.; costs within health care system, costs to patient and family, costs in other sectors. | — |
Contacts
Public ContactM.A. Pouw
University Center of Geriatric Medicine, University Medical Center Groningen
Outcome results
None listed