Acute ischemic stroke in elderly patients treated in Hospital at Home: a cost minimization analysis.

Università degli Studi di Torino, Torino, Piedmont, Italy
Journal of the American Geriatrics Society (Impact Factor: 4.57). 09/2005; 53(8):1442-3. DOI: 10.1111/j.1532-5415.2005.53433_5.x
Source: PubMed
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    ABSTRACT: Riassunto. Lo scompenso cardiaco è un importante e cre-scente problema di sanità pubblica che colpisce circa 10 mi-lioni di Europei e 5 milioni di Nord Americani. L'ospedaliz-zazione a domicilio, definita come la «modalità attraverso cui le strutture ospedaliere seguono con il proprio perso-nale, direttamente a domicilio, pazienti con patologie tali da richiedere un processo assistenziale di livello ospedalie-ro», può essere un un'alternativa sicura ed efficace al rico-vero ospedaliero per pazienti anziani affetti da scompenso cardiaco in fase acuta. I dati esposti in questo articolo sug-geriscono che il trattamento a domicilio di pazienti anziani selezionati, affetti da scompenso cardiaco cronico riacutiz-zato, può essere associato ad un differimento dei tempi di riammissione ospedaliera, ad un miglioramento della qua-lità di vita e del tono dell'umore, senza differenze nelle per-centuali di mortalità. Parole chiave. Anziani, insufficienza cardiaca, ospedaliz-zazione a domicilio, scompenso cardiaco acuto. Summary. Acute decompensation of heart failure in the elderly frail patient: an innovative model of care.
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    ABSTRACT: Aim of the study was to evaluate mortality and functional, cognitive, affective status in elderly patients (>or=75 years) with exacerbation of chronic obstructive pulmonary disease (COPD) or acute congestive heart failure (CHF) admitted to the emergency department (ED) of S. Giovanni Battista Hospital of Torino and randomly assigned to the geriatric home hospitalization service (GHHS) or to a general medical ward (GMW). All patients were evaluated on admission, on discharge and at 6 months, using a standardized study protocol. We excluded patients with unstable medical conditions. The total sample included 73 patients: 35 with COPD exacerbation (19 GHHS, 16 GMW) and 38 with CHF (19 GHHS, 19 GMW). Mean age was 81.7+/-8.0 years. At baseline, no significant differences in demographic, social and clinical conditions were found between the two groups of patients. 56.7% of COPD patients had a severe exacerbation, according to Anthonisen criteria; 65% of CHF patients were NYHA-III and 35% NYHA-IV (according to the criteria of the New York Heart Association) (FE<35% in 40% of patients). On admission all patients were partially dependent in ADLs and IADLs, with a moderate impairment of depression score and a fairly good quality of life. On discharge depression score and quality of life were significantly better only in GHHS patients. Mortality was similar in the two setting of care. Patients managed at home had a significantly longer length of treatment. At 6-month follow-up we did not observe a difference in mortality, but we observed a higher readmission rate in patients previously treated in hospital. In conclusion, our study indicates that home-treated patients with COPD or CHF have better depressive scores and quality of life and a lower rate of hospital readmission after six months.
    No preview · Article · Jan 2007 · Archives of Gerontology and Geriatrics
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    ABSTRACT: We have conducted a study on 82 elderly patients with advanced dementia admitted to the Geriatric Department of S. Giovanni Battista Hospital of Torino in order to evaluate mortality, functional and cognitive impairment and caregiver's stress at 2-year follow-up. Patients were examined using a standardized protocol which included demographic characteristics, comorbidity, duration and type of dementia, severity of disease (clinical dementia rating scale: CDR), behavioral disturbances (neuro-psychiatric inventory: NPI), functional status (activities of daily living: ADL, and instrumental activities of daily living: IADL), cognitive status (short portable mental status questionnaire: SPMSQ). Characteristics of primary caregivers were evaluated and their level of stress was assessed by the relatives' stress scale (RSS). After two years, mortality in the total sample was 61%; the mean age of survivors was 81.3+/-5.3 years; 88% of the sample was still living at home with a relative (76%) or with paid personnel (24%). A statistically significant worsening of the cognitive status was detected (baseline SPMSQ=7.5+/-1.7; follow-up SPMSQ=8.4+/-1.8; p<0.05). Functional status did not change significantly, since it resulted already seriously compromised at the beginning of the study. Most caregivers (80%) were the same as two years before and their stress level was very high (baseline RSS=36.6+/-13.9; follow-up RSS=33.2+/-14). In conclusion, most of the patients included in the follow-up were still living at home, despite the high caregiver's burden and the increasing severity of the disease. Therefore, there is a strong need to further improve health services for the patients with advanced dementia living in their homes.
    No preview · Article · Dec 2007 · Archives of Gerontology and Geriatrics
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