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Eldercare Review | Monday, October 03, 2022
At first sight, it might appear obvious that a hospital would be in the best position to look after someone, but there is proof that this may not be the case.
FREMONT, CA: The increasing elderly population is one of the biggest questions. Older people are being admitted to hospitals increasingly, putting rising pressure on an already stretched service confronting ever tighter budgets.
In an emergency, like a fall or sudden illness, doctors may suggest that a frail older person should be admitted to the hospital. But there are worries that this may not present the right sort of care that they require.
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The challenge
Not just is the number of older people in the population increasing. Still, they also have tough health needs – along with physical frailty, reduced mental ability (cognitive decline), and dementia – along with any long-term health conditions.
Nearly two-thirds of the people admitted into hospitals are over 65 years old, and a growing number are frail or have dementia. At the same time, there are third fewer hospital emergency beds than 25 years ago, although these admissions grow at a rate of 2 to 3% every year. The numbers just don’t add up.
One way to cope with this issue is to reduce the time people stay in the hospital, but this duration is growing for people over 85. Working out how to decode this issue is a major worry for the 21st century if we want to offer the best healthcare for as many people as possible with pride, respect, and compassion.
Home or hospital – the evidence
At first sight, it might appear obvious that a hospital would be in the best position to look after someone, but there is proof that this may not be the case.
Small studies have indicated that admitting frail older people to the hospital can decrease their physical ability. There’s also a chance of picking a hospital-acquired infection, which can reason serious complications or even death. And if someone is already getting regular care at home, sending someone to the hospital can interrupt the relationship with their carer. This bond can be hard to re-establish.
Older people are also at a considerably increased risk of expanding a condition named delirium if admitted to the hospital. A little-known but normal condition in the elderly, delirium is a state of acute confusion. It can have serious effects, like expediting or triggering dementia, and usually causes people to spend a long time in hospital and eventually wind up in residential care. It’s not familiar exactly why hospital admissions should lead to delirium. Still, the unfamiliar and stressful surroundings of the ward and the loss of a comforting home routine doubtless play a part.
There are also financial and personal costs associated with hospital care. Keeping people in hospital is costly, and over 85 account for a quarter of every bed day in the NHS. Preventing this would be better for older people, reducing admission to residential care, keeping people at home longer, and saving money.
By other means, some health authorities provide something called a ‘Hospital at Home with Comprehensive Geriatric Assessment (CGA)’ – efficiently taking the hospital to the patient in lieu of taking the patient to the hospital. Rather than admitting an elderly person into the hospital after a fall or unexpected illness, a multidisciplinary team of experts – along with specialist nurses, a physiotherapist, an occupational therapist, and other professionals like psychiatrists, speech therapists, dieticians, and social workers – will analyze the patient’s individual health requirements and work out a plan for delivering proper care in their own home. Of course, they can always be admitted to a hospital if required, and they still have access to their general GP and local care.
Generally, there seems to be the least risk of death six months after a drop or sudden sickness for people who are cared for in their own homes in this method, compared with those who are admitted to a hospital, although this has just been shown in small research studies. So it’s still unclear whether Hospital at Home can impact outcomes.
Making a difference
The Hospital at Home study is important to evidence-based healthcare, planning, and policy. People aren’t easy, and providing healthcare for a complete population is a hard problem with limited budgets and a complicated system. So we urgently need research like this to determine what best to do.
Politicians and healthcare chiefs must employ public money well but with kindness, dignity, and respect, putting patients at the core of the NHS.
The Hospital at Home trial doesn’t just regard the potential economic advantages. It could be better for patients, their families, carers, and medical personnel. And if you ask them, most older people want to live in their own homes as long as possible.
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