Alternatives to acute hospital admissions for older people are safe and reduce hospital use

Alternatives to acute hospital admissions for older people appear safe and could reduce use of acute hospital care and length of time receiving care, a new study from the University of Bristol published in BMJ Open has found.

The study, funded by the National Health Institute for Research and led by Professor Sarah Purdy at the University of Bristol’s Centre of Academic Primary Care, has identified and appraised alternatives to acute hospital care for people over the age of 65.

The systematic review looked at 19 randomised and non-randomised controlled studies and seven previous reviews. The studies included patients with specific conditions such as heart failure or chronic obstructive pulmonary disease, as well as mixed chronic and acute conditions such as elderly frail patients with pneumonia.

The study identified four main types of acute hospital alternatives for patients:

• paramedic intervention
• intervention in A&E
• care in a community hospital
• ‘hospital-at home’

‘Hospital at home’ provides treatment that would normally only be available in hospital, for patients where they live.

The evidence suggests that these alternatives to hospital admission appear safe with potential to reduce acute hospital care use and length of time receiving care. For example, patients with heart failure treated through ‘hospital at home’ saw a significant increase in the time to their next hospital readmission, with similar mortality rates compared with standard hospital admission.

Paper

‘A systematic review to identify and assess the effectiveness of alternatives for people over the age of 65 who are at risk of potentially avoidable hospital admission‘: Alyson L Huntley, Melanie Chalder, Ali R G Shaw, William Hollingworth, Chris Metcalfe, Jonathan Richard Benger, Sarah Purdy. Published in BMJ Open