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IIAGG 2017 World Congress
Background: Nursing home (NH) residents with demen-
tia exhibit challenging behaviors or resistiveness to care
(RTC) that increase staff time, stress, and NH costs. RTC
is linked to elderspeak communication. Communication
training (CHAT) was provided to staff to reduce their use
of elderspeak.
Hypothesis: We hypothesized that CHAT would improve
staff communication and subsequently reduce RTC.
Methods: Thirteen NHs were randomized to intervention
and control groups. Dyads (n= 42) including 29 staff and
27 persons with dementia (PWD) were videorecorded dur-
ing care before and/or after the intervention, and at a three
month follow-up. Videos were behaviorally coded for 1)staff
communication (normal, elderspeak, or silence) and 2)resi-
dent behaviors (cooperative or RTC). Linear mixed modeling
was used to evaluate training effects.
Results: On average elderspeak declined from 34.6%
(SD=18.7) at baseline by 13.6 percentage points (SD=20.00)
post-intervention and 12.2 percentage points (SD=22.0) at
3-month follow-up. RTC declined from 35.7% (SD=23.2)
by 15.3 percentage points (SD = 32.4) post-intervention
and 13.4 percentage points (SD=33.7) at 3-months. Linear
mixed modeling determined that change in elderspeak was
predicted by the intervention (b=-12.20, p=.028) and base-
line elderspeak (b=-0.65, p < .001) while RTC change was
predicted by elderspeak change (b=0.43, p < .001); baseline
RTC (b=-0.58, p < .001); and covariates.
Conclusions: Abrief intervention can improve communi-
cation and reduce RTC, providing an effective nonpharma-
cological intervention to manage behavior and improve the
quality of dementia care. No adverse events occurred.
SESSION 4625 (SYMPOSIUM)
HOSPITAL AT HOME-A DELIVERY MODEL FOR 21ST
CENTURY GERIATRICS CARE
Chair: J.M.Jacobs, Hadassah-Hebrew University Hospital,
Jerusalem, Israel
Co-Chair: G.Caplan, Prince of Wales Hospital
The primary purpose of Hospital at Home (HaH) is to
enable the delivery of complex care at home as an alternative
to in-patient care. Traditional in-patient care for older people
frequently has numerous negative repercussions, and the ris-
ing number of HaH models from different Healthcare systems
bears witness to this developing niche in health care deliv-
ery. Compared to usual hospital care, HaH has proven high
patient satisfaction, quality of care outcomes, and evidence
favors reduced mortality and overall costs. Furthermore,
innovative and available technological advancements are
expanding the range of treatment options available at home,
and facilitating the delivery of care to a wide spectrum of
increasingly more complex patients.
Yet, HaH dissemination has been limited by numerous
barriers, including challenging logistics, bias towards facility-
based care, and lack of payment models. Recent advances in
HaH models seek to ameliorate such barriers, but they still
exist. Moreover, the implementation of HaH on a widespread
basis has not been well described in the research literature.
In addition to a critical review and meta-analysis of cur-
rent literature, this symposium will present innovative models
of HaH providing a wide platform of care for older adults,
and technologies facilitating care for specic patient groups
with acute heart failure, or requiring long term mechanical
ventilation. Challenges facing the implementation of wide-
spread HaH will be addressed.
Understanding the impact of new modes of Hospital at
Home care delivery, and ways at promoting implementation,
is of critical importance to geriatric health service delivery in
the 21st century.
A META-ANALYSIS OF HOSPITAL IN THE HOME
G.Caplan1, N.Sulaiman1, D.Mangin 4, N.Aimonino
Ricauda 2, A.Wilson 3, L.Barclay 1, 1. Department of
Geriatric Medicine, Prince of Wales Hospital, Sydney,
Sydney, New South Wales, Australia, 2. Unit of Geriatrics
and Metabolic Bone Diseases, Molinette Hospital, “AOU
Città della Salute e della Scienza” of Torino;, Torino, Italy,
3. Universtiry of Leicester, Leicester, United Kingdom, 4.
University of Otago, Christchurch, New Zealand
This meta-analysis of Hospital- in-the-Home (HITH)
compared to in-hospital care identied 61 Randomised
Controlled Trials from MEDLINE, Embase, Social Sciences
Citation Index, CINAHL, EconLit, PsycINFO and the
Cochrane Database of Systematic Reviews. HITH care led
to reduced mortality (odds ratio [OR] 0.81;95% CI, 0.69
to 0.95;p = 0.008; 42 RCTs; 6992 patients), readmission
rates (OR 0.75;95% CI,0.59 to 0.95;p = 0.02; 41 RCTs;
5372 patients) and cost (mean-difference 1567.11; 95% CI,
2069.53 to 1064.69; p < 0.001; 11 RCTs; 1215 patients).
The number needed to treat at home to prevent one death
was 50. Mortality data was homogenous, but heterogene-
ity was observed for readmission rates and cost. HITH had
higher patient and carer satisfaction (21/ 22; 6/8 studies
respectively); carer burden was nonsignicantly lower (8/11
studies).
HITH is associated with reductions in mortality, readmis-
sion rates and cost, and increases in patient and carer satis-
faction, but no change in carer burden.
THE HOSPITAL AT HOME/MACT ‘PLATFORM’
MODEL—A SPECTRUM OF FACILITY-LEVEL CARE
PROVIDED AT HOME
B.A.Leff1, L.De Cherrie2, A.Wajnberg2, A.Federman2,
T. Soones2, A.Brody3, A.Siu2, 1. Johns Hopkins University
School of Medicine, Baltimore, Maryland, 2. Icahn School
of Medicine, Mount Sinai, New York, New York, 3. New
York University, New York, New York
To date, Hospital at Home (HaH) care has focused on
substitutive admission avoidance or early discharge models.
In the context of a U.S. Federal innovation award program
for the Center for Medicare and Medicaid Services, we have
evolved the HaH model into a care “platform” for older
adults. In addition to providing substitutive admission avoid-
ance care, the platform includes: 1) “observation” stay at
home; 2)acute palliative care at home; 3)acute care for hos-
pital adverse patients (people who refuse hospital admission
under all circumstances) at home; and 4)subacute rehabilita-
tion care at home as a substitute for admission to inpatient
subacute rehabilitation. This platform evolved in recognition
of the evolving health care delivery system, the need to create
greater demand for HaH resources, provide adequate patient
Innovation in Aging, 2 0 1 7, Vol. 1, No. S1
1246
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