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conferenceseries
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Volume 7, Issue 5 (Suppl)
J Palliat Care Med, an open access journal
ISSN: 2165-7386
Geriatrics 2017
September 4-5, 2017
September 4-5, 2017 | Edinburgh, Scotland
Geriatrics Gerontology & Palliative Nursing
7
th
International Conference on
INTEGRATED CARE AT HOME REDUCES UNNECESSARY HOSPITALIZATIONS OF
COMMUNITY-DWELLING FRAIL OLDER ADULTS: A PROSPECTIVE CONTROLLED
TRIAL
Laura Di Pollina
a
a
Geneva University Hospitals, Switzerland
Statement of the problem:
Care of frail and dependent older adults is a major challenge for health care systems. The study
objective was to test the efficacy of providing integrated care at home to reduce unnecessary hospitalizations, emergency room
visits, institutionalization, and mortality in community dwelling population. A prospective controlled trial was conducted, in
real-life clinical practice settings, in a suburban region in Geneva, Switzerland, served by two home visiting nursing service
centers. Three hundred and one community-dwelling frail and dependent people over 60 years old were allocated to previously
randomized nursing teams into Control (N=179) and Intervention (N=122) groups: Controls received usual care by their
primary care physician and home visiting nursing services, the Intervention group received an additional home evaluation by
a community geriatrics unit with access to a call service and coordinated follow-up. Recruitment began in July 2009, goals were
obtained in July 2012, and outcomes assessed until December 2012. Length of follow-up ranged from 5 to 41 months (mean
16.3). Primary outcome measure was the number of hospitalizations. Secondary outcomes were reasons for hospitalizations,
the number and reason of emergency room visits, institutionalization, death, and place of death.
Results:
The number of hospitalizations did not differ between groups however, the intervention led to lower cumulative
incidence for the first hospitalization after the first year of follow-up. Secondary outcomes showed that the intervention group
had less frequent unnecessary hospitalizations, lower incidence for the first emergency room visit, and death occurred more
frequently at home. No significant differences were found for institutionalization and mortality.
Conclusion:
Integrated care that included a home visiting multidisciplinary geriatric team significantly reduced unnecessary
hospitalizations, emergency room visits and allowed more patients to die at home. It is an effective tool to improve coordination
and access to care for frail and dependent older adults.
J Palliat Care Med 2017, 7:5(Suppl)
DOI: 10.4172/2165-7386-C1-012