Measures such as ’hospital at home’ or admission to community hospital are as effective for over 65s as acute hospital admissions, according to new research.
The researchers from the University of Bristol and the University for the West of England looked at several studies on alternatives to acute hospital admission and found that these options are as safe and may be more cost-effective than hospital admission.
The highest quality evidence was for hospital-type services delivered in the patient’s own home.
The study found that this had similar levels of patient safety and recovery as acute hospital admission for several conditions such as COPD, heart failure, pulmonary embolism and pneumonia – though not for stroke, perhaps due to the expertise of the stroke unit staff.
They found that other alternatives, such as interventions initiated by paramedics, A&E treatment, admission to a local community hospital and hospital-type services in the patient’s house or in a nursing home, were also similar in terms of patient safety and recovery to acute hospital admission.
However, the research in these areas is not as strong.
Professor Sarah Purdy, GP and principle investigator, said: ‘Reducing unnecessary hospital admission and consequent length of stay is one of the biggest challenges currently facing the NHS. NHS England reports that there has been a 65% increase in hospital admissions for those over 75-years-old in the last decade.
’Those over 85-years-old, now account for 11% of emergency admissions and 25% of bed days. This is complicated by the fact that, while for some older people the decision to admit is straightforward, for others the decision is uncertain. Our research has helped identify the difficulties of admitting older people appropriately into hospital.’
The research is funded by NIHR, and is published as an evidence report.
