delirium Dementia
Conditions
Interventions
When hospital admission is indicated after a visit to the emergency department,
eligible patients with informed consent will be randomized to receive hospital
care in their own home (H@H-care) or us
Sponsors
Universitair Medisch Centrum Groningen
Eligibility
Age
18 Years to 99 Years
Inclusion criteria
Inclusion criteria: > Age >= 65yr > Established dementia, delirium or other cause of cognitive impairment present Previously diagnosed or; Confirmed with the IQCODE-sf (family) or in a patient by the 4AT-test31 and/or Short Blessed Test on the ED > Presentation with a defined acute illness > Felt to require hospital admission by attending ED physician, but not expected to require emergency interventions MEWS Living in hospital catchment area > Ambulatory ability 24hrs prior to ED presentation > Informal caregiver present, able to understand and perform instructions > Appropriate home circumstances (running water, adequate heating, safety)
Exclusion criteria
Exclusion criteria: - Need for medium or intensive care, based on MEWS-score and clinician judgment > Cut-off value emergency scores: MEWS >=3 / VIEWS >7 - Need for surgical assessment - Hospitalized within 7 days preceding ED presentation - Nursing home residents or awaiting a nursing home place on an active waiting list (excluding so called sleeping waiting list candidates) - Suspected acute coronary syndrome or cardiac arrythmia - Dialysis dependent patients - Expected terminal events or in need of palliative care due to oncological illness - Acute illness requiring hospital admission independent of the target diagnosis of presentation
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| The main study parameters are the participation rate of the H@H trial among patients 65 years and older with cognitive impairment at the ED and the reasons for non-participation. | — |
Secondary
| Measure | Time frame |
|---|---|
| Furthermore the different steps in the H@H care process will be timed and evaluated and if the quality of H@H care differs from usual hospital care will be studied. In addition we investigate advantages and disadvantages of H@H care and usual hospital care with regards to: time spent at home, number of transfers needed, number of health care professionals involved, (medical) equipment needed, functional status (ADL), health status, (health related) quality of life and costs. | — |
Countries
Netherlands
Outcome results
None listed