Older patients with both acute and long-term conditions can be treated safely and effectively in “hospital at home” style setting that avoid full admission, according to UK researchers.
Their study follows widespread acknowledgement that more treatment is needed in community settings to take the pressure of hospitals.
“Making a decision to admit an older patient can be difficult”
There has been a 65% increase in hospital admissions in England for those over 75 in the last decade and patients over 85 now account for 11% of emergency admissions and 25% of bed days.
The rise in numbers has been complicated by the fact that, while for some older people the decision to admit is straightforward, for others it is uncertain, noted the review’s authors.
The researchers, from Bristol University and the University of the West of England, reviewed evidence on alternative options to admitting patients aged over 65 to hospital. They looked at 19 studies and eight systematic reviews published between 2010 and 2015.
They concluded that treatment hospital at home, admission to a local community hospital or extended stays and treatment in accident and emergency were a “viable option”.
The researchers looked at mortality and clinical outcomes for patients with conditions such as chronic obstructive pulmonary disease, stroke, heart failure, pulmonary embolism and pneumonia.
They found that, with the exception of stroke, the five alternatives they looked at were safe and could often be more cost-effective than acute hospital care.
In line with National Institute for Health and Care Excellence guidance, the needs of stroke patients were found to be best dealt in specialist units, said the researchers.
The five options they assessed were:
- Interventions initiated by paramedics and other 999 ambulance staff
- Alternatives delivered in hospital A&E departments
- Admission to a local community hospital
- Hospital-type services delivered in the patient’s own home
- Hospital-type services delivered in a nursing or care home
A report on the findings, published today, said: “Alternative care to hospital at the point of potential acute admission for the population over 65 years is broadly safe with comparable mortality and clinical outcomes for a range of acute and chronic conditions.”
The report authors noted that the majority of studies in the review provided “little or no cost data”, making it difficult to compare acute hospital admission and care at home. In addition, the review did not include either patient or health professional views of alternatives to hospital admissions.
It stated: ”Whilst there is evidence that patients don’t want to go into hospital and prefer to be at home, conversely there is evidence that patients and carers expect an admission to hospital if they are very ill or have a sudden deterioration in their health.
“In terms of health professionals, making a decision to admit an older patient can be difficult,” it said. “This is illustrated by the study populations and the clinical guidelines, which reflect professional experience and are influenced by broader factors such as living conditions and individual/family/carer coping.
‘Hospital at home’ approach is safe and effective
“If alternatives to acute admission are available for health professionals to refer to they have be confident in these alternative pathways for their patients,” the report noted.
Senior review author Professor Sarah Purdy, associate dean of Bristol’s health sciences faculty, added: “Reducing unnecessary hospital admission and consequent length of stay is one of the biggest challenges currently facing the NHS.
“Our research has helped identify the difficulties of admitting older people appropriately into hospital,” she said.
The study was funded by the National Institute for Health Research, which itself is funded by the Department of Health in order to improve the health and wealth of the nation through research.