Objective: To assess the feasibility of home hospitalization for elderly patients with advanced dementia and a relevant degree of comorbidity and to identify benefits of this care setting compared with general medical care in reducing behavioral problems and use of anti-psychotic drugs.
Design: Randomized controlled trial.
Materials and Methods: The study was conducted on 109 elderly patients (mean age 83.5 years) with advanced dementia, requiring admission to Hospital Emergency Department for acute illnesses. Patients were randomly assigned to Geriatric Home Hospitalization Service-GHHS (56 patients) and to General Medical Ward-GMW (53 patients). GHHS allows to perform diagnostic and therapeutic interventions, which are usually made in hospital, also at home. GHHS has also an important role in health education, training, counselling and supervision of family caregiver. The GHHS team includes geriatricians, nurses, physiotherapists, social workers and counselors. Both groups were examined using the same protocol and were evaluated on admission and on discharge. The study protocol included: demographic characteristics (age, gender, education, marital status), comorbidity (assessed by Cumulative Illness Rating Scale-CIRS), duration and type of dementia, severity of dementia (assessed by Clinical Dementia Rating scale-CDR), behavioral disturbances (assessed by a modified version of the Neuropsychiatric Inventory-NPI), nutritional status, functional status (assessed by Activities of Daily Living- ADL and Instrumental Activities od Daily Living-IADL) and cognitive status (assessed by Short Portable Mental Status Questionnaire-SPMSQ).
Results: Demographic characteristics, comorbidity, duration, type and severity of dementia, behavioral disturbances, nutritional, functional and cognitive status on admission were not different in both groups. Length of stay was similar in two groups: 27.6±9.2 days in GHHS and 25.1±22.2 days in GMW. Mortality of total sample was 19.3%, with no significant difference in the two settings of care. During admission to hospital we found a greater number of patients with agitation, aggressiveness, feeding and sleep disturbances in GMW group than in GHHS group. Indeed, on discharge the use of antipsychotic drugs was significantly reduced in GHHS patients (p<0.001) and not in the control group.
Conclusion: Our study suggest that GHHS is a feasible care method, alternative to hospitalization of patients with advanced dementia. When treated at home, patients do not have to change their environment or routine and psychiatric symptoms, especially insomnia, psychosis, agitation and aggressiveness, are less represented.
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