Hospital at Home Care for Older Patients with Cognitive Impairment: a Protocol for a Randomised Controlled Feasibility Trial

Overview

Journal BMJ Open

Specialty General Medicine

Date 2018 Mar 30

PMID 29593022

Citations 10

Authors

Maaike A Pouw

Agneta H Calf

Barbara C van Munster

Jan C Ter Maaten

Nynke Smidt

Sophia E de Rooij

Affiliations

Soon will be listed here.

Abstract

Introduction: An acute hospital admission is a stressful life event for older people, particularly for those with cognitive impairment. The hospitalisation is often complicated by hospital-associated geriatric syndromes, including delirium and functional loss, leading to functional decline and nursing home admission. Hospital at Home care aims to avoid hospitalisation-associated adverse outcomes in older patients with cognitive impairment by providing hospital care in the patient's own environment.

Methods And Analysis: This randomised, non-blinded feasibility trial aims to assess the feasibility of conducting a randomised controlled trial in terms of the recruitment, use and acceptability of Hospital at Home care for older patients with cognitive impairment. The quality of care will be evaluated and the advantages and disadvantages of the Hospital at Home care programme compared with usual hospital care. Eligible patients will be randomised either to Hospital at Home care in their own environment or usual hospital care. The intervention consists of hospital level care provided at patients' homes, including visits from healthcare professionals, diagnostics (laboratory tests, blood cultures) and treatment. The control group will receive usual hospital care. Measurements will be conducted at baseline, during admission, at discharge and at 3 and 6 months after the baseline assessment.

Ethics And Dissemination: Institutional ethics approval has been granted. The findings will be disseminated through public lectures, professional and scientific conferences, as well as peer-reviewed journal articles. The study findings will contribute to knowledge on the implementation of Hospital at Home care for older patients with cognitive disorders. The results will be used to inform and support strategies to deliver eligible care to older patients with cognitive impairment.

Trial Registration Number: e020313; Pre-results.

Citing Articles

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References

Gavinski K, Carnahan R, Weckmann M . Validation of the delirium observation screening scale in a hospitalized older population. J Hosp Med. 2016; 11(7):494-7. PMC: 4931982. DOI: 10.1002/jhm.2580. View

Stratton R, Hackston A, Longmore D, Dixon R, Price S, Stroud M . Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the 'malnutrition universal screening tool' ('MUST') for adults. Br J Nutr. 2004; 92(5):799-808. DOI: 10.1079/bjn20041258. View

Krumholz H . Post-hospital syndrome--an acquired, transient condition of generalized risk. N Engl J Med. 2013; 368(2):100-2. PMC: 3688067. DOI: 10.1056/NEJMp1212324. View

Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D . Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011; 20(10):1727-36. PMC: 3220807. DOI: 10.1007/s11136-011-9903-x. View

Macknight C, Rockwood K . A Hierarchical Assessment of Balance and Mobility. Age Ageing. 1995; 24(2):126-30. DOI: 10.1093/ageing/24.2.126. View

Shepperd S, Cradduck-Bamford A, Butler C, Ellis G, Godfrey M, Gray A . A multi-centre randomised trial to compare the effectiveness of geriatrician-led admission avoidance hospital at home versus inpatient admission. Trials. 2017; 18(1):491. PMC: 5653984. DOI: 10.1186/s13063-017-2214-y. View

Dundar Z, Ergin M, Karamercan M, Ayranci K, Colak T, Tuncar A . Modified Early Warning Score and VitalPac Early Warning Score in geriatric patients admitted to emergency department. Eur J Emerg Med. 2015; 23(6):406-412. DOI: 10.1097/MEJ.0000000000000274. View

Ridley S . The recognition and early management of critical illness. Ann R Coll Surg Engl. 2005; 87(5):315-22. PMC: 1963963. DOI: 10.1308/003588405X60669. View

Cei M, Bartolomei C, Mumoli N . In-hospital mortality and morbidity of elderly medical patients can be predicted at admission by the Modified Early Warning Score: a prospective study. Int J Clin Pract. 2009; 63(4):591-5. DOI: 10.1111/j.1742-1241.2008.01986.x. View

10.

Fried T, Bradley E, Towle V, Allore H . Understanding the treatment preferences of seriously ill patients. N Engl J Med. 2002; 346(14):1061-6. DOI: 10.1056/NEJMsa012528. View

11.

Shepperd S, Harwood D, Jenkinson C, Gray A, Vessey M, Morgan P . Randomised controlled trial comparing hospital at home care with inpatient hospital care. I: three month follow up of health outcomes. BMJ. 1998; 316(7147):1786-91. PMC: 28578. DOI: 10.1136/bmj.316.7147.1786. View

12.

Clegg A, Young J, Iliffe S, Rikkert M, Rockwood K . Frailty in elderly people. Lancet. 2013; 381(9868):752-62. PMC: 4098658. DOI: 10.1016/S0140-6736(12)62167-9. View

13.

Mukadam N, Sampson E . A systematic review of the prevalence, associations and outcomes of dementia in older general hospital inpatients. Int Psychogeriatr. 2010; 23(3):344-55. DOI: 10.1017/S1041610210001717. View

14.

Subbe C, Kruger M, Rutherford P, Gemmel L . Validation of a modified Early Warning Score in medical admissions. QJM. 2001; 94(10):521-6. DOI: 10.1093/qjmed/94.10.521. View

15.

Caplan G, Sulaiman N, Mangin D, Aimonino Ricauda N, Wilson A, Barclay L . A meta-analysis of "hospital in the home". Med J Aust. 2012; 197(9):512-9. DOI: 10.5694/mja12.10480. View

16.

van Exel N, Scholte Op Reimer W, Brouwer W, van den Berg B, Koopmanschap M, van den Bos G . Instruments for assessing the burden of informal caregiving for stroke patients in clinical practice: a comparison of CSI, CRA, SCQ and self-rated burden. Clin Rehabil. 2004; 18(2):203-14. DOI: 10.1191/0269215504cr723oa. View

17.

Sullivan D, Sun S, Walls R . Protein-energy undernutrition among elderly hospitalized patients: a prospective study. JAMA. 1999; 281(21):2013-9. DOI: 10.1001/jama.281.21.2013. View

18.

Shepperd S, Iliffe S, Doll H, Clarke M, Kalra L, Wilson A . Admission avoidance hospital at home. Cochrane Database Syst Rev. 2016; 9:CD007491. PMC: 6457791. DOI: 10.1002/14651858.CD007491.pub2. View

19.

Katz S, Ford A, Moskowitz R, Jackson B, JAFFE M . STUDIES OF ILLNESS IN THE AGED. THE INDEX OF ADL: A STANDARDIZED MEASURE OF BIOLOGICAL AND PSYCHOSOCIAL FUNCTION. JAMA. 1963; 185:914-9. DOI: 10.1001/jama.1963.03060120024016. View

20.

Glover A, Bradshaw L, Watson N, Laithwaite E, Goldberg S, Whittamore K . Diagnoses, problems and healthcare interventions amongst older people with an unscheduled hospital admission who have concurrent mental health problems: a prevalence study. BMC Geriatr. 2014; 14:43. PMC: 3992161. DOI: 10.1186/1471-2318-14-43. View